Q / Ferning in amniotic fluid: Is it a useful indicator of ruptured membranes?

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A / YES. The presence of arborized crystals (ferning) in amniotic fluid is both sensitive (74%-100%) and specific (77%-100%) for diagnosing rupture of membranes in laboring women who report loss of fluid (strength of recommendation [SOR]: A, multiple prospective cohort studies). However, it is much less sensitive and specific for women with fluid loss who aren't in labor (SOR: B, 1 prospective cohort study).


Gross contamination of amniotic fluid with blood or antiseptic solutions may decrease the diagnostic accuracy of ferning, whereas contamination with meconium doesn't (SOR: C, bench research).

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