Membrane Rupture Test

Test Code
MRT - NOCO


Alias/See Also
Fetal Membrane Rupture (PAMG-1)
AmniSure® ROM Test


Preferred Specimen
Vaginal specimen collected with Sterile Polyester Swab from AmniSure® ROM Test


Instructions
  • The polyester tip of the swab should not touch anything prior to insertion into vagina.
  • Hold the swab in the middle of its shaft and, while a patient is lying on her back, carefully insert the polyester tip of the swab into the vagina until the fingers contact the skin (no more than 2-3 inches or 5-7 cm deep). Withdraw the swab from the vagina after one minute.
  • After the swab has been removed from the vagina, immediately place the polyester tip into the provided solvent vial and rinse by rotating for one minute.
  • Remove the swab from the vial and dispose in Biohazard waste.
  • Label container with two patient identifiers (full name, DOB or MR),specimen source, and date and time of collection.
  • Maintain sterility and forward promptly. Container may be transported via tube station or walked.


Transport Container
AmniSure® Solvent Vial


Specimen Stability
Specimen Type Temperature Time
Vaginal Ambient 4 hours
Vaginal Refrigerate 6 hours


Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
  • Received more than 4 hours after collection.
  • If swab is left in solvent vial.
  • Significant amount of blood present.
  • Specimen collected in or by any sample deivce other than the AmniSure® ROM Test.


Methodology
Qualitative Immunochromatographic

Setup Schedule
Monday through Sunday; Continuously


Report Available
Same day


Limitations
Use results in conjunction with other clinical information.

False negatives may result in less than 37 weeks gestation. Each test is a single use disposable unit and cannot be reused. The result is qualitative, make no quantitative interpretation. Significant presence of blood can make the test malfunction (trace amounts of blood are ok). In rare cases when a sample is taken 12 hours or after rupture, false negative may occur. Test performance in patient without signs/symptoms of ROM is unknown. The performance of the test has not been established in the presence of the following contaminates: Anti-fungal creams or suppositories, K-Y Jelly, Monistat Yeast Infection Treatment, Baby Powder (Starch or Talc), Replens Feminine Moisturizer, or Baby Oil.


Reference Range
Negative


Clinical Significance
The timely and accurate diagnosis of rupture of [fetal] membranes (ROM) is crucial because ROM me be associated with serious neonatal and maternal consequences.


Performing Laboratory
North Colorado Medical Center
Banner Fort Collins Medical Center
Sterling Regional Medical Center
East Morgan County Hospital
Ogallala Community Hospital



The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.