How is amniotic fluid like snowflakes?
Today, I finally found snowflakes under my microscope. Say what?!
Part of my job as an intern is to see the term patients (patient who are greater than or equal to 37 weeks gestation, i.e. have reached their 9th month of pregnancy) for whatever concern brings them our triage area; be it not feeling the baby move as much, vaginal bleeding, having contractions and possibly in labor or the, should-be-straightforward-but-often-isn't "I think my water broke). In OB parlance, this is known as "r/o SROM" (Ruling Out Spontaneous Rupture of Membranses).
I've had a run of patients who have "been leaky for the past few days"...some not sure if it was to the hot weather in the area recently, or the extra discharge that women produce as they get near delivery time, or losing their mucus plug, or because having all that extra weight pressing on your bladder means that "yes, you may unintentionally lose fluid when you laugh or cough or sneeze". What this involves is a sterile speculum exam (it takes longer to set it all up than to get a quick look inside and use a sterile q-tip to get some fluid), looking to see if fluid spills from the cervical os when you ask the patient to cough or if there is a large pool of clear fluid just below the opening of the cervix, you grab a sample of this at the end of the q-tip and smear it on a slide that also has pH paper (Nitrazine paper) that will change color when amniotic fluid comes in contact with it. Then you take your slide and set it out to dry for 15-20 minutes (and if your in a hurry you set it on the microscope light to dry faster). I've been bent over, collecting samples, collecting samples, and collecting more samples. Yesterday, I missed out on delivering a patient whom I'd been following all day, because I was busy...you got it...collecting a sample of fluid at the exact same time they needed someone in the room; my med student got lucky and was able to deliver my patient with the midwife. All to not avail, no pooling in any vaults, no changes in the nitrazine paper, and nothing but scattered bacilli, squamous cells and misc. neutophils...but no ferning under the microscope.
Amniotic fluid (mainly composed of fetal urine) crystallizes on the slide in the shape of a fern...or as one of the upper residents described "It looks like snowflakes. Isn't it great?" Once before, I thought I had seen it, but then came to find out there are two kinds: cervical mucus ferning which has the ferns coming out at right angles from the center line, and amniotic fluid ferning, where the "branches" come out at 45 degree angles.
But today, today, was different. I saw snowflakes! The first time I could finally say unequivocably, "she broke her bag of water, let's admit her!" *huge smile*
And now you know more than you ever cared to know about amniotic fluid. But if you're curious, I'm sure you can just google the pictures...and see snowflakes for yourself. ;)
-Del
Part of my job as an intern is to see the term patients (patient who are greater than or equal to 37 weeks gestation, i.e. have reached their 9th month of pregnancy) for whatever concern brings them our triage area; be it not feeling the baby move as much, vaginal bleeding, having contractions and possibly in labor or the, should-be-straightforward-but-often-isn't "I think my water broke). In OB parlance, this is known as "r/o SROM" (Ruling Out Spontaneous Rupture of Membranses).
I've had a run of patients who have "been leaky for the past few days"...some not sure if it was to the hot weather in the area recently, or the extra discharge that women produce as they get near delivery time, or losing their mucus plug, or because having all that extra weight pressing on your bladder means that "yes, you may unintentionally lose fluid when you laugh or cough or sneeze". What this involves is a sterile speculum exam (it takes longer to set it all up than to get a quick look inside and use a sterile q-tip to get some fluid), looking to see if fluid spills from the cervical os when you ask the patient to cough or if there is a large pool of clear fluid just below the opening of the cervix, you grab a sample of this at the end of the q-tip and smear it on a slide that also has pH paper (Nitrazine paper) that will change color when amniotic fluid comes in contact with it. Then you take your slide and set it out to dry for 15-20 minutes (and if your in a hurry you set it on the microscope light to dry faster). I've been bent over, collecting samples, collecting samples, and collecting more samples. Yesterday, I missed out on delivering a patient whom I'd been following all day, because I was busy...you got it...collecting a sample of fluid at the exact same time they needed someone in the room; my med student got lucky and was able to deliver my patient with the midwife. All to not avail, no pooling in any vaults, no changes in the nitrazine paper, and nothing but scattered bacilli, squamous cells and misc. neutophils...but no ferning under the microscope.
Amniotic fluid (mainly composed of fetal urine) crystallizes on the slide in the shape of a fern...or as one of the upper residents described "It looks like snowflakes. Isn't it great?" Once before, I thought I had seen it, but then came to find out there are two kinds: cervical mucus ferning which has the ferns coming out at right angles from the center line, and amniotic fluid ferning, where the "branches" come out at 45 degree angles.
But today, today, was different. I saw snowflakes! The first time I could finally say unequivocably, "she broke her bag of water, let's admit her!" *huge smile*
And now you know more than you ever cared to know about amniotic fluid. But if you're curious, I'm sure you can just google the pictures...and see snowflakes for yourself. ;)
-Del