ABSTRACT
Introduction@#Prelabor rupture of membranes (PROM) occurs in 8% of all pregnancies and is a major cause of preterm birth and perinatal morbidity and mortality. In 47% of cases, clinicians are uncertain regarding the diagnosis of PROM based on examination and history alone. A misdiagnosis often leads to unnecessary interventions that may be detrimental to mother and fetus. There is currently no ideal noninvasive diagnostic test that can diagnose prelabor rupture of membranes with certainty. @*Objective@#This study aims to determine if a quantitative assay of vaginal fluid creatinine can correctly diagnose prelabor rupture of membranes in women with singleton pregnancies at 28-42 weeks age of gestation@*Methodology@#A prospective study was performed at a tertiary hospital from December 2015 to August 2017 with a computed sample size of 180 patients (60 per group). If a history of watery discharge was confirmed by egress of fluid, then the patient was included in the Ruptured membranes group. If despite a history of watery discharge, no egress is noted, then she was included in the Unsure membrane status group. 60 women with normal pregnancies were randomly chosen for the control group. Vaginal fluid was collected for Litmus Paper, Fern, and Vaginal Fluid Creatinine Tests.@*Results and Conclusion@#Vaginal fluid creatinine at 1.00 mg/dL has higher sensitivity, specificity, positive and negative predictive values, and a higher positive likelihood ratio than the litmus paper or ferning tests. High accuracy values, with a low false negative rate of 0, and a large AUC make vaginal fluid creatinine an excellent test for the detection of PROM, in accordance with previous studies.
Subject(s)
Creatinine , Amniotic FluidABSTRACT
OBJECTIVE: The purpose of this study is to compare the detection rate among diagnostic methods used for preterm premature rupture of membrane (PPROM). METHODS: The study population was composed of pregnant women who visited delivery room at our hospital due to vaginal watery discharge from 1 March 2002 to 28 February 2003. The gestational age was between 15 and 36+6/7 weeks of gestation. The study group was composed of 74 pregnant women. The rupture of membrane was tested by nitrazine test, ROM-check test and actim PROM test. It was regarded true positive that normal spontaneous preterm delivery was occurred within 72 hrs. The detection rates of each test were analyzed. RESULTS: There were positive results in 65 cases of nitrazine test, 23 cases of ROM-check test and 53 cases of actim PROM test. Of these positive cases, cases that delivered within 72 hours were in 33 cases of nitrazine test, 13 cases of ROM-check test and 30 cases of actim PROM test. Among three diagnostic methods, the sensitivity is highest for nitrazine test (86.8%) and the specificity is highest for ROM- check test (72.2%). The positive predictive value shows no significant difference among three methods and the negative predictive value is highest for actim PROM test (61.9%). The combination of ROM-check test and actim PROM test shows most accurate detection rates for diagnosis of preterm premature rupture of the membranes (sensitivity 84.2%, specificity 42.3%, positive predictive value 56.1%, negative predictive value 64.7%). CONCLUSION: Our data shows that combination of diagnostic methods might improve detection rate for PPROM. Future studies remain to improve detection rate of PPROM.