Volume 11, Issue 2 (4-2013)                   IJRM 2013, 11(2): 93-0 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Kariman N, Afrakhte M, Hedayati M, Fallahian M, Alavi Majd H. Diagnosis of premature rupture of membranes by assessment of urea and creatinine in vaginal washing fluid. IJRM 2013; 11 (2) :93-0
URL: http://ijrm.ir/article-1-387-en.html
Diagnosis of premature rupture of membranes by assessment of urea and creatinine in vaginal washing fluid
Nourossadat Kariman * 1, Maryam Afrakhte2 , Mehdi Hedayati3 , Masoumeh Fallahian4 , Hamid Alavi Majd5
1- Nursing and Midwifery Faculty, Ph.D. Candidate of Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran , n_kariman@sbmu.ac.ir
2- Faculty of Shahid Beheshti Medical School, Shohadaye Tajrish Hospital, Tehran, Iran
3- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4- Faculty of Shahid Beheshti Medical School, Ayatollah Taleghani Hospital, Tehran, Iran
5- Faculty of Shahid Beheshti, Para Medical School, Tehran, Iran
Abstract:   (2854 Views)
Background: Rupture of fetal membranes can occur at any gestational age. Premature rupture of membranes (PROM) means rupture of fetal membranes before the onset of labor.
Objective: The purpose of this study was to evaluate and compare the reliability of the vaginal washing fluid urea and creatinine for the diagnosis of PROM and to determine cut-off values.
Materials and Methods: A total of 179 pregnant women were recruited. All patients underwent different examinations. These included nitrazine paper test, fern test, amniotic fluid pooling, vaginal washing fluid urea and creatinine sampling. The one group consisted of 126 pregnant women between 14 and 41 weeks of gestation with the complaint of vaginal fluid leakage. Patients who had positive pooling, nitrazine paper test and fern test were considered as confirmed PROM group (group 1). On the other side, patients with pooling (-) and/or nitrazine paper test (-) and/or fern test (-) were taken as suspected unconfirmed PROM cases (group 2). The control group consisted of 53 pregnant women between 14 and 41 weeks of gestation without any complaint or complication. Weconducted one-way ANOVA test on the urea and creatinine measures and post-hoc comparison test. Cut-off value was determined by receiver operating characteristic (ROC) curve.
Results: Vaginal fluid concentrations of urea and creatinine were significantly different between the three groups (p<0.001). The sensitivity, specificity, positive and negative predictive values and accuracy were all 100% in detecting premature rupture of membranes by evaluation of vaginal fluid creatinine concentration with a cut-off value of 0.45 mg/dl, respectively.
Conclusion: This study demonstrates that of two markers investigated creatinine has the higher diagnostic power.
Keywords: Premature rupture of membranes, Creatinine, Urea, Vaginal washing fluid.
Full-Text [PDF 470 kb]   (668 Downloads) |   |   Full-Text (HTML)  (396 Views)  
Type of Study: Original Article |
References
1. Cunningham F, Gant F, Leveno J. Williams Obstetrics. 23nd Ed. New York, McGraw-Hill; 2010.
2. Rupture of Membranes 1998 Washington, DC: American College of Obstetricians and Gynecologists. (ACOG Practice Bulletin No. 1).
3. Caughey AB, Robinson JN, Norwitz ER. Contemporary diagnosis and management of preterm premature rupture of membranes. Rev Obstet Gynecol 2008; 1: 11-22.
4. ParkJ S, Lee Si E, Norwitz ER. Non-invasive Testing for Rupture of the Fetal Membranes. US Obstet Gynecol 2007; 13-16.
5. Liu J, Feng ZC, Wu J. The Incidence Rate of Premature Rupture of Membranes and its Influence on Fetal–neonatal Health: A Report from Mainland China. J Trop Pediatr 2010; 56: 36-42. [DOI:10.1093/tropej/fmp051]
6. ACOG Committee on Practice Bulletins-Obstetrics, authors. Clinical Management guidelines for obstetrician-gynecologists. (ACOG Practice Bulletin No. 80: premature rupture of membranes). Obstet Gynecol 2007; 109: 1007-1019.
7. Wiberg-Itzel E, Cnattingius S, Nordström L. Lactate determination in vaginal Fluids: a new method in the diagnosis of prelabour rupture of membranes. BJOG 2005; 112: 754-758. [DOI:10.1111/j.1471-0528.2004.00521.x]
8. Nili F, Shams Ansari AA. Neonatal complications of premature rupture of Membrane. Acta Medica Iranica 2003; 41: 175-179.
