Can Vaginal Washing Fluid Urea, Creatinine and Qualitative <i>β</i>-hCG Diagnose Suspected Premature Rupture of Membranes?

Abstract

Several markers have been studied to diagnose PROM but there is still limitation with a gold standard test for the diagnosis [1]. Objective: To evaluate and compare the accuracy of urea, creatinine and hCG in vaginal fluid washing for diagnosis of PROM and to determine cut off levels. Type of the study: Prospective study performed on pregnant women in their third trimester who are coming to Kasr El Ainy maternity outpatient clinic with history of fluid leakage. Patients and methods: 150 patients between 26 -40 weeks were included in the study. Group I included 50 patients with clinically confirmed ROM, group II included 50 with unconfirmed ROM and 50 controls with no complaints (group III). All patients were subjected to speculum examination for amniotic fluid pooling, nitrazine paper test, vaginal fluid washing for measurement of creatinine, urea and β-hCG, and ultrasound examination. The results were compared as regards the 3 study groups.Results: There was no statistically significant difference among the 3 study groups as regards age, parity BMI, nor gestational age. There was a statistically significant difference in creatinine level among confirmed, suspected and control groups. Urea levels showed also a statistically significant difference among the three groups. There was a positive correlation between vaginal creatinine and urea and gestational age in the 3 groups (r = 0.43, and 0.51 respectively). There was a statistically significant difference between vaginal fluid wash urea and creatinine levels and β-hCG as sensitivity, specificity, positive and negative predictive values and accuracy for urea and creatinine were all 100% and for qualitative β-hCG 83%, 100%, 100%, 85.6%, and 91% respectively. Conclusion

Qualitative Determination of Human Chorionic Gonadotropin in Vaginal Washings for the Early Diagnosis of Premature Rupture of Fetal Membranes

“…16 Researchers had who used a cut-off point 25 mUI/mL also achieved sensibility and specificity rates higher than than 90%, which suggest this can be an appropriate value. 1,12,17,18 During pregnancy, the cervical glands release hCG in the vaginal fluid, but the concentration remains lower than 10 mUI/mL after the 20th gestational week, 1 which supports the possibility of performing the β-hCG qualitative test with a cut-off point of 10 mUI/mL. However, in this study, the β-hCG-10 test provided a low accuracy (58.6%).…”

“…Its prevalence ranges from [8][9][10][11][12][13][14][15][16][17][18][19].53% of term pregnancies, and from 2-25% of all pregnancies. Traditionally, the diagnosis of PROM involves vaginal discharge history of amniotic fluid verified at speculum examination with the ferning test in the microscopic exam and the nitrazine test of the vaginal discharge.…”

The Study of Vaginal Fluid Urea, Creatinine, B-HCG and Placental Alpha-1 Microglobulin in Diagnosis of Premature Rupture of Membranes

“…In a study performed by Mangano et al 2000, it was performed on 52 women (20 women with intact membranes, 21 women with definitive ROM and 11 women with suspicious ROM), the researchers concluded that vaginal washing fluid B-HCG is a suitable, cheap and non-invasive method for the diagnosis of PPROM [25] [26]. In the other hand another study performed by Shahin and Raslan 2006 which evaluated vaginal fluid concentrations of three markers (AFP, prolactin and B-HCG), they were significantly higher in the PROM group than in the control group (p < 0.001).…”

Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings

“…Urea and creatinine have shown promise in multiple studies for highly sensitive and specific detection of PROM with close to 100% sensitivity and 100% specificity, although the optimal cutoff values have varied between studies. 203,216,217,223–229 In these studies, the urea and creatinine are measured from vaginal washes, where 3 to 5 mL of saline is injected into the posterior vaginal fornix and subsequently aspirated with the same syringe. 226 Urea is detected with a spectrometer and creatinine with an enzymatic based assay, but a ladder-based LFA for creatinine was developed in the laboratory which runs within 20 minutes and has 90% agreement with the traditional Jaffe method.…”