Abstract
INTRODUCTION: Preterm premature rupture of membranes (PPROM) is a significant contributor to preterm birth. Amnio-dye test is diagnostic. Indigo carmine is typically used but is currently unavailable. Indocyanine green has been safely used in neonatal invasive studies and may be a viable alternative. METHODS: Case report. 19 year old G1 presented at 26 3/7 weeks gestation with an amniotic fluid index (AFI) of 5.6 cm with report of minimal vaginal discharge. The fetus had normal anatomy and an estimated weight of 813 grams (33rd percentile). She was hydrated with no change in AFI, and evaluated for PPROM with speculum exam negative for fluid pooling, nitrazine reaction, and ferning. The patient was counseled, confirmed to have no iodide allergies and an amniocentesis was performed instilling dilute indocyanine green without complication. PPROM was confirmed with vaginal leaking of green fluid. Continuous electronic fetal monitoring following the procedure was reassuring. RESULTS: The patient and fetus remained stable until preterm labor ensued with delivery 23 days post-procedure. A viable male infant was born via spontaneous vaginal delivery at 30 3/7 weeks gestation with Apgar scores of 6 and 9 at 1 and 5 minutes respectively. Umbilical cord arterial blood gas was normal. The infant was admitted to the NICU due to prematurity and did require intubation. At submission, the infant is 4 days of age and requiring minimal ventilatory support with no additional complications. CONCLUSION: Indocyanine green may be an acceptable dye when diagnosis of PPROM is inconclusive via non-invasive testing.
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