9. Tejada BM, Boulvain M, Dumps P, Bischof P, Meisser A, Iriona O. Can us improve the diagnosis of rupture of membranes? The value of insulin-like Growth factor binding protein-1. Br J Gynecol 2006; 113: 1096-1099. [DOI:10.1111/j.1471-0528.2006.01028.x]
10. Cooper L, Vermillion T, Soper E. Qualitative human chorionic gonadotropin testing of cervicovaginal washing for the detection of preterm premature rupture membrane. Am J Obstet Gynecol 2004; 191: 593-596. [DOI:10.1016/j.ajog.2004.06.076]
11. Wu J, Liu J, Feng ZC, Huang JJ, Wu G. Influence of premature rupture of Membranes on neonatal health. Zhonghua Er Ke Za Zhi 2009; 47: 452-456.
12. Mercer BM. Management of premature rupture of the membranes before 26weeks' gestation. Obstet Gynecol Clin North Am 1992; 19: 339-351.
13. Kim Y, park Y, kwon H. Vaginal fluid ß-Human chorionic gonadotropin level in the diagnosis of premature rupture of membranes. Acta Obstet Gynecol Scand 2005; 84: 802-805.
14. Esim E, Turan C, Unal O, Dansuk R, Cengizglu B. Diagnosis of premature rupture of membranes by identification of ß-HCG in vaginal washing fluid. Eur J Obstet Gynecol Reprod Biol 2003; 107: 37-40. [DOI:10.1016/S0301-2115(02)00277-4]
15. Hannah ME, Hodnett ED, Willan A, Foster GA, Di Cecco R, Helewa M. The Term PROM Study Group, authors. Prelabor rupture of the membranes at term: expectant management at home or in hospital? Obstet Gynecol 2000; 96: 533-538.
16. Healy AJ, Veille JC, Sciscione A, McNutt LA, Dexter SC. The timing of elective Delivery in preterm premature rupture of the membranes: a survey of members of the Society of Maternal-Fetal Medicine. Am J Obstet Gynecol 2004; 190:1479-1481. [DOI:10.1016/j.ajog.2004.02.036]
17. Sucak A, Moroy P, Cakmakl P. Insulin-like growth factor binding protein-1: a rapid detection of amniotic fluid leakage after amniocentesis. Turk J Med 2005; 35:157-161.
18. Kariman N, HedayatiM, Taheri Z, Fallahian M, Salehpoor S, Alavi Majd SH. Comparison of ELISA and Three Rapid HCG Dipsticks in Diagnosis of Premature Rupture of Membranes. Iran Red Crescent Med J 2011; 13: 415-419.
19. Buyukbayrak EE, Turan C, Unal O, Dansuk R, Cengizoğlu B. Diagnostic Power of the vaginal washing-fluid prolactin assay as an alternative method for the diagnosis of premature rupture of membranes. J Matern Fetal Neonatal 2004; 15: 120-125. [DOI:10.1080/14767050410001659842]
20. Koninckx PR, Trappeniers H, van Assche FA. Prolactin concentration in vaginal fluid: a new method for diagnosing ruptured membranes. Br J Obstet Gynaecol 1981; 88: 607-610. [DOI:10.1111/j.1471-0528.1981.tb01216.x]
21. Shahin M, Raslan H. Comparative study of three amniotic fluid markers in premature rupture of membranes: prolactin, beta subunit of human chorionic gonadotropin, and alpha-fetoprotein. Gynecol Obstet Invest 2006; 63: 195-199. [DOI:10.1159/000097844]
22. Kishida T, Yamada H, Negishi H, Sagawa T, Makinoda S, Fujimoto S. Diagnosis of premature rupture of the membranes in preterm patients, using an improved AFP kit: comparison with ROM-check and/or Nitrazine test. Eur J Obstet Gynecol Reprod Biol 1996; 69: 77-82. [DOI:10.1016/0301-2115(95)02519-7]
23. Gaucherand P, Guibaud S, Awada A, Rudigoz RC. Comparative study of three vaginal markers of the premature rupture of membranes. Insulin like growth factor binding protein, 1 diamineoxidase, and pH. Acta Obstet Gynecol Scand 1997; 76: 536-540. [DOI:10.3109/00016349709024579]
24. Jeurgens-Borst AJ, Bekkers RL, Sporken JM, vander Berg PP. Use of insulin like growth factor binding protein-1 in the diagnosis of ruptured fetal membranes. Eur J Obstet Gynecol Reprod Biol 2002; 102: 11-14. [DOI:10.1016/S0301-2115(01)00560-7]
25. Kubota T, Takeuchi H. Evaluation of insulin-like growth factor binding protein-1 as a diagnostic tool for rupture of the membranes. J Obstet Gynaecol Res 1998; 24: 411-417. [DOI:10.1111/j.1447-0756.1998.tb00116.x]
26. Lockwood CJ, Wein R, Chien D, Ghidini A, Alvarez M, Berkowitz RL. Fetal membrane rupture is associated with the presence of insulin-like growth factor-binding protein-1 in vaginal secretions. Am J Obstet Gynecol 1994; 171: 146-150. [DOI:10.1016/0002-9378(94)90461-8]
27. Lockwood CJ, Senyei AE, Dische MR, Casal D. Shah KD. Thung SN, et al. Fetal fibronectin in cervical andvaginal secretions defines a patient population at high risk for preterm delivery. N Engl J Med 1991; 325: 669-674.
