To determine that the fluid is amniotic fluid: sterile speculum exam
- Pooling: fluid collection @ posterior fornix
- Valsalva: bear down to see if there's fluid
- Ferning: place a thin layer of fluid on a slide
- Nitrazine (not used that often); Amnisure is used
DDx of ROM: urine, vaginal discharge
When you do the speculum exam, do three slides
- KOH for Candida
- Saline for BV (clue cells)
- For BV (caused by Gardnerella vaginalis proliferation, not necessarily an STD; treat pt w/ metronidazole)
- Check ferning
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