Placental alpha microglobulin-1 (AmniSure test) versus insulin-like growth factor binding protein-1 (Actim PROM test) for detection of premature rupture of fetal membranes.

AIM: This study was designed to compare the accuracy of placental alpha microglobulin-1 (PAMG-1) versus insulin-like growth factor binding protein-1 (IGFBP-1) to diagnose premature rupture of fetal membranes (PROM). MATERIAL AND METHODS: This comparative prospective study was carried out over 3 years in Al-Rashid Maternity and Ahmadi Hospitals, Kuwait. One hundred and fifty pregnant women after 37 weeks gestation were included in this study for induction of labor and divided into two groups according to presence or absence of PROM. RESULTS: In this study, the sensitivity and specificity (97.3% and 98.7%) of PAMG-1 to diagnose PROM were statistically insignificant compared with the sensitivity and specificity (89.3% and 82.7%) of IGFBP-1. The PPV and NPV (98.6% and 97.4%) of PAMG-1 were also statistically insignificant compared with the PPV and NPV (83.8% and 88.6%) of IGFBP-1. Also, the accuracy (98%) of PAMG-1 was statistically insignificant compared with the accuracy (86%) of IGFBP-1 (P > 0.05). CONCLUSION: Although AmniSure test seems to be the most accurate test to diagnose rupture of the fetal membranes with high sensitivity and specificity, in this study the sensitivity, specificity and accuracy of AmniSure test to diagnose PROM were statistically insignificant compared with the sensitivity, specificity and accuracy of Actim PROM test.

Sequential clomiphene citrate/hMG versus hMG for ovulation induction in clomiphene citrate-resistant women.

OBJECTIVE: This study was designed to compare sequential clomiphene citrate/hMG regimen to hMG regimen for ovulation induction in clomiphene citrate-resistant women. STUDY DESIGN: A comparative prospective study. PATIENTS AND METHODS: Ninety infertile women were randomized to receive either sequential CC/hMG regimen (45 women) or low-dose step-up protocol of hMG (45 women). All participants had received at least six consecutive cycles of clomiphene citrate for ovulation induction within the last year before inclusion in this study, but they did not conceive. The CC/hMG regimen group received clomiphene citrate 100 mg/day for 5 days, followed by hMG 75 IU for 4 days. The hMG group received low-dose step-up protocol for 10-14 days. To detect the number and size of the follicles, TVS was done on cycle day 8 and repeated daily or every other day according to follicular development. When one to three follicles reached a diameter ≥18 mm, hCG injection was scheduled. Before hCG injection, the E2 level and endometrial thickness were evaluated. ß-hCG levels were measured on cycle day 22. RESULTS: There was no significant difference between the two studied groups regarding the demographic data, sperm parameters, and day 3 FSH, LH and estradiol. Also, there was no significant difference between the two studied groups regarding endometrial thickness, number of mature follicles, peak of E2 before hCG injection and number of cases that developed ovarian cyst or OHSS. The dose of gonadotropins used was significantly low in the CC/hMG group compared to the hMG group (295.2 ± 75.5 vs. 625.3 ± 65.0, respectively), and the pregnancy rate was significantly high in the CC/hMG group compared to the hMG group [12 (26.7 %) vs. 3 (6.7 %), respectively, p < 0.05]. CONCLUSION: The sequential CC/hMG regimen is as effective as hMG regimen for ovulation induction, produces satisfactory pregnancy results and reduces the treatment cost.

Placental alpha microglobulin-1 (AmniSure(®) test) for detection of premature rupture of fetal membranes.

OBJECTIVES: This study was designed to detect the accuracy of the placental alpha microglobulin-1 (PAMG-1) (AmniSure(®) test) to diagnose premature rupture of the fetal membranes (PROM). STUDY DESIGN: This comparative prospective study was carried out over 2 years in Al-Rashid Maternity Hospital, Kuwait from January 2006 till January 2008. PATIENTS AND METHODS: One hundred and fifty (150) pregnant women after 37 weeks gestation were included in this study for induction of labor and divided into two groups according to the presence or absence of PROM; 75 patients with PROM were included in group I and 75 patients without PROM were included in group II as controls. Patients with multiple pregnancies or fetal distress or vaginal bleeding or preterm labor or chorioamnionitis were excluded from this study. Trans-abdominal ultrasound was done to detect the gestational age and the amniotic fluid index (AFI ≤5 cm in PROM) followed by sterile speculum examination to detect amniotic fluid pooling from the cervical canal and for the collection of samples. RESULTS: In this study, the sensitivity and the specificity of PAMG-1 to diagnose PROM were 97.33 and 98.67%, respectively, compared with 84% sensitivity and 78.67% specificity for Ferning test and 86.67% sensitivity and 81.33% specificity for Nitrazine test. The positive predictive value (PPV) and negative predictive value (NPV) of PAMG-1 were 98.64 and 97.37%, respectively, compared with 79.74% PPV and 83.1% NPV for Ferning test and 82.28% PPV and 85.91% NPV for Nitrazine test. PAMG-1 was accurate (98%) for detection of PROM than Ferning (81.33%) or Nitrazine (84.0%) tests. CONCLUSION: Detection of the PAMG-1 in the vaginal fluid using AmniSure(®) test is an accurate method to diagnose rupture of the fetal membranes, with high sensitivity, specificity, negative and positive predictive values.

Elevated serum levels of interleukin-15, interleukin-16, and human chorionic gonadotropin in women with preeclampsia.

OBJECTIVES: We sought to investigate the relationship between serum levels of interleukin 15 (IL-15), interleukin 16 (IL-16), and human chorionic gonadotropin (beta-hCG) in women with a normal pregnancy and with preeclampsia, and their association with disease severity. We also wished to calculate the accuracy of these markers in diagnosing the disease and predicting its severity. MATERIALS AND METHODS: The study was conducted at Al Fayoum University in Cairo between December 2006 and September 2007. Thirty-two primigravid women with preeclampsia (preeclamptic group) scheduled for Caesarean Section were recruited and matched for age and duration of pregnancy with 35 normotensive primigravid women (control group). Of the preeclamptic women, 18 had severe preeclampsia, and 14 had mild preeclampsia. Blood sampling was performed for assays of serum IL-15, IL-16, and beta-hCG. RESULTS: Serum concentrations of IL-15, IL-16, and beta-hCG were significantly greater in preeclamptic women than in normotensive pregnant women (P < 0.001). Moreover, they were significantly higher in women with severe preeclampsia than in mild cases (P < 0.001). There was a positive correlation between serum IL-15, IL-16, and beta-hCG among all groups. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of serum beta-hCG in predicting preeclampsia were 56.25%, 91.43%, 85.71%, 69.57%, and 74.63%, respectively. These values for IL-15 were 94.44%, 89.8%, 77.27%, 97.78%, and 91.04%, respectively, and for IL-16, the values were 88.89%, 95.92%, 88.89%, 95.92%, and 94.03%, respectively. CONCLUSION: Serum levels of IL-15, IL-16, and beta-hCG were significantly increased in preeclamptic women compared with normotensive women, and these levels correlated with disease severity. However, serum IL-15 and 16 had a greater overall accuracy than beta-hCG in diagnosing severe preeclampsia.