Can Vaginal Washing Fluid Urea, Creatinine and Qualitative β-hCG Diagnose Suspected Premature Rupture of Membranes?
Affiliation(s)
1 Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt. 2 Cairo University, Cairo, Egypt.
1 Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt. 2 Cairo University, Cairo, Egypt.
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: Urea and creatinine in vaginal washings can be accurately used in diagnosing suspected PROM and are more accurate than β-HCG.
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: Urea and creatinine in vaginal washings can be accurately used in diagnosing suspected PROM and are more accurate than β-HCG.
Cite this paper
Osman, O. and Elghazaly, M. (2014) Can Vaginal Washing Fluid Urea, Creatinine and Qualitative β-hCG Diagnose Suspected Premature Rupture of Membranes?. Open Journal of Obstetrics and Gynecology, 4, 967-972. doi: 10.4236/ojog.2014.415136.
Osman, O. and Elghazaly, M. (2014) Can Vaginal Washing Fluid Urea, Creatinine and Qualitative β-hCG Diagnose Suspected Premature Rupture of Membranes?. Open Journal of Obstetrics and Gynecology, 4, 967-972. doi: 10.4236/ojog.2014.415136.
References
[1] Caughy, A.B., Robinson, J.N. and Norwitz, E.R. (2008) Contemporary Diagnosis and Management of Preterm Premature Rupture of Membranes. Reviews in Obstetrics & Gynecology, 1, 11-22. [2] ACOG Committee on Practice Bulletins-Obstetrics (2007) ACOG Practice Bulletin No. 80: Premature Rupture of Membranes. Premature Rupture of Membranes. Clinical Management Guidelines for Obstetricians Gynecologists. Obstetrics & Gynecology, 109, 1007-1020.
http://dx.doi.org/10.1097/01.AOG.0000263888.69178.1f [3] Esim, E., Turan, C., Unal, O., et al. (2003) Diagnosis of Premature Rupture of Membranes by Identification of β-HCG in Vaginal Washing Fluid. European Journal of Obstetrics and Gynecology and Reproductive Biology, 107, 37-40. http://dx.doi.org/10.1016/S0301-2115(02)00277-4 [4] Kim, Y.H., Park, Y.W., Kwon, H.S., et al. (2005) Vaginal Fluid ?-Human Chorionic Gonadotropin Level in the Diagnosis of Premature Rupture of Membranes. Acta Obstetricia et Gynecologica Scandinavica, 84, 802-805. [5] Sucak, A., Moroy, P. and Cakmakl, P. (2005) Insulin-Like Growth Factor Binding Protein-1: A Rapid Detection of Amniotic Fluid Leakage after Amniocentesis. Turkish Journal of Medical Sciences, 35, 157-161. [6] Gurbuz, A., Karateke, A. and Kabaca, C. (2004) Vaginal Fluid Creatinine in Premature Rupture of Membranes. International Journal of Gynecology & Obstetrics, 86, 370-371. [7] Kafali, H. and Okuzler, C. (2007) Vaginal Fluid Urea and Creatinine in Diagnosis of Premature Rupture of Membranes. Archives of Gynecology and Obstetrics, 275, 157-160.
http://dx.doi.org/10.1007/s00404-006-0240-1 [8] Lee, S.E., Park, J.S., Norwitz, E.R., et al. (2007) Measurement of Placental Alpha-Microglobulin-1 in Cervicovaginal Discharge to Diagnose Rupture of Membranes. Obstetrics & Gynecology, 109, 634-640. http://dx.doi.org/10.1097/01.AOG.0000252706.46734.0a [9] Bernstein, P.S., Stern, R., Lin, N., et al. (1998) ?-Human Chorionic Gonadotropin in Cervicovaginal Secretions as Predictor of Delivery. American Journal of Obstetrics & Gynecology, 79, 870-873. http://dx.doi.org/10.1016/S0002-9378(98)70180-2 [10] Li, H.Y. and Chang, T.S. (2000) Vaginal Fluid Creatinine, Human Chorionic Gonadotropins and Alpha-Fetoprotein Levels for Detecting Premature Rupture of Membranes. Zhonghua Yi Xue Za Zhi (Taipei), 63, 686-690. [11] Kariman, N., Toloui, H., Azarhoush, R., Alavi Majd, H. and Jan-nesari, S.H. (2010) Diagnostic Values of Urea and Creatinine Values of Cervicovaginal Discharges in Determining of Premature Rupture of Membranes. Pajouhesh Dar Pezeshki, 33, 222-227. [12] Kariman, N., Afrakhte, M., Hedayati, M., Fallahian, M. and Majd, H. (2013) Diagnosis of Premature Rupture of Membranes by Assessment of Urea and Creatinine in Vaginal Washing Fluid. Iran Journal of Reproductive Medicine, 11, 93-100. [13] Olivera, F.R., Barros, E.G. and Magalhaes, J.A. (2000) Biochemical Profile of Amniotic Fluid for the Assessment of Fetal Renal Development. Brazilian Journal of Medical and Biological Research, 35, 215-222. http://dx.doi.org/10.1590/S0100-879X2002000200010 [14] Movahed, F., Elmizadeh, K., Javadi, A. and Choopani, A. (2012) The Value of Qualitative Detection of Human Chorionic Gonadotropin in Vaginal Washing Fluid for Diagnosis of Preterm Premature Rupture of Membranes. Pakistan Journal of Medical Sciences, 28, 900-903. [15] Cooper, A.L., Vermillion, S.T. and Soper, D.E. (2004) Qualitative Human Chorionic Gonadotropin Testing of Cervicovaginal Washings for the Detection of Preterm Premature Rupture of Membranes. American Journal of Obstetrics & Gynecology, 191, 593-597.
http://dx.doi.org/10.1016/j.ajog.2004.06.076 [16] Al-Bayati, M., Al-Kazaly, E. and Athrab, S. (2011) Vaginal Washing Fluid β-HCG Levels for Detecting Premature Rupture of Membranes. The Iraqi Postgraduate Medical Journal, 10, 61-66.
