{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T18:01:52Z","timestamp":1770832912327,"version":"3.50.1"},"reference-count":14,"publisher":"Georg Thieme Verlag KG","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Preterm prelabor rupture of membranes (PPROM) diagnosis is made through visualization of amniotic fluid (pooling), nitrizine testing, sonographic low amniotic fluid, and microscopic detection of amniotic fluid arborization (ferning). Data exist on the specificity and sensitivity of ferning detection but have not focused on the second trimester. Our objective is to evaluate the presence of ferning in transvaginally collected amniotic fluid in pregnancies with known second-trimester PPROM to determine if there is a difference in ferning based on gestational age and sample drying time.<\/jats:p><jats:p>This was a prospective study evaluating amniotic fluid in individuals undergoing termination of pregnancy between 15 and 24 weeks gestation. A control vaginal swab was collected prior to rupture of membranes and a sample vaginal swab was collected at the time of rupture of membranes at a termination procedure. A 10-mL sample of amniotic fluid was collected too and then centrifuged to separate blood. Slides were analyzed at five different drying time intervals after rupture of membranes, on both the vaginal and centrifuged samples, and examined by two blinded investigators to assess for ferning. Maternal demographics, obstetrical history, and termination information were collected. Statistical analysis was performed using descriptive statistics and regression analyses.<\/jats:p><jats:p>A total of 99 individuals consented and 93 were included. The mean gestational age at the time of the termination was 19.5\u2009\u00b1\u20092.5 weeks. There was a significant effect of drying time with the odds of observing ferning increasing with longer drying time, up to 10\u2009minutes (p\u2009&lt;\u20090.001). Gestational age did not impact ferning detection (p\u2009=\u20090.09). Centrifuging increased ferning detection by 15% at 10\u2009minutes compared to the vaginal swab.<\/jats:p><jats:p>In cases of known second-trimester PPROM, ferning was detected more often after 10\u2009minutes of sample drying, and centrifuging the amniotic fluid to remove blood.<\/jats:p>","DOI":"10.1055\/a-2515-2718","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T19:36:16Z","timestamp":1736883376000},"page":"1526-1532","source":"Crossref","is-referenced-by-count":2,"title":["Assessing Second-Trimester Ferning in Diagnosing Preterm Prelabor Rupture of Membranes"],"prefix":"10.1055","volume":"42","clinical-trial-number":[{"clinical-trial-number":"nct04963465","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1686-5303","authenticated-orcid":false,"given":"Michelle N.","family":"Lende","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine, CHRISTUS Children's Hospital, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derek","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna C.","family":"Bringley","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul J.","family":"Feustel","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3656-7124","authenticated-orcid":false,"given":"Tara A.","family":"Lynch","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1097\/AOG.0000000000003700","article-title":"Prelabor Rupture of Membranes: Practice Bulletin 217","volume":"135","author":"American College of Obstetricians and Gynecologists","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1055\/s-2007-994637","article-title":"The ferning and nitrazine tests of amniotic fluid between 12 and 41 weeks gestation","volume":"10","author":"S L Bennett","year":"1993","journal-title":"Am J Perinatol"},{"issue":"S 01","key":"ref3","first-page":"11","article-title":"Amniotic fluid dynamics","volume":"75","author":"A B Modena","year":"2004","journal-title":"Acta Biomed"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1016\/S0002-9378(16)34244-2","article-title":"Diagnosis of ruptured fetal membranes. Clinical study and review of the literature","volume":"104","author":"M L Friedman","year":"1969","journal-title":"Am J Obstet Gynecol"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1055\/s-2007-994535","article-title":"Value of the fern test to confirm or reject the diagnosis of ruptured membranes is modest in nonlaboring women presenting with nonspecific vaginal fluid loss","volume":"11","author":"H H de Haan","year":"1994","journal-title":"Am J Perinatol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"659","DOI":"10.3109\/14767058.2011.553694","article-title":"Guidelines for the management of spontaneous preterm labor: identification of spontaneous preterm labor, diagnosis of preterm premature rupture of membranes, and preventive tools for preterm birth","volume":"24","author":"G C Di Renzo","year":"2011","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"05","key":"ref7","first-page":"389","article-title":"Second trimester amniotic fluid is reliably fern positive and \u03b11-microglobulin positive: dispelling a labor deck myth","volume":"31","author":"N S Fogelson","year":"2014","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1007\/s00404-011-2106-4","article-title":"Placental alpha microglobulin-1 (AmniSure) test) for detection of premature rupture of fetal membranes","volume":"285","author":"I A Abdelazim","year":"2012","journal-title":"Arch Gynecol Obstet"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s00404-011-1895-9","article-title":"Placental \u03b1-microglobulin-1 to detect uncertain rupture of membranes in a European cohort of pregnancies","volume":"285","author":"A Birkenmaier","year":"2012","journal-title":"Arch Gynecol Obstet"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1097\/01.AOG.0000252706.46734.0a","article-title":"Measurement of placental alpha-microglobulin-1 in cervicovaginal discharge to diagnose rupture of membranes","volume":"109","author":"S E Lee","year":"2007","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"100200","DOI":"10.1016\/j.ajogmf.2020.100200","article-title":"Diagnosis of rupture of membranes: AmniSure, clinical assessment, and the Food and Drug Administration warning","volume":"2","author":"B Thumm","year":"2020","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"02","key":"ref13","first-page":"248","article-title":"Amniotic fluid arborization: effect of blood, meconium, and pH alterations","volume":"64","author":"E A Reece","year":"1984","journal-title":"Obstet Gynecol"},{"key":"ref14","first-page":"338","article-title":"Ferning of amniotic fluid contaminated with blood","volume":"75","author":"R L Rosemond","year":"1990","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1097\/00003081-199112000-00007","article-title":"Detection of premature rupture of the membranes","volume":"34","author":"K M Davidson","year":"1991","journal-title":"Clin Obstet Gynecol"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2515-2718.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T22:30:40Z","timestamp":1755556240000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2515-2718"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":14,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,8,18]]},"published-print":{"date-parts":[[2025,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2515-2718","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,1,14]]},"published":{"date-parts":[[2025,1,14]]}}}