Ultrasound Obstet Gynecol 2003; 21: 521–522 Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/uog.104 Picture of the Month Use of color Doppler in the diagnosis of PPROM R. DEVLIEGER, F. P. H. A. VANDENBUSSCHE and D. OEPKES Fetal Diagnosis and Therapy Unit, Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands Preterm premature rupture of the fetal membranes (PPROM) is the most common single factor of prematurity and remains one of the major perinatal challenges 1 . In the optimal management of this condition, a correct diagnosis is crucial. First, it enables the prompt initiation of appropriate obstetric measures 2 . Second, it permits realistic counseling of the parents especially in the previable period, when survival following PPROM is low, and morbidity in any survivors is frequent 3 . Finally, the exclusion of PPROM in pregnant patients presenting with the frequent complaint of fluid loss per vaginam is at least as important to avoid unnecessary intervention and anxiety. When PPROM is suspected, often based on history, the clinician relies on speculum examination to confirm pooling of amniotic fluid in the posterior fornix. In case of doubt the cervicovaginal secretions can be tested for pH, capacity to dry in a certain pattern (ferning), or biochemical markers (e.g. alpha-fetoprotein, fibronectin, prolactin, IGFBP-1). These tests potentially increase the risks for ascending inoculation and development of chorioamnionitis. So far the role of ultrasound in PPROM has been limited to the evaluation of fetal condition and remaining amniotic fluid volume. More recently, attempts have been made to sonographically predict pulmonary hypoplasia and preterm delivery in these patients 4,5 . A 38-year-old patient was referred to our unit with the tentative diagnosis of PPROM based on history at a gestational age of 30 + 2 weeks. Transabdominal ultrasound examination showed a normally grown fetus in breech presentation with acute oligohydramnios (amniotic fluid index of 2). Using high-sensitivity color Doppler (4.0-MHz probe; color Doppler sensitivity, 0.028; gain, 43) (Sequoia  , Acuson Corp., Mountain View, CA, USA), the flow of amniotic fluid through the cervix into the vagina could be demonstrated (Figure 1), confirming the diagnosis of PPROM. The patient was admitted for bed-rest, antibiotics and steroid treatment. One week later, she developed uterine contractions with fetal heart rate decelerations and was delivered by emergency Cesarean section. A healthy 1755-g girl was delivered. She required ventilatory support for 1 day and had no obvious signs of infection. We conclude that b Figure 1 (a) Sagittal sonographic view through the patient’s bladder and cervix showing turbulence of amniotic fluid accumulating at the internal os of the cervix (arrow). (b) Identical view, 15 s later. The flow is now visible through the cervical canal and the amniotic fluid is pooled in the posterior fornix (arrow). transabdominal ultrasound and color Doppler can be useful in confirming the suspicion of PPROM without manipulation in the cervical region, therefore potentially reducing the risks for chorioamnionitis. Correspondence to: Dr R. Devlieger, Department of Obstetrics, Leids Universitair Medisch Centrum K6-34, P.O. Box 9600, 2300 RC Leiden, The Netherlands (e-mail: roland.devlieger@eurofoetus.org) Copyright  2003 ISUOG. Published by John Wiley & Sons, Ltd. PICTURE OF THE MONTH