الفهرس 
The Fetal MembranesOnly 14 pages are availabe for public view
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Abstract
Premature rupture of membranes (PROM) is defined as
rupture of the fetal membranes before the onset of labor
irrespective of gestational age. It occurs in approximately 8% of
women with pregnancy at term. Epidemiological data on the
time interval from PROM at term to spontaneous labour
demonstrates that over 60% of these women begin labour
spontaneously within 24 hours and over 95% begin labour
spontaneously within 72 hours.
The false diagnosis of membranes rupture can lead to
inappropriate intervention such as hospitalization or induction
of labor. Therefore, it is highly desirable to establish a definite
diagnosis of rupture of membranes in uncertain cases without
delay, however, traditional diagnostic method and tests has
some limitation and cannot be applied to all patients with 100%
accuracy.
One the most recent amniotic fluid markers in vaginal
environment is measuring vaginal fluid creatinine for
diagnosis of PROM because fetal urine is the most important
source of amniotic fluid in second half of pregnancy.This study was conducted to evaluate the reliability of
vaginal fluid creatinine for the diagnosis of premature rupture
of membranes.
The study was carried out at Ain Shams University
Maternity-Hospital, A total of 100 pregnant women were
included in the study, between 28-40 weeks of gestation,
divided into two groups:
group I was including 50 pregnant women between 28-
40 weeks of gestation with history of vaginal fluid leakage, that
was positive for amniotic fluid pooling by using sterile Cusco
speculum examination with or without Valsalva maneuver and
was considered as a (confirmed PROM group).
group II was including 50 normal pregnant women
between 28-40 weeks of gestation and was considered as
(control group).
On admission, all women were underwent sterile Cusco
speculum examination and amniotic fluid pooling with or
without Valsalva maneuver was noted.
After giving an informed consent, 5ml of sterile saline
irrigating the posterior vaginal fornix using a sterile Cusco
speculum and 3ml of the irrigated saline was aspirated with the same syringe and the sample was sent immediately to the
laboratory for assay of creatinine.
Then all patients were followed up until delivery and
gestational age at delivery time was documented. The
parameters (age, parity, gestational age, vaginal fluid
creatinine) were also documented.
In this study The mean creatinine level in the amniotic
fluid in group I and group II were 1.71±0.73 mg/dl (range
0.33–3.43), 0.31±0.10 mg/dl (range 0.09–0.50) respectively,
where the difference was statistically highly significant (P <
0.001).
In this study Vaginal creatinine had significant high
diagnostic performance in predicting ROM, vaginal creatinine
≥0.60 mg/dL had perfect specificity& PPV and high other
characteristics in prediction of ROM.