الفهرس 
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Abstract
Occurrence of PROM defined as rupture of the amniotic sac and chorion more than an hour before the onset of labor.
The incidence of PROM reported in literature rates from 3-18.5% about 9-10% of the patients at term present rupture of membranes before labor.
Term pregnancy complicated by premature rupture of membranes (PROM) is thought to be associated in part with subclinical infection, and places mothers and neonates at an increased risk for several complications.
Therefore, perinatal care would be greatly helped if a reliable clinical measure were available for predicting the incidence of PROM.
CRP is a highly conserved plasma protein that Participates in the systemic response to inflammation. Its plasma concentration increase slightly with increasing gestational age, and peak around the time of delivery So this study tried to determine the relation between serum C reactive protein level and the incidence of pre labor rupture of membranes in term Pregnancies. Also the study assessed the relation between vaginal PH and the incidence of PROM as a secondary outcome.
This study was carried in Ain Shams University, Maternity hospital 200 pregnant women with gestational age 40-42 completed weeks were included in this study among the period from October 2010 to March 2012.
Single measurement of maternal plasma C-reactive protein was done and vaginal PH by special indicator (Medi test, Germany), and they were followed up till delivery.
According to the onset of labor women were divided into 4 groups:
‐ Group A: including women who developed prelabor rupture of the membranes (PROM).
‐ Group B: including women who developed contractions without PROM.
‐ Group C: including women who reached 41 weeks gestation and were either induced for labor or underwent CS according to protocol of Ain shams university.
‐ Group D: including women who had induction of labor or CS before 41 weeks gestation for indications other than PROM or past-date. Women belonging to this latter group [Group D] were, therefore, excluded from statistical analysis Inclusion criteria:
1. Singleton pregnancy.
2. Gestational age of 40-42 completed weeks based on the date of last normal menstrual period and confirmed by first trimester ultrasound.
Exclusion criteria:
1. Evidence of infection either genital or extra genital.
2. Patients had past history of any medical disorders. Such as, hypertension, diabetes mellitus, renal diseases, cardiac diseases and symptomatic infectious diseases and malignancies.
3. None reassuring fetal well being assessed by CTG and biophysical profile.
4. Oligohydramnios.
5. Known congenital malformations.
6. Pregnancy induced hypertension.
7. Other indications for induction of labor or CS.
For all patients :
Full history taking to exclude the previous criteria in the selected cases.
Complete general and abdominal examination.
Pelvic examination for assessment of presentation, cervical state and vaginal PH by special indicator (Medi test, Germany).
Antenatal ultrasonography:
-To determine the fetal size
-To exclude: IUGR, IUFD and abruptio placenta.
-To evaluate amniotic fluid volume.
Single measurement of maternal plasma C-reactive Protein by turbidimetric method
All the data was statistically analyzed and tabulated.
The results showed that:
‐ As regard demographic data there were no significant difference between women of groups A, B, and C regarding the gestational age at recruitment. The maternal age and parity were significantly lower in women of group C, when compared to women of groups A and B.
‐ There were no significant differences between women with PROM and women without PROM regarding vaginal pH ‐ The association between serum CRP level and PROM was statistically significant [AUC = 0.686, 95% CI (0.606 to 0.767),
p<0.001], indicating good predictability of serum CRP level for
PROM. The best cutoff value of serum CRP as predictor of PROM was ≥ 7.7 mg/dl.
‐ A significant negative correlation between serum CRP concentration and recruitment-to-delivery interval
‐ The association between serum CRP level and spontaneous onset of labor was statistically significant [AUC = 0.751, 95% CI (0.678 to 0.825), p<0.001], indicating good predictability of serum CRP level for spontaneous onset of labor.
‐ The best cutoff value of serum CRP as predictor of spontaneous onset of labor without PROM was ≥ 8.7 mg/dl.
In conclusion, we maintain that CRP levels in normal pregnancies at term are directly related to the onset of delivery, and that high serum CRP can predict the incidence of PROM at term, and also can predict shorter recruitment to delivery interval These findings may have implications regarding the management of pregnancies at term with high CRP values, such as closer fetal and maternal surveillance, more frequent monitoring, and investigation for other markers of inflammation, maternal education regarding fetal movement count and signs of ruptured membranes, and a non-stress test at pre-defined intervals.
At present, it might be recommended that CRP assays could be used in the follow-up and surveillance of selected population e.g. post date women who might be not reliable for routine follow up. In addition, there is evidence that the employment of CRP assays in the prediction of PROM diminishes the rate of perinatal complications.