الفهرس 
The Fetal MembranesOnly 14 pages are availabe for public view
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Abstract
Premature rupture of membranes (PROM) is defined as rupture of the fetal membranes before the onset of labor irrespective of gestational age. It occurs in approximately 8% of women with pregnancy at term. Epidemiological data on the time interval from PROM at term to spontaneous labour demonstrates that over 60% of these women begin labour spontaneously within 24 hours and over 95% begin labour spontaneously within 72 hours.
The false diagnosis of membranes rupture can lead to inappropriate intervention such as hospitalization or induction of labor. Therefore, it is highly desirable to establish a definite diagnosis of rupture of membranes in uncertain cases without delay, however, traditional diagnostic method and tests has some limitation and cannot be applied to all patients with 100% accuracy.
One the most recent amniotic fluid markers in vaginal environment is measuring vaginal fluid creatinine for diagnosis of PROM because fetal urine is the most important source of amniotic fluid in second half of pregnancy.
Patients who developed PPROM had significantly shorter CL and higher degrees of funneling in the second trimester compared with similar patients who did not develop PPROM. A very short CL (< 10 mm) or a significant percentage of CF (> 75%) was predictive of subsequent PPROM.
This study was conducted to evaluate the reliability of vaginal fluid creatinine and transvaginal cervical length for the diagnosis of premature rupture of membranes.
The study was carried out at Ain Shams University Maternity-Hospital, A total of 80 pregnant women were included in the study, between 28-34 weeks of gestation, divided into two groups:
Group I was including 60 pregnant women between 28-34 weeks of gestation with history of vaginal fluid leakage, that was positive for amniotic fluid pooling by using sterile Cusco speculum examination with or without Valsalva maneuver and was considered as a (confirmed PROM group).
Group II was including 20 normal pregnant women between 28-34 weeks of gestation and was considered as (control group).
On admission, all women were underwent sterile Cusco speculum examination and amniotic fluid pooling with or without Valsalva maneuver was noted.
After giving an informed consent, 5ml of sterile saline irrigating the posterior vaginal fornix using a sterile Cusco speculum and 3ml of the irrigated saline was aspirated with the same syringe and the sample was sent immediately to the laboratory for assay of urea and creatinine. This was followed by transvaginal ultrasonic follow up of the cervical length by using the transvaginal probe for two times to asses any changes in the cervical during the follow up.
Then all patients were followed up until delivery and gestational age at delivery time was documented. The parameters (age, parity, gestational age, vaginal fluid creatinine) were also documented.
In this study the mean vaginal fluid creatinine concentrations of group I were 0.2493±0.17582 mg/dl while in the second group the mean vaginal fluid creatinine concentrations were 0.1405±0.09462 ; with highly statistically significant difference could be detected between the both group as the p<0.01. This result was supported by result obtained by Li Hy et al., 2000, Gurbuz et al., 2003, Gurbuz et al., 2004 and Kafali and Oksuzler, 2007.
In this study the mean cervical length I in the group I was 2.987±0.6495 while in the group II it was 3.730±0.2793; with highly statistically significant difference could be detected between the both group as the (p<0.01). And the mean cervical length II in the group I was 2.852±0.6594while in the group II it was 3.520±0.3270; with highly statistically significant difference could be detected between the both group as the (p<0.01). This result was supported by result obtained by Odibo et al., 2001, Kurtzman et al. 1999.
And by a comparison between all studied groups according to PROM there was no statistically significant difference could be detected as regard parity, age and gestational age.
And by a comparison between all studied groups according to PROM the mean of vaginal fluid creatinine concentrations was 0.3703±0.1061and there was a highly statistically significant difference could be detected as the p<0.01.
And by a comparison between all studied groups according to PROM the mean cervical length I was 2.531±0.4336 and mean cervical length II was 2.381±0.4169 and there was a highly statistically significant difference could be detected as the p<0.01.