labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Tuesday, August 12, 2008

Ferns






One of the coolest things, in my opinion, is amniotic ferning. Amniotic fluid, when dried, creates a fern leaf like pattern that can be seen microscopically. The presence of ferns are a strong indicator that the bag of waters has broken. Two others are looked for: pooling of water in the vagina seen on speculum exam or visualizing fluid coming from the opening of the cervix and a positive nitrizine test (pH paper turns blue).






Its incredible the number of women who come in saying their water broke when in fact they either peed or have a lot of vaginal discharge. Both are pretty common late in pregnancy. I often wonder how many have a "high leak" for days before realizing that perhaps their water broke. I'd imagine that is more common than we realize.






Either way, here is what the ferns look like. Cool, huh?

10 comments:

Mom said...

Verrry interesting!

Jody said...

wow Awesome. I'm a new L&D nurse and haven't trained yet in Ttiage where they usually do smears for determining ROM. This DOES give me heads up tho. Great visual!

Paula said...

That is fabulous! I love the two pictures for comparison. As a doula, I don't get the chance to see what they are looking at under the microscope. I am there for the creation of the slide, though.

Stephanie said...

very cool! thanks for sharing =)

may said...

wow. it is amazing! i honestly don't know this before. what can i say? we learn something new everyday, and sometimes, it's about amazing things like this. thanks.

I am a Monkey's Mama said...

I'm wondering what your threshold for safety/comfort is when it comes to ROM? Is that something you have any control over is it the standard of care to section after a certain amount of time?

Rachel said...

Very cool. So do you have any advice for women about distinguishing between the real thing vs. a little urinary incontinence?

Labor Nurse said...

Monkey's mama- my threshold has yet to be established. I'm inclined to say that I am fine with ROM for as long as needed so long there are no signs of infection (maternal temp, fetal tachycardia, maternal tachycardia, maternal abdominal tenderness, foul smelling amniotic fluid). However, there is a huge gap b/t what many CNMs are comfortable with and what hospital policy or practice dictates. Where I work we rarely see anyone who's ROM'ed and not in labor- technically called PROM- go longer than a few hours. Chalk that up to antsy doc's. My clinical sites for school have varied based on the provider I have worked with- anywhere from 6 hours to 12 hours before starting the induction.

Rachel- good question. No specific advice but if you are not sure what the fluid is you need to get it checked out. And if it doesn't gross you out then smell it. Amniotic fluid does not smell like urine.

Real said...

You know, I went way overdue with my sixth baby (45 weeks). I kept holding off an induction because surely it was going to be "any day now". I finally consented to induction when I was complete with just an anterior lip, but not contracting. As it turns out, my water was ruptured already. I hadn't known it. But looking back on it, I had three times (over the course of several days) where I had a small gush of fluid. But not a drop after the gush. I figured it couldn't be SROM because there was no continued leakage.

So it turns out that the amniotic sac ruptured 10 days earlier and I still wasn't in labor. Weird, huh? But no signs of infection or anything. That was cool. I always wonder how things would have gone differently if I had been aware for those 10 days that the membrane was ruptured...

evil cake lady said...

that photo is really amazing! i just discovered your blog and am enjoying reading it.