Question

A pregnant woman at term comes to the labor unit saying her membranes have ruptured. Which characteristic of the client's vaginal secretions would confirm that the membranes had ruptured? The vaginal secretions: A. Are positive for glucose B. Contain red blood cells C. Turn nitrazine paper a reddish orange D. Appear fern like under the microscope when dried on a slide.

Short answer

The characteristic of the client's vaginal secretions that would confirm that the membranes had ruptured is D. Appear fern like under the microscope when dried on a slide.

Step-by-step solution

Understanding the Question

To confirm the rupture of membranes in a pregnant woman, an assessment of the characteristics of vaginal secretions must be performed. The membranes refer to the amniotic sac, and specific traits in the secretions indicate their rupture.

Reviewing Each Option

Evaluate each option to determine which characteristic of vaginal secretions confirms the rupture of membranes: A) Glucose content is not typically used to assess for rupture of membranes. B) Red blood cells might indicate bleeding, not necessarily rupture of membranes. C) Nitrazine paper turning reddish orange indicates acidic pH, which is not characteristic of amniotic fluid (which is alkaline). D) Amniotic fluid crystallizes in a fern-like pattern when dried on a microscope slide, which is a sign of ruptured membranes.

Choosing the Correct Answer

Select the option that specifically indicates amniotic fluid is present, which in this case is the fern-like pattern observed under the microscope, confirming the rupture of the membranes.

Key concepts

Vaginal Secretions Assessment

Assessing the characteristics of vaginal secretions is an important procedure to determine various conditions during pregnancy, including the rupture of membranes. When the amniotic sac ruptures, the fluid that has been surrounding and protecting the fetus throughout pregnancy leaks out through the vagina. Sudden gushes or steady trickles of fluid may be observed, but sometimes the leakage is not as obvious and requires further assessment.

To confirm whether the fluid is indeed amniotic fluid, a healthcare provider will collect a sample of the vaginal secretions. Color, consistency, odor, and volume can provide preliminary information; however, these are not definitive indicators. Hence, more specific tests are required, such as the nitrazine paper test and the fern test, which are aimed at detecting the presence of amniotic fluid in the secretions.

Nitrazine Paper Test

The nitrazine paper test is a simple, bedside diagnostic test used to determine whether a pregnant woman's membranes have ruptured. This test involves the use of nitrazine pH paper, which changes color when it comes into contact with bodily fluids of different pH levels. Normal vaginal pH is slightly acidic and will turn nitrazine paper yellow or olive green.

Amniotic fluid has a slightly alkaline pH, usually around 7.1 to 7.3. When a sample of vaginal secretion is applied to the nitrazine paper, if the paper turns blue or blue-green, this indicates the presence of alkaline fluid and suggests that the membranes have likely ruptured. However, false positives can occur, for example, in the presence of blood, semen, or bacterial vaginosis, which also have an alkaline pH.

Fern Test Amniotic Fluid

Another confirmatory test for the rupture of membranes is the fern test. This test is named after the characteristic 'fern' pattern that amniotic fluid forms when it dries on a microscope slide. The presence of sodium chloride (salt) in the amniotic fluid is responsible for creating this unique crystallization.

To perform the fern test, a sample of the vaginal secretions is placed on a glass slide and allowed to air dry. Under microscopic examination, if the rupture of membranes has occurred, the dried amniotic fluid displays a fern-like pattern due to the crystallization of the salts. The ferning pattern is quite distinct and is a strong indication of ruptured membranes. Unlike the nitrazine test, the fern test has fewer factors that can lead to misleading results, making it highly reliable for diagnosing membrane rupture.