الفهرس 
THE FETAL MEMBRANESOnly 14 pages are availabe for public view
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Abstract
Preterm prelabor rupture of membranes (PROM) is a condition where the amniotic sac leaks fluid before 37 weeks of gestation (Deering et al., 2007).
Correct diagnosis of PROM has great importance because failure of diagnosis can lead to unwanted obstetric complications (Kim et al., 2005).
The false diagnosis of membrane rupture can lead to in appropriate interventions such as hospitalization or induction of labor. Therefore, any biochemical test used to establish a correct diagnosis must be reliable, simple and rapid (Esim et al., 2002).
All these tests have advantages and drawbacks, up till now is no gold standard test for PROM (Kafali and Oksuzler, 2007).
Li Hy et al., (2000) found creatinine less expansive and more easir to measure than hCG and appear more accurate than hCG, creatinine may be helpful in diagnosing PROM because fetal urine is the most important source of amniotic fluid in the second half of pregnancy (Gurbuz et al., 2004).
In addition the beta subunit of human chorionic gonadotropin has been evaluated as a possible predictor of preterm PROM (Bernistein et al., 1998).
This prospective case-control study was carried out at Ain Shams University Hospital.
The study included 150 pregnant women between 24- 36 weeks of gestation were subdivided into three groups of women.
Group I: (Confirmed PROM)
Included 50 pregnant women, they were positive for amniotic fluid pooling (by visualization of amniotic fluid leakage by sterile cusco speculum examination).
Group II: (Suspected PROM)
Included 50 pregnant women were negative for amniotic fluid poling by using sterile cuscospecutlum examination.
Group III: (Control group)
Included 50 normal pregnant women between 24-36 weeks of gestation those were attending the outpatient clinic for routine antenatal care.
All subjects were provided all information about the purpose of the study and the method of sample collection.
All pregnant women of the three groups were subjected to full history, general examination, abdominal examination, sterile cusco speculum examination and transabdomianl U/S.
• Patients lied in lithotomy position in good illumination.
• Sterile vaginal examination using a speculum was done then participants had the posterior vaginal fornix irrigated with 5 mL of sterile saline.
• With the same syringe, the vaginal washings aspirated from the posterior fornix and 4 mL of it was injected out with the same syringe and sent immediately to the laboratory for: measuring of vaginal fluid creatinine with a creatinine assay.
We applied 2 DROPs of collected sample on Qu PID plus one step pregnancy (Stanbio Laboratory, Boerae, Texas, USA) its cost was 8 L.E/test, its sensitivity is 20 mIU/mL.
It was found that there was no significant statistical difference between the confirmed, suspected and control groups as regard maternal age, parity, gestational age history of V.D, C.S.
• The results of creatinine level testing of vaginal washing fluid it was found that best cut off value of creatinine was 0.21 mg/dL, with sensitivity, specificity and accuracy of 100%.
• The results of human chorionic gonadotropin testing of vagingl fluid washing in the three groups were:
- In confirmed group: qualitative b-hCG test was +ve in 40 patients and was –ve is 10 patients.
- In suspected group: qualitative b-hCG test was +ve in 6 patients and was –ve in 44 patients.
- In control group: qualitative b-hCG test was –ve in 50 patients.
The sensitivity, specificity, accuracy of qualitative b-hCG test in the vaginal washing fluid is 80%, 100%, 90% respectively.
This study was designed to compare the reliability of vaginal fluid creatinine and b human chorionic gonadotropin for the diagnosis of premature rupture of membranes.
Li Hy et al., (2000) was the first who conducted a study using creatinine, quantitative b-hCG, AFP to diagnosis PROM and reported 90%, sensitivity, 100% specificity 95% accuracy for creatinine and 80% sensivitity, 70% specificity, 75% accuracy for hCG.
This study was shown that vaginal fluid creatinine could be used as an extremely useful marker in doubtfull cases of PROM.
This study concluded that creatinine levels in vaginal fluid was more accurate than qualitative b-hCG test (they found to be the same cost).
Both tests were the same costs and the same simplicity and availability that makes them attractive in clinical practice.
In conclusion both creatinine assay and qualitative b-hCG are best bed side tests for diagnosis of PROM than other methods but creatinine level is more accurate than qualitative b-hCG test.