Predictive value of aspartate aminotransferase and alanine aminotransferase levels in vaginal fluid for the diagnosis of premature rupture of membranes

Preterm premature rupture of membranes [PPROM] occurs in 3% of pregnancies and 30-40% of preterm labors are related to this problem. Early diagnosis of PPROM is very important due to its impact on pregnancy outcomes. To determine the diagnostic value of aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes as a non-invasive and available test. A total of 148 pregnant women between the 26th-36th gestational weeks were enrolled in the study. 74 patients were in PROM group and 74 in control group. AST and ALT levels in vaginal fluid were measured in each group. Mann Whitney U-test was used to compare AST and ALT levels in each group. The mean of AST level in vaginal fluid was 12.77 +/- 10.06 in PROM group vs. 6.91 +/- 10.92 in control group [p<0.001], while there were no significant difference between ALT levels in PROM group 1.51 +/- 3.17 and control group 0.89 +/- 1.15 [p=0.49]. Optimal cut point of AST for the diagnosis of PROM was 4.5 IU/L in this study. The sensitivity, specificity, positive and negative predictive values were 82.4%, 63.5%, 69.32% and 78.33% respectively. According to the findings of this study, measurement of AST level in vaginal fluid can be used as a reliable test for diagnosis of PROM, but there is no good cut point for ALT level that can be practically used

Survey of predictive value of 4-hour urine collection for diagnosis of proteinuria in preeclampsia

Measuring the 24-hour urine protein >/= 300 mg is the standard threshold value for diagnosis of preeclampsia. This study was intended to determine if a patient's 4-hour urine protein correlate with the 24-hour value for diagnosis of preeclampsia. This was a cross sectional study performed on 84 women with suspected preeclampsia due to positive urinary test strip with minimum protein content of 1+ and BP >/= 140/90 at Al-zahra Educational Hospital in Rasht [Iran] from May 2007 to January 2008. Urine samples were collected within 24 hours in successive periods: The first 4-hour and the next 20-hours urine, in separate containers. The protein contents of 4-hour and 24-hour urine samples were calculated. Data were analyzed by intra-class correlation coefficient, and Receiver Operating Characteristic [ROC] curve. The ROC curve showed the cut-off point of 55.5 for 4-hour urine protein. The correlation between 4- and 24-hour urine protein excretions identified that most women [about 85.1%] with protein excretion rate of 300 mg/24h or more [with preeclampsia] had the same amount of protein of 55.5 or more in their 4-hour urine excretion [p<0.001]. Also, most of them [about 83.7%] with a total urinary protein excretion of less than 300 mg/24h [no preeclampsia] had a protein excretion rate of less than 55.5 mg/4h. This study showed 4-hour protein collection can be used as acceptable substitute for assessing the protein content of 24-hour urine samples as a more convenient, faster, and cheaper method for diagnosis of preeclampsia and the cut-off point for 4-hour urine protein is 55.5 mg

Perinatal outcomes of pregnancies with borderline versus normal amniotic fluid index

Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. The purpose of this study was to compare the pregnancy outcomes of a borderline versus normal AFI. This cross-sectional study was carried out on a total of 235 pregnant women referred to Alzahra Medical Center between 2009-2011. Women with a singleton pregnancy in third trimester were enrolled into this study; of these subjects, 141 cases were in normal AFI group and 94 cases in borderline AFI group. Adequate information was obtained from the patients' medical record and the groups were compared on maternal and fetal complications. Data analysis was performed by using SPSS. The mean maternal age in borderline AFI group was 25.96 +/- 5.92 years and in normal AFI group was 27.88 +/- 6.5 years [p=0.023]. Maternal outcomes such as preterm delivery and labor induction in women with borderline AFI were considerably higher than those in normal group [p=0.01 and p=0.001]. There were no significant differences between the two groups in terms of high blood pressure, preeclampsia, diabetes and neonatal respiratory distress. The borderline AFI group had higher rate of neonatal complications such as Apgar score of less than 7 [p=0.004], IUGR [0.0001], LBW [0.001], and crucial need to NICU [0.003]. Findings indicated that there are statistical differences between adverse outcomes in borderline AFI group and normal group