Use of a Menstrual Cup to Assist in Diagnosis of Preterm Premature Rupture of Membranes [ID 2683492]

INTRODUCTION: Several methods exist for diagnosis of preterm premature rupture of membranes (PPROM), including pooling on speculum exam, nitrazine test, arborization under microscopy, immunoassay, and amnio-dye test. Diagnostic accuracy is particularly important for PPROM because a missed diagnosis may result in life-threatening maternal and fetal consequences. We present a novel method for evaluating PPROM in equivocal cases using a menstrual cup. METHODS: Written informed consent was obtained for submission of a case report. A 36-year-old G6P5005 at 29 2/7 weeks presented with leakage of fluid. She was found to have negative pooling on speculum exam, negative arborization on microscopy, a maximum vertical pocket (MVP) of 4.0 cm, and a negative urinalysis. She was discharged with precautions and returned 2 days later with persistent symptoms. Workup again showed no pooling, no arborization, and a normal MVP. The patient suggested using a menstrual cup to capture her intermittent leakage of fluid. She wore a menstrual cup for 30 minutes in triage. A sample of the fluid tested positive for arborization. She was admitted to labor and delivery for latency antibiotics, betamethasone, and fetal and maternal monitoring. CONCLUSION: Preterm premature rupture of membranes can occur without overt vaginal pooling due to small volume leakage. Conventional testing is less sensitive when pooling is absent. In these cases, a menstrual cup may help facilitate diagnosis and avoid invasive tests such as the amnio-dye test. Care must be taken to use a clean menstrual cup without gel, limit the duration of menstrual cup use to avoid infection, and to distinguish arborization of amniotic fluid from that of cervical mucus.