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The Amnisure ROM test is another new test that is easy, fast, and minimally invasive, with high sensitivity and specificity ( 7, 8). Intra amniotic dye injection and observation for fluid passage transvaginally was designated an “unequivocal” diagnostic method for confirmation of membrane rupture, but this invasive test carries increased maternal and fetal risk ( 6). Even amniotic fluid determination by ultrasound examination was not a reliable test to evaluate membrane rupture because it cannot differentiate PROM from other causes of oligohydramnios ( 5). History is reliable in 10% to 50% of cases speculum examination of fluid leakage from the cervix was associated with 12% - 30% false negative results, Nitrazine test was associated with false positive or negative results due to contamination by urine (alkaline), blood or meconium, antibiotics, vaginal and cervical infections, and fern test was also associated with 13-30% false negative and 5-30% false positive results ( 4).
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However these conventional methods are associated with drawbacks. Failure to identify patient or false positive diagnosis of PROM may lead to inappropriate management and serious maternal and neonatal complications or unnecessary obstetric interventions ( 2).ĭiagnosis of PROM can be made by showing the three gold standards of conventional findings by a clinician ( 3) 1) Observation of clear amniotic fluid flow or accumulation of fluid at posterior fornix with a sterile speculum, 2) Observation of transition from yellow to blue with pH indicator paper due to basic amniotic fluid flow (nitrazine test) and/or 3) Detection of palm leaf-pattern in dried amniotic fluid with microscopic method (fern test). Accurate history, clinical examination and specialized tests are the hallmark for diagnosing PROM. It occurs in 10% of all term pregnancies and about 2- 4% of preterm pregnancies, and is associated with complications such as infection and preterm birth ( 1). Premature rupture of membranes (PROM) refers to rupture of the fetal membranes prior to the onset of labor, regardless of gestational age. Introduction of this method into routine use even in low resource community setting is feasible, practical and cost effective. The areas under the curves are 0.952 for creatinine, 0.999 for urea and 0.635 for AFI.Ĭonclusion: Detection of vaginal fluid urea and creatinine to diagnose PROM is a simple, reliable and rapid test.
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The sensitivity, specificity, PPV, NPV and accuracy of amniotic fluid index (AFI) to diagnose PROM were 30%, 91.8%, 83.33%, 57.32% and 62 % respectively, with a cut-off value of ≤ 7 cm. Results: The demographic data of both groups were comparable at the time of sampling (p > 0.05).Vaginal fluid urea and creatinine was significantly higher in study group (p 6mg/dl and creatinine with a cut off value of > 0.3 mg/dl to diagnose PROM were all more than 90%. Data analysis was done by Student’s t-test, receiver operator curve and chi square test. Women having gestational age of 28 to 42 weeks were divided into two equal groups: Fifty with history of leaking per vagina (study group) and an equal number with gestation matched none leaking (control group) were recruited. Materials and methods: The current study was a prospective case control. This study aimed to evaluate the reliability of vaginal washing fluid urea and creatinine for diagnosis of PROM and to determine the cut off value. Objective: Diagnosis of premature rupture of membranes (PROM) is difficult in equivocal cases with traditional methods.