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  • GAIA Level 1 Assessment of Premature Preterm Rupture of Membranes is defined by five criteria: first, presentation between 24 0/7 and 36 6/7 weeks gestation with a clinical history of rupture of membranes, the fluid from which may be any color, including clear, blood-tinged, meconium-tinged (fetal stool), or purulent-tinged (yellowish, suggesting infection); second, the patient is determined to not be in preterm labor (having less than or equal to 4 contractions per hour documented clinically or on tocodynometer, with less than 2cm cervical dilation); third, visible leakage of fluid on vaginal speculum exam; fourth, one of the two following requirements must be met: a) Visible arborization (ferning) on microscopy of amniotic fluid; OR b) Ultrasound with oligohydramnios (amniotic fluid index (AFI) less than 5, or maximum vertical pocket (MVP) less than 2); fifth, documentation of the membrane rupture by one of the following diagnostic tests: a) Positive intra-amniotic dye-injection method; b) Positive result on amniotic fluid alpha-fetoprotein test kit; c) Amniotic fluid pH measurement (nitrazine paper test); d) Amniotic fluid placental alpha macroglobulin-1 protein assay (PAMG-1) test (AmniSure test); e) Amniotic fluid insulin-like growth factor binding protein (IGFBP-1) test (Actim PROM test).
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