Testing for PPROM

How is PPROM Diagnosed?

If you think your water may have broken, it is important to be evaluated by a healthcare provider. PPROM is not always obvious. Some people experience a large gush of fluid, while others notice only a small, intermittent, or persistent leak.

Healthcare providers may use more than one method to determine whether the amniotic membranes have ruptured.

Sterile Speculum Exam

A healthcare provider may use a speculum to look inside the vagina and examine the cervix. They will look for amniotic fluid leaking from the cervix or pooling in the vagina. This is an important part of the evaluation for suspected PPROM.

Nitrazine Test

A nitrazine test uses a paper test strip to measure the pH, or acidity, of vaginal fluid. Amniotic fluid is generally more alkaline than normal vaginal secretions.

Other substances can sometimes affect vaginal pH, so the nitrazine test is usually considered along with the examination and other findings.

Ferning Test

For a ferning test, a small sample of vaginal fluid is placed on a microscope slide and allowed to dry. Amniotic fluid may form a characteristic branching pattern that looks similar to frost or the leaves of a fern.

Amniotic Fluid Swab Tests

Biochemical tests may be used when the diagnosis is uncertain. These tests look for proteins that are normally present in amniotic fluid.

Examples include:

• AmniSure

• Actim PROM

A positive or negative result is interpreted along with your symptoms, examination, and other clinical findings.

Ultrasound

An ultrasound may be used to evaluate the pregnancy and measure the amount of amniotic fluid surrounding the baby. Low amniotic fluid can support suspicion of PPROM, particularly when there has been a history of leaking.

Please note: An ultrasound alone cannot confirm or rule out PPROM.

Some people with PPROM continue to have measurable or even normal-appearing amounts of amniotic fluid, while low fluid can occur for reasons other than ruptured membranes.

When the Diagnosis Is Not Clear

PPROM can occasionally be difficult to diagnose, especially when:

• leaking is small or intermittent;

• rupture occurred some time before the examination;

• there is still a measurable amount of amniotic fluid;

• vaginal bleeding or other fluids affect testing; or

• individual test results do not agree.

More than one test or evaluation may be needed.

If you continue to experience leaking or other symptoms after an evaluation, tell your healthcare provider about your ongoing concerns. Keep track of the time and duration of symptoms.

If You Think Your Water Broke

If you believe you may be leaking amniotic fluid, contact your healthcare provider or Labor & Delivery for evaluation.

Do not rely on an at-home symptom checklist or ultrasound alone to determine whether your membranes have ruptured. PPROM requires medical evaluation.

Learn More

Clinical Information

The American College of Obstetricians and Gynecologists describes current approaches to evaluating suspected rupture of membranes, including sterile speculum examination, pooling, nitrazine and ferning testing, biochemical testing, and ultrasound assessment when appropriate.

ACOG: Premature Rupture of Membranes (PROM) Evaluation

Research

For additional PPROM research, including emerging diagnostic tests and biomarkers:

Visit the PPROM Library