*If the Nitrazine and Fern Test are positive, probable membrane rupture has occurred. Procedure Notes *The Nitrazine test is highly sensitive but not specific. which indicates a positive result for amniotic fluid. If the pH Nitrazine paper color is blue-green to deep blue, the corresponding pH is 6.5 to 7.5. Results If the pH Nitrazine paper color is yellow to olive green, the corresponding pH is 4.5 to 6.0, which indicates a negative result for amniotic fluid. Immediately match the strip color with the closest color on the dispenser color chart. Apply patient sample to the Nitrazine paper. Procedure Tear off a piece of Nitrazine paper of the desired length. Specimen contamination will result in erroneous pH results. False negative results may be produced by prolonged rupture of membranes (longer than 24 hours) or when a small volume of fluid has leaked. Interferences False positive results may occur from specimen contamination due to heavy vaginal discharge, blood, cervical mucus, semen alkaline urine, and soap. ►Test sample immediately after collection. ►Do Not touch the swab or the pH paper to the mucus plug in the cervix. Specimen Requirements ►Vaginal secretions from the posterior vaginal pool. *Specimen Requirements *Interferences *Procedure *Results *Procedure Notes The risk is largely eliminated by induction of labor. Premature rupture of the membranes before onset of labor may lead to fetal infection and subsequent mortality. It is used in conjunction with the Fern Test to help detect ruptured membranes. Nitrazine paper is used to detect small quantities of amniotic fluid in vaginal secretions. The PROM test is the most accurate diagnostic test and predictor of latency in patients with suspected PROM.Audience: L&D only Author: Tracy Lacy, Medical Technologist Point of Care Coordinator Department: Laboratory, ext 2637 Date: March 2006 The dipstick method of detecting IGFBP-1 in the vaginal fluid is a rapid, reliable and noninvasive method. Only a positive PROM test was associated with delivery within 7 days. The nitrazine test results were affected by vaginal discharge but the PROM test results were not affected. The sensitivity, specificity and accuracy of the nitrazine test, the PROM test and AFI were 97, 16 and 56%, 97, 97 and 97% and 94, 91 and 92%, respectively. AFI was measured by the four-quadrant method and an AFI of <80 mm was considered as oligohydroamnios. IGFBP-1 in the cervicovaginal fluid was measured by a rapid dipstick method (PROM test). Patients with preterm labor and PROM, patients at <20 gestational weeks, and those with multiple pregnancies were excluded. One hundred and fifty-one patients (36 definite PROM, 35 no PROM and 80 suspected PROM) at 20-42 weeks' gestation were included in the study. We aimed to study the accuracy of detecting insulin-like growth factor binding protein-1 (IGFBP-1) in vaginal fluid by a rapid dipstick method in comparison with the nitrazine test and amniotic fluid index (AFI) and we studied the predictivity of these methods on the latency of pregnancy in patients with suspected PROM. The diagnosis of premature rupture of membranes (PROM) is sometimes challenging, and common diagnostic tests are of limited value in the diagnosis.
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