Rupture of Membranes

Determining whether membranes have ruptured is an important predictor of the likelihood of imminent labor as well as the potential for complications such as infection or cord prolapse.3 SROM occurs during the course of active labor in most patients, although it may occur prior to the onset of labor in 10 percent of third- trimester patients. SROM typically occurs with a gush of clear or blood-tinged fluid. It can be confirmed by using nitrazine paper to test residual fluid in the fornix or vaginal vault while a sterile speculum examination is performed. Amniotic fluid has a pH of 7.0 to 7.4 and will turn nitrazine paper dark blue. Vaginal fluid typically has a pH of 4.5 to 5.5 and will make the nitrazine strip remain yellow. False-positive tests may occur with blood, lubricant, or other contaminants. Another test used to confirm rupture of membranes (ROM) is ferning, or observing sodium chloride crystals on a slide as amniotic fluid dries.

If membranes are intact, an amniotomy should not be performed in the ED, as this may lead to precipitous labor and increase the potential for cord prolapse. Note whether meconium appears after the ROM, indicated by the presence of thick, greenish-brown fluid. ROM occurring prior to the onset of labor is called premature ROM. Prolonged ROM occurs if delivery does not take place within 18 h of ROM. ROM that occurs before 37 weeks is called preterm ROM.

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