Ladfors L, Mattsson L A, Eriksson M, Fall O
Department of Obstetrics and Gynecology East Hospital, Göteborg, Sweden.
Acta Obstet Gynecol Scand. 1997 Sep;76(8):739-42. doi: 10.3109/00016349709024339.
To determine the false negative rate of a sterile speculum examination for the diagnosis of rupture of the membranes in women not in labor and without visible amniotic fluid at speculum examination. Furthermore, possible risks to the mother and the baby after suspected rupture of the membranes were analyzed.
In women not in labor with suspected rupture of the membranes between gestational weeks 34 and 42, a sterile speculum examination was performed. If no amniotic fluid was visible, a test for Diamine oxidase was carried out. The results of tests were not known to the obstetricians or the women. The women were allowed to return home with no further controls if no amniotic fluid was visible at the speculum examination. Neonatal and obstetric outcome was recorded prospectively.
Of 27,502 deliveries, 2,099 women not in labor attended the delivery ward for suspected rupture of the membranes after week 34. Amniotic fluid was visualized in 1,580 women. In 519 women in whom no amniotic fluid was seen at the speculum examination, the Diamine oxidase test was negative in 456 and positive in 63. Antibiotics were given to eleven children (2.4%) in the group with a negative Diamine oxidase and to one infant (1.6%) in the positive Diamine oxidase group (p>0.05). No differences in obstetric outcome were recorded.
The false negative rate of a speculum examination for the diagnosis of rupture of the membranes in women without amniotic fluid visible at a speculum examination was 12% when Diamine oxidase was used as the standard for the diagnosis of rupture of the membranes. This study did not show any disadvantages for mothers and infants if the