Clinical Manifestations and Diagnostic Tests

• The main clinical manifestation of PROM and PPROM is amniotic fluid leaking or gushing from the vagina. The fluid may be clear, yellowish, greenish, or blood-tinged depending on its composition.



• Other signs and symptoms may include:

  • Absence or irregularity of uterine contractions.

  • Fetal heart rate changes, such as tachycardia or decelerations.

  • Maternal fever, chills, or malaise.

  • Foul-smelling vaginal discharge or amniotic fluid.

  • Abdominal tenderness or pain.

• The diagnosis of PROM and PPROM is confirmed by the following tests:

• Nitrazine paper test: A strip of paper is placed in contact with the vaginal fluid. If the paper turns blue-green, it indicates that the fluid is alkaline and likely amniotic. If it remains yellow, it indicates that the fluid is acidic and likely urine or vaginal secretions.



• Ferning test: A sample of vaginal fluid is placed on a microscope slide and allowed to dry. If fern-like patterns are seen under the microscope, it indicates that the fluid contains amniotic salts and proteins.

• AmniSure test: A swab of vaginal fluid is tested for placental alpha microglobulin-1 (PAMG-1), a protein that is present in high concentrations in amniotic fluid. A positive result indicates membrane rupture

• Ultrasound: An ultrasound can measure the amount of amniotic fluid around the fetus. A low amount (oligohydramnios) may indicate membrane rupture. An ultrasound can also detect fetal position, placental location, and gestational age