[1] Caughy, A.B., Robinson, J.N. and Norwitz, E.R. (2008) Contemporary Diagnosis and Management of Preterm Premature Rupture of Membranes. Reviews in Obstetrics & Gynecology, 1, 11-22. [2] ACOG Committee on Practice Bulletins-Obstetrics (2007) ACOG Practice Bulletin No. 80: Premature Rupture of Membranes. Premature Rupture of Membranes. Clinical Management Guidelines for Obstetricians Gynecologists. Obstetrics & Gynecology, 109, 1007-1020.
http://dx.doi.org/10.1097/01.AOG.0000263888.69178.1f [3] Esim, E., Turan, C., Unal, O., et al. (2003) Diagnosis of Premature Rupture of Membranes by Identification of β-HCG in Vaginal Washing Fluid. European Journal of Obstetrics and Gynecology and Reproductive Biology, 107, 37-40. http://dx.doi.org/10.1016/S0301-2115(02)00277-4 [4] Kim, Y.H., Park, Y.W., Kwon, H.S., et al. (2005) Vaginal Fluid ?-Human Chorionic Gonadotropin Level in the Diagnosis of Premature Rupture of Membranes. Acta Obstetricia et Gynecologica Scandinavica, 84, 802-805. [5] Sucak, A., Moroy, P. and Cakmakl, P. (2005) Insulin-Like Growth Factor Binding Protein-1: A Rapid Detection of Amniotic Fluid Leakage after Amniocentesis. Turkish Journal of Medical Sciences, 35, 157-161. [6] Gurbuz, A., Karateke, A. and Kabaca, C. (2004) Vaginal Fluid Creatinine in Premature Rupture of Membranes. International Journal of Gynecology & Obstetrics, 86, 370-371. [7] Kafali, H. and Okuzler, C. (2007) Vaginal Fluid Urea and Creatinine in Diagnosis of Premature Rupture of Membranes. Archives of Gynecology and Obstetrics, 275, 157-160.
http://dx.doi.org/10.1007/s00404-006-0240-1 [8] Lee, S.E., Park, J.S., Norwitz, E.R., et al. (2007) Measurement of Placental Alpha-Microglobulin-1 in Cervicovaginal Discharge to Diagnose Rupture of Membranes. Obstetrics & Gynecology, 109, 634-640. http://dx.doi.org/10.1097/01.AOG.0000252706.46734.0a [9] Bernstein, P.S., Stern, R., Lin, N., et al. (1998) ?-Human Chorionic Gonadotropin in Cervicovaginal Secretions as Predictor of Delivery. American Journal of Obstetrics & Gynecology, 79, 870-873. http://dx.doi.org/10.1016/S0002-9378(98)70180-2 [10] Li, H.Y. and Chang, T.S. (2000) Vaginal Fluid Creatinine, Human Chorionic Gonadotropins and Alpha-Fetoprotein Levels for Detecting Premature Rupture of Membranes. Zhonghua Yi Xue Za Zhi (Taipei), 63, 686-690. [11] Kariman, N., Toloui, H., Azarhoush, R., Alavi Majd, H. and Jan-nesari, S.H. (2010) Diagnostic Values of Urea and Creatinine Values of Cervicovaginal Discharges in Determining of Premature Rupture of Membranes. Pajouhesh Dar Pezeshki, 33, 222-227. [12] Kariman, N., Afrakhte, M., Hedayati, M., Fallahian, M. and Majd, H. (2013) Diagnosis of Premature Rupture of Membranes by Assessment of Urea and Creatinine in Vaginal Washing Fluid. Iran Journal of Reproductive Medicine, 11, 93-100. [13] Olivera, F.R., Barros, E.G. and Magalhaes, J.A. (2000) Biochemical Profile of Amniotic Fluid for the Assessment of Fetal Renal Development. Brazilian Journal of Medical and Biological Research, 35, 215-222. http://dx.doi.org/10.1590/S0100-879X2002000200010 [14] Movahed, F., Elmizadeh, K., Javadi, A. and Choopani, A. (2012) The Value of Qualitative Detection of Human Chorionic Gonadotropin in Vaginal Washing Fluid for Diagnosis of Preterm Premature Rupture of Membranes. Pakistan Journal of Medical Sciences, 28, 900-903. [15] Cooper, A.L., Vermillion, S.T. and Soper, D.E. (2004) Qualitative Human Chorionic Gonadotropin Testing of Cervicovaginal Washings for the Detection of Preterm Premature Rupture of Membranes. American Journal of Obstetrics & Gynecology, 191, 593-597.
http://dx.doi.org/10.1016/j.ajog.2004.06.076 [16] Al-Bayati, M., Al-Kazaly, E. and Athrab, S. (2011) Vaginal Washing Fluid β-HCG Levels for Detecting Premature Rupture of Membranes. The Iraqi Postgraduate Medical Journal, 10, 61-66.