Vaginal Fluid Urea and Creatinine in the Diagnosis of Premature Rupture of Membranes in Resource Limited Community Settings
,
Abstract
Objective: Diagnosis of premature rupture of membranes (PROM) is difficult in equivocal cases with traditional methods. 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.
Materials and methods: The current study was a prospective case control. 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. Data analysis was done by Student’s t-test, receiver operator curve and chi square test.
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 < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of vaginal fluid urea with a cut off value > 6mg/dl and creatinine with a cut off value of > 0.3 mg/dl to diagnose PROM were all more than 90%. 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. The areas under the curves are 0.952 for creatinine, 0.999 for urea and 0.635 for AFI.
Conclusion: Detection of vaginal fluid urea and creatinine to diagnose PROM is a simple, reliable and rapid test. Introduction of this method into routine use even in low resource community setting is feasible, practical and cost effective.
DeFranco E, Atkin K, Heyi PS. Preterm labour, premature rupture of membranes and cervical insufficiency, Manual of Obstetrics,7th Edition, Evans, Arthur T(eds). Lippincott Williams & Wilkins, 2007.
Zanjani MS, Haghighi L. Vaginal fluid creatinine for the detection of premature rupture of membranes. J Obstet Gynaecol Res 2012; 38: 505-8.
ACOG Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol 2007; 109:1007-19.
Kariman, N., Toloui, H., Azarhoush, R., AlaviMajd, H. and Jan-nesari, S.H. Diagnostic Values of Urea and Creatinine Values of Cervico vaginal Discharges in Determining of Premature Rupture of Membranes. Pajouhesh Dar Pezeshki 2010; 33: 222-7.
Park J, Lee Si, Norwitz ER. Non-invasive Testing for Rupture of the Fetal Membranes. Fetal and Maternal Healthcare. US Obstetric and Gynecology 2007:13-6.
El-Messidi A, Cameron A. Diagnosis of premature rupture of membranes: inspiration from the past and insights for the future. J Obstet Gynaecol Can 2010; 32:561–9.
Doret M, Cartier R, Miribel J, Massardier J, MassoudM, BordesA, et al. Premature preterm rupture of the membrane diagnosis in early pregnancy: PAMG-1 and IGFBP-1 detection in amniotic fluid with biochemical tests. Clin Biochem 2013; 46: 1816-9.
Palacio M, Kuhnert M, Berger R, Larios CL, Marcellin L. Metaanalysis of studies on biochemical marker tests for the diagnosis of premature rupture of membranes: comparison of performance indexes. BMC Pregnancy and Childbirth 2014; 14: 183.
Caughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol 2008; 1: 11-22.
Abdelazim IA, Abu-Faza M. FetalFibronectin (Quick Check fFn Test) Versus Insulin-Like Growth Factor Binding Protein-1 (Actim PROM Test) for Detection of Premature Rupture of Fetal Membranes. J Gynecol Obstet Med 2014; 1:1-12.
Ruanphoo P, Phupong V. Evaluation of the performance of the insulin-like growth factor-binding protein-1/alpha-fetoprotein test in diagnosing ruptured fetal membranes in pregnant women. J Perinatol 2015; 35: 558–60.
Tigga MP, Malik S. Comparative analysis of four biomarkers in diagnosing premature rupture of membranes and their correlation with onset of labour. Int J Reprod Contracept Obstet Gynecol 2015; 4:1070-5.
Ghasemi M, Jaami R, Alleyassin A, Ansarimoghaddam A. The value of urea, creatinine, prolactin, and beta sub-unit of human chorionic gonadotropin of vaginal fluid in the diagnosis of premature preterm rupture of membranes in pregnancy. Turk J Obstet Gynecol 2016;13: 62-6
Waters TP and Mercer B. Preterm PROM: prediction, prevention, principles. Clin Obstet Gynecol 2011; 54: 307-12
Kafali H, Oksuzler C. Vaginal fluid urea and creatinine in diagnosis of premature rupture of membranes. Arch Gynecol Obstet 2007; 275: 157-60.
Mohamed A, Mostafa W. The value of measurement of vaginal urea, ceatinineand beta HCG in the diagnosis of premature rupture of membranes. KAJOG 2011; 2: 41-7.
Kariman N., Afrakhte, M., Hedayati M., Fallahian M. and Majd H. Diagnosis of Premature Rupture of Membranes by Assessment of Urea and Creatinine in Vaginal Washing Fluid. Iran Journal of Reproductive Medicine 2013; 11: 93-100.
Osman OM, Elghazaly M. Can Vaginal Washing Fluid Urea, Creatinine and Qualitative β-hCG Diagnose Suspected Premature Rupture of Membranes? Open Journal of Obstetrics and Gynecology 2014; 4: 967-72.
Gezer C, Ekin A, Golbasi C, Kocahakimoglu C, Bozkurt U, Dogan A, et al. Use of urea and creatinine levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes and delivery interval after membrane rupture. J Matern Fetal Neonatal Med 2017; 30;772-8.
| Files | ||
| Issue | Vol 11, No 1 (March 2017) | |
| Section | Original Articles | |
| Keywords | ||
| Premature Rupture of Membranes (PROM) Urea Creatinine Vaginal Discharge | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
