Confirming Rupture of Membranes with Intra-amniotic Fluorescein Dye Test

Introduction – We describe two patients presenting with preterm loss of fluid and inconclusive evaluations requiring further assessment. Patient 1 was a 41-year-old G3P1011 at 21 weeks and 6 days; Patient 2 was a 22-year-old G2P1001 at 31 weeks and 5 days. In both, preterm pre-labor rupture of membranes (PPROM) workups yielded mixed results, prompting intra-amniotic dye testing. Due to a national indigo carmine shortage, sodium fluorescein was used. We present photographs of tampons examined under UV light, confirming PPROM in both cases. Methods – Under ultrasound guidance, 5 cc of sodium fluorescein was injected into the amniotic cavity. Patients wore a tampon for 15 minutes while ambulating. Both provided consent for publication. Results – On direct visualization, tampons appeared normal. Under UV light (Wood’s lamp), the fluorescein emitted a bright neon green fluorescence. Both specimens demonstrated photoluminescence, confirming PPROM. Conclusions/Implications – Although the use of 2–5 cc of fluorescein for intra-amniotic dye testing is described in literature, visual documentation of positive results is limited. These images may guide clinicians in confirming PPROM when indigo carmine is unavailable, supporting fluorescein as a viable diagnostic alternative.