الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
 |  | from | 86 |  |  |
| | | from | 86 | | |
Abstract
Premature rupture of membranes (PROM) refers to rupture
of the fetal membranes prior to the onset of labor and can
occur at any gestational age even at 42nd week. PROM has
previously been reported to occur in 8-19.53% of term
pregnancies and 2-25% of all pregnancies(10).
This is a prospective cohort study, carried out in Ashmoun
General Hospital in Menoufia. A total of 90 pregnant women
were included in the study, between 28-40 weeks of
gestation, divided into three groups:
I. group 1 :- (suspected group): consists of 30 cases of
pregnant women with suspected pre-labour rupture of
membranes based on history of vaginal discharge,
decreased amniotic fluid index and speculum
examination not conclusive.
II. group 2:- (confirmed group): consist of 30 pregnant
women with definitive pre- labor rupture of
membranes based on history of excessive vaginal
discharge, decreased amniotic fluid index and positive
speculum examination (pooling of fluid from vagina).
III. group 3:- (control group) consist of 30 healthy
pregnant women as control group with no history of
vaginal discharge and normal amniotic fluid index.
Summary
51
After giving an informed consent, All included Pregnant
women were subjected to:
o Full history taking including present history, past history of
medical disorders, surgical or gynecological operations,
obstetric history.
o General examination: Vital signs and symptoms: focusing
on blood pressure, temperature, respiratory rate and patients’
texture (to exclude chorioamnioinitis).
o Obstetric ultrasonography: ultrasound examination was done
for assessment of gestational age, exclusion of congenital
anomalies and estimation of amniotic fluid index.
o Local vaginal examination a sterile speculum (Cusco)
examination was performed to all participants. We see if
Amniotic fluid is pooling in posterior fornix, either
spontaneously or after Valsalva maneuver or not, leak of
fluid or not was inspected and results were registered.
Specimen collection in control and suspected cases by
injection of 5ml of sterile saline solution in the posterior
vaginal fornix using a sterile Cusco speculum and 3ml of the
injected saline was withdrawn with the same syringe and in
confirmed cases specimen was taken directly from the
leaking liquor. They were sent immediately to the laboratory
for assay of prolactin hormone by ELISA method.
Then all patients were followed up until delivery and
gestational age at delivery and time interval from sampling
to delivery were documented.
Summary
52
The study was conducted to assess the reliability of vaginal
fluid prolactin for the diagnosis of suspected cases of
prelabour rupture of membranes and to determine a
diagnostic cut-off value.
The current study showed that there was no statistically
significant difference between the three studied groups as
regards demographic data. There was statistically significant
difference regarding gestational age at delivery and interval
period.
The current study also showed that there was a high
statistically significant difference between the three studied
groups as regards liquor volume where group with definite
rupture of membranes had significantly higher percentage of
patients with below average liquor more than the other two
groups.
Also this study showed that group with definite rupture of
membranes had a high level of vaginal fluid prolactin as
compared to other groups with a high statistically difference
in between. The suspected group had a high level of vaginal
fluid prolactin as compared to control group with a high
statistically differences.
The current study showed that vaginal prolactin
concentration is a good predictor of suspected cases of
PROM. The cut off value of vaginal fluid prolactin level as
diagnostic test of suspected pre-labor rupture of membranes
is 0.84 ng/ml with sensitivity of 86.7% and specificity of
48.3%,
Summary
53
Our study showed significant difference between groups
regarding complications where there was increased rate of
complications in suspected and confirmed groups over than
the control group.
There was increased rate of cesarean section in confirmed
group over than the suspected group. Also there was
increased rate of cesarean section in suspected group over
than the control group.
from this study, it is recommended to have vaginal fluid
prolactin testing as diagnostic test for suspected cases of
rupture of membranes.
This test is to be done under strict aseptic conditions.