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HelpTest Code ASURE Amnisure Rupture of Membranes (ROM), Amniotic Fluid
Synonyms/Keywords
ROM, Amnisure
Specimen Requirements
| Specimen Type | Preferred Container/Tube | Acceptable Container/Tube | Specimen Volume |
|---|---|---|---|
| Cervicovaginal secretions | AmniSure ROM Test Specimen Collection Kit containing a polyester tipped swab and transport vial with solvent | 1 mL |
Collection/Processing Instructions
Contact laboratory for kit.
Only samples collected using the AmniSure kit will be accepted.
Do not collect earlier than 6 hours after the removal of any disinfectant solutions or medicines from the vagina.
Placenta previa and performing digital exams prior to sample collection can lead to inaccurate test results.
1. Insert the tip of the sterile swab into the vagina no more than 2-3 inches.
2. Wait one (1) minute.
3. Withdraw the swab and then immediately place the polyester tip into blue-capped solvent vial.
4. Rinse the swab by rotating in the solvent vial for one (1) minute.
5. Remove and then discard the swab; recap the solvent vial.
6. Send vial to lab.
Specimen Stability Information
| Specimen Type | Temperature | Time |
| Cervicovaginal secretions | Ambient | 4 hours |
| Refrigerated | 6 hours |
Rejection Criteria
Samples collected with any other type of collection devices
Grossly bloody samples
Reference Range Information
Positive - indicates ruptured membrane.
Negative - indicates no ruptured membrane.
Marshfield Labs Performing Department
Marshfield Labs Chemistry
Performing Information
| Performing Location | Day(s) Test Performed | Analytical Time | Methodology/Instrumentation |
|---|---|---|---|
| Beaver Dam | Monday - Sunday | Same Day | Amnisure ROM |
| Eau Claire | Monday - Sunday | Same Day | Amnisure ROM |
| Marshfield | Monday - Sunday | Same Day | Amnisure ROM |
| Minocqua | Monday - Sunday | Same Day | Amnisure ROM |
| Rice Lake | Monday - Sunday | Same Day | Amnisure ROM |
| Weston | Monday - Sunday | Same Day | Amnisure ROM |
CPT Codes
| CPT | Modifier (if needed) |
Quantity | Description | Comments |
|---|---|---|---|---|
| 84112 |
Ordering Applications
| Ordering Application | Description |
|---|---|
| Cerner | Amnisure ROM (COMMON) |