Sterile Speculum exams for ?ROM

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This might be a silly question but anyway.....

When you do a sterile speculum exam to determine if a pt has pooling of fluid in the lady parts, and to obtain a sample for ferning do you use KY gel? I was always taught, no gel in this situation. If the pt is indeed ruptured, its not usually a problem. But have you ever had those pts, (who I think are secretly just trying to get a cervical exam to see if they've changed) come in and say they think their water broke and you just can't get that darn spec in because they are so dry. I had one the other night that I just couldn't get the spec in and I had to use a little bit of gel. Did I do wrong???:bugeyes:

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

NO use NOTHING===you do a dry sterile spec for fern testing, always.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I have (knock wood) never been unable to get a spec in to do the exam. Some of the keys are to warm the spec before use and to prepare the woman for the exam.....and go very slowly.....

these all help a lot.

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Specializes in Maternal - Child Health.

Only docs did speculum exams where I worked, so I've never encountered this situation before. But, is warm sterile water acceptable?

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Specializes in Perinatal, Education.

That reminds me of one of my favorite stories--don't read if you are easily offended. This is from an ex-coworker of mine and had me almost passing out laughing at a Christmas party best story contest. She was in the same situation--needed to do a sterile spec w/o gel to check for SROM. The patient asked if she was going to use gel and she explained that she couldn't. She needed to leave the room for a sec and when she got back, the patient was "touching herself". The nurse, being a very proper person, was a bit shocked and asked what the patient was doing. She replied, "Just getting 'er ready for you!". I guess that patient found her own solution?

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Only docs did speculum exams where I worked, so I've never encountered this situation before. But, is warm sterile water acceptable?

Interesting idea! I'm not sure about that one, I don't see why not. Water doesn't cause ferning on a slide and it would be a good way to warm the spec up. Maybe even sterile saline??? Other thoughts appreciated...Maybe i'm wrong.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Sterile saline/water should be acceptable. I would run this by the manager for policy review. I just take and put the (wrapped) spec under my arm to warm it while I prepare the patient for the exam. Works like a charm.

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I've seen warm sterile water used. I remember hearing or reading that saline may interfere with the sodium crystal pattern you are attempting to see on your slide.

Personally I have never had a problem getting a speculum in a term pregnant woman b/c of their natural KY jelly!

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We have just started using something new for checking for ROM. It is called AMNISURE, and we have found it to be very sensitive and it picked up amniotic fluid even when pH and ferning were negative. Check it out at amnisure.com.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I have heard of Amnisure. But our Docs are NOT onboard w/this yet.

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Speculum? We don't use no stinking speculum. ;)

Seriously - we don't.

This needs to be on the regional OB differences thread.

steph

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Really? How do you do ferning then Steph?

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