METHODS USED TO DIAGNOSE PREMATURE RUPTURE OF MEMBRANES - A NATIONAL SURVEY OF 812 OBSTETRIC NURSES

Objective: To identify methods used to diagnose premature rupture of m embranes (PROM). Methods: A 14-item questionnaire was mailed to 1992 r egistered nurses certified in inpatient obstetrics to determine inform ation on practice facility, obstetric services, procedures used to obt ain vaginal fluids for testing, and methods used to diagnose PROM. Res ults: A total of 812 (40.8%) surveys were available for analysis. Of t ests used to confirm PROM, observation of pooling fluid in the posteri or fornix and fern tests were much more likely to be used in teaching and military hospitals and in facilities with tertiary obstetric servi ces than in private hospitals (all P values < .001). To obtain vaginal fluids for fern and nitrazine testing, the dry glove method (ie, inse rtion of a gloved hand or nitrazine strip into the vagina) was used si gnificantly more often in private hospitals than in teaching or milita ry facilities (P < .001). In addition, the dry glove method was used s ignificantly more often (P < .001) and the speculum examination was us ed less often (P < .001) to collect vaginal fluids for testing when pr ivate physicians performed more than 75% of deliveries at a particular hospital. In contrast, vaginal fluid was obtained during a sterile sp eculum examination more often in facilities in which more than 75% of deliveries were performed by residents (P < .001), and/or when more th an 75% of speculum examinations were performed by nursing personnel (P < .001). Multiple linear regression analyses indicated that observati on of pooling fluid and use of the fern test were significantly associ ated with hospital type, percentage of deliveries by private physician s, and percentage of speculum examinations performed by nursing person nel (all P values < .001). Conclusion: A sterile speculum examination is used more often to obtain vaginal fluids for testing and to diagnos e ruptured membranes in teaching or military facilities and when nursi ng personnel have been trained in speculum examinations. (Obstet Gynec ol 1998;92:384-9. (C) 1998 by The American College of Obstetricians an d Gynecologists.).