Vaginal wetness or leakage of fluid in pregnancy may be due to a variety of causes. The most concerning is loss of amniotic fluid (eg, labor, intraamniotic infection); therefore, all pregnant patients with leakage of fluid require evaluation for prelabor rupture of membranes (PROM).
ROM regardless if PROM or PPROM typically causes a large gush of fluid but may also cause vaginal wetness or intermittent leakage of small volumes + visualization of amniotic fluid emerging from the cervix with Valsalva (eg, cough)
Risk factors include previous premature rupture of membranes, a vaginal or cervical infection, and cigarette smoking.
| Diagnosis | • Vaginal pooling or fluid from cervix • Nitrazine-positive (blue) fluid due to (ie, alkaline amniotic fluid) • Ferning on microscopy | | --- | --- |
Initial evaluation includes a sterile speculum examination of the vagina, which may show pooling of amniotic fluid or leakage of fluid from the cervical os. Nitrazine testing of the fluid will disclose a pH of 7.0 to 7.3, and ferning will be seen on microscopic examination. Ultrasonography can also be utilized to determine the amount of residual amniotic fluid, which would be decreased in the setting of the rupture of membranes.