Kariman Nourossadat, Afrakhte Maryam, Hedayati Mehdi, Fallahian Masoumeh, Alavi Majd Hamid
Nursing and Midwifery Faculty, Ph.D. Candidate of Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Faculty of Shahid Beheshti Medical School, Shohadaye Tajrish Hospital, Tehran, Iran.
Iran J Reprod Med. 2013 Feb;11(2):93-100.
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.
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.
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.
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.
This study demonstrates that of two markers investigated creatinine has the higher diagnostic power.
胎膜破裂可发生于任何孕周。胎膜早破（PROM）是指在临产前胎膜破裂。
本研究旨在评估和比较阴道冲洗液中尿素和肌酐对胎膜早破诊断的可靠性，并确定临界值。
共纳入179例孕妇。所有患者均接受了不同检查，包括石蕊试纸试验、羊齿状结晶试验、羊水积聚试验、阴道冲洗液尿素和肌酐采样。一组由126例妊娠14至41周、主诉有阴道液体渗漏的孕妇组成。羊水积聚试验、石蕊试纸试验和羊齿状结晶试验呈阳性的患者被视为确诊的胎膜早破组（第1组）。另一方面，羊水积聚试验（-）和/或石蕊试纸试验（-）和/或羊齿状结晶试验（-）的患者被视为疑似未确诊的胎膜早破病例（第2组）。对照组由53例妊娠14至41周、无任何主诉或并发症的孕妇组成。我们对尿素和肌酐测量值进行了单因素方差分析和事后比较检验。通过受试者操作特征（ROC）曲线确定临界值。
三组之间阴道液中尿素和肌酐浓度存在显著差异（p<0.001）。以0.45mg/dl为临界值，通过评估阴道液肌酐浓度诊断胎膜早破时，敏感性、特异性、阳性和阴性预测值及准确性均为100%。
本研究表明，在所研究的两种标志物中，肌酐具有更高的诊断效能。
