الفهرس 
The Fetal Membranes
Amniotic Fluid (Liquor)Only 14 pages are availabe for public view
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Abstract
This a prospective case controlled study was carried out on pregnant women attending the Obstetrics outpatient clinic and inpatient departments of Obstetrics and Gynecology at Ain Shams University Maternity Hospital between July 2010 and. June 2011.
Aim of the study was to evaluate the value of vaginal β-hCG for the diagnosis of premature rupture of membranes (PROMs).
This study included 90 pregnant women between 20-37 weeks of gestational age, divided into 3 groups:
group I: included 30 normal pregnant women between 20-37 weeks of gestational age with confirmed PROM.
group II: included 30 pregnant women between 20-37 weeks of gestational age came with suspected unconfirmed PROM.
group III: included 30 pregnant women between 20-37 weeks of gestational age attending the outpatient clinic for routine antenatal care. After follow up we further subdivided suspected group into 2 subgroups:
- Subgroup IIa: included 9 women who had the PROM confirmed later on.
- Subgroup IIb: included 21 women who had the PROM excluded.
- At admission all women underwent sterile Cusco speculum examination for confirmation of amniotic fluid pooling.
- After approval of local ethics committee and oral informed consents and after confirming absence of bloody vaginal discharge, vagina was cleaned by a sterile swab and the posterior fornix was irrigated with 5 ml sterile saline using 5ml syringe, with the same syringe, the vaginal fluid washing was aspirated from the posterior fornix, samples were immediately centrifuged at 1500 rpm for 5 minutes and the supernatant were stored at -20 C until assay. This was followed by ultrasonic assessment of amniotic fluid index, gestational age and placental localization.
- The parameters (maternal age, gestational age at sampling and at delivery, parity, delivery interval between sampling and delivery and amniotic fluid index) were also documented.This study showed no statistically significant differences between the three groups regarding age and parity.
The median vaginal fluid β-hCG concentration was slightly higher among women who had PROM [both group I and Subgroup IIa] when compared to women who had intact membranes [both group III and Subgroup IIb], this difference was not statistically significant.
This study showed that the mean gestational age at delivery was significantly lower among women who had PROM [both group I and Subgroup IIa] when compared to women who had intact membranes [both group III and Subgroup IIb].
In this study There was a significant negative correlation between vaginal fluid β-hCG concentration and gestational age at delivery from which we can conclude that high vaginal washing (-hCG) levels is much more associated with imminent delivery.
The study showed that the validity of the cutoff value of vaginal fluid (-hCG) concentration as diagnostic of PROM in all included women (≥ 38.5 mIU/ml) was relatively poor [sensitivity of 74.4%, specificity of 54.9%, PPV of 55.8%, NPV of 73.7%]. Also The validity of the cutoff value of vaginal fluid (-hCG) concentration as diagnostic of PROM in women with initially suspected PPROM (≥ 41 mIU/ml) was relatively poor [sensitivity of 55.6%, specificity of 66.7%, PPV of 41.7%, NPV of 77.8%].