الفهرس 
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Abstract
Premature rupture of membranes (PROM) constitutes one of the most important dilemmas in the obstetric practice. It could be defined as rupture of membranes before the onset of labor, irrespective of the gestational age (Ngwenya and Lindow, 2004).
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 inappropriate 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., 2003).
The methods used to diagnose premature rupture of membranes are variable; it begins by history taking and clinical examination by vaginal speculum. Diagnosis may be helped by measuring Amniotic Fluid Index by ultrasound, by amnioinfusion of indigo carmine or other biological tests; vaginal pH by nitrazine paper, prolactin, alpha fetoprotein, human chorionic gonadotropin and fetal fibronectin (Esim et al., 2003).
All these tests have advantages and drawbacks, up till now is no gold standard test for PROM (Kafali and Oksuzler, 2007).
Recently, it is hypothesized that vaginal fluid creatinine may be helpful in diagnosing PROM because fetal urine is the most important source of amniotic fluid in the second half of pregnancy (Kafali and Oksuzler, 2006).
This study was conducted to evaluate the reliability of vaginal fluid creatinine and qualitative beta hCG for the diagnosis of PROMs.
This prospective case-control study was carried out at EL Fayoum general hospital
The study included 200 pregnant women between 28-41 weeks of gestation were subdivided into two groups of women.
group 1&2: (Confirmed PROM)
Each group 50 pregnant women, they were positive for amniotic fluid pooling (by visualization of amniotic fluid leakage by sterile cusco speculum examination).
group 3&4: (Control group)
Each group 50 pregnant women between 28-41 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 two 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 3 ml of sterile saline.
• With the same syringe, the vaginal washings aspirated from the posterior fornix and 3 ml of it was injected out with the same syringe and sent immediately to the laboratory investigations
• To measure vaginal fluid creatinine; 3ml of collected fluid was quantitatively tested for creatinine
• Performing beta hCG: After shaking the syringe, 2 drops of collected sample were applied on one step pregnancy test with a sensitivity of 20 mIU/ml and appearance of two red lines was the indicator for a positive result of the test.
It was found that there was no significant statistical difference between the confirmed and control groups as regard maternal age, parity, gestational age.
. The study showed that confirmed PROM of B-hCG with a sensitivity 76%, specificity 100%, positive predictivity 100% and negative predictivity 80.6% with a diagnostic accuracy of 88%.
. The study showed that confirmed PROM of creatinine with a sensitivity 97%, specificity 100%, positive predictivity 100% and negative predictivity 98.7% with a diagnostic accuracy of 99%.
The mean vaginal fluid creatinine concentrations of group I were
1.9 ± 0.31 mg/dl found higher against the group II, 0.25 ± 0.07 mg/dl.
Previous studies concluded that creatinine, and qualitative beta hCG in vaginal fluid near term gestations are good tests in sure premature rupture of membranes. Any watery secretion from cervix or vagina might mimic amniotic fluid at inspection and could lead to wrong clinical diagnosis, thus vaginal fluid creatinine and B HCG in these case can be a helpful tool.
Also the test doesn’t require an invasive procedure in collection of vaginal samples so the test was well valuable as a screening method for PROM.
In conclusion, creatinine assay are cheaper and faster than B HCG and has higher sensitivity and specificity to establish accurate diagnosis. It is a possible candidate to become gold standard tests for PROM.