28. Wiberg-Itzel E, Pettersson H, Cnattingius S, Nordstrom L. Association between lactate in vaginal fluid and time to spontaneous onset of labour for women with suspected prelabour rupture of the membranes. BJOG 2006; 113: 1426-1430. [DOI:10.1111/j.1471-0528.2006.01088.x]
29. Li HY, Chang TS. Vaginal fluid creatinine, human chorionic gonadotropin and Alpha-fetoprotein levels for detecting premature rupture of membranes. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63: 686-690.
30. El-Messidi Cameron a. Diagnosis of premature rupture of membranes: inspiration from the past and insights for the Future. J Obstet Gynaecol Can 2010; 32: 561-569. [DOI:10.1016/S1701-2163(16)34525-X]
31. Kafali H, Oksuzler C. Vaginal fluid urea and creatinine in diagnosis of premature rupture of membranes. Arch Gynecol Obstet 2007; 275: 157-160. [DOI:10.1007/s00404-006-0240-1]
32. Nicolaou, Kyriacos C, Tamsyn M. Molecules That Changed the World. Wiley-VCH; 2008.
33. Delanghe J, De Slypere JP, De Buyzere M, Robbrecht J, Wieme R, Vermeulen A. Normal reference values for creatine, creatinine, and carnitine are lower in vegetarians. Clin Chem 1989; 35: 1802-1803.
34. Mercer BM, Goldenberg RL, Meis PJ, Moawad AH, Shellhaas C, Das A, et al. The NICHD Maternal-Fetal Medicine Units Network, authors. The Preterm Prediction Study: prediction of preterm premature rupture of membranes through clinical findings and ancillary testing. Am J Obstet Gynecol 2000; 183: 738-745. [DOI:10.1067/mob.2000.106766]
35. Garite TJ. Management of premature rupture of membranes. Clin Perinatol 2001; 28: 837-847. [DOI:10.1016/S0095-5108(03)00081-2]
36. Gurbuz A, Karateke A, Kabaca C. Vaginal fluid creatinine in premature rupture of membranes. Int J Gynecol Obstet 2004; 86: 270-271. [DOI:10.1016/j.ijgo.2003.09.012]
37. Kariamn N, Toloui H, Azarhoush R, Alavi Majd H, Jan-nesari Sh. Diagnostic values of urea and creatinin values of cervicovaginal discharges in determining of premature rupture of membranes. Pajouhesh Dar Pezeshki 2010; 33: 222-227.
38. Mohamed A, Mostafa W. The Value of Measurement of Vaginal Fluid Urea, Creatinine & Beta HCG in the Diagnosis of Premature Rupture of Membranes. KAJOG 2011; 2: 41-47.
39. Hennemann CE, Andersson GV, Tejavey A. Fetal maturation and amniotic fluid. Am J Obstet Gynecol 1970; 108: 302-307. [DOI:10.1016/0002-9378(70)90313-3]
40. Oliveira FR, Barros EG, Magalhães JA. Biochemical profile of amniotic fluid for the assessment of fetal and renal development. Braz J Med Biol Res 2000; 35: 215-222. [DOI:10.1590/S0100-879X2002000200010]
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Designed & Developed by : Yektaweb