I am a 13-year-old boy

A patient came in tonight (21 years old, my sister's age, aka, TOO YOUNG to be having children!) 33 weeks pregnant, with a chief complaint of post-coital bleeding. Bleeding after intercourse, while you're pregnant, is very common and not something generally to be worried about, but then she said she was also having some contractions (can also happen after sex) and may have been leaking some fluid (OK, now you've got our attention).

To check for ruptured membranes, you can do a few things. First, you do a sterile speculum exam without using any lubricating jelly. You look for:

• pooling -- fluid will collect on the bottom half of the speculum; if it's clear, that's a strong indicator for amniotic fluid. If you push on the abdomen and simultaneously see more fluid flow out the cervix, that's a pretty good indicator too.
• nitrazine test -- stick a qtip in the fluid and swipe it on a piece of nitrazine paper, which is a pH paper. If it changes from yellowish to blue, it has come into contact with a basic substance, and while the vagina is normally acidic, amniotic fluid is not. Things that will give false positive results include water, lubricating jelly, blood, and semen, so the test is useless if any of those are present.
• ferning -- you swipe the qtip on a microscope slide, let it air dry, and look at it under a microscope. Amniotic fluid will produce a pattern that looks like the fronds of a fern, or like snowflakes.

If none of those tests are possible, there are a few other things you can do, but it's not important here.

The patient had some pooling, but the fluid was tinged pink from some blood. Knowing that the pooling itself was not definitive and that nitrazine was useless due to the blood, we swiped some fluid onto a slide to see if, by chance, there was any ferning.

There wasn't.

But guess what there was.





Sperm.

Heehee!

I've never seen sperm under the microscope before, so that was fun to add to my list of things-I've-come-across-in-real-life. It also explained the pooling: Semen, duh.



Oh yeah, and gross. Definitely gross. I've seen lots of stuff under the microscope: trichomonas, bacterial vaginosis, and all sorts of nasty vaginal discharge. But sperm... that's gross in a different way.


But heehee, they just had seee-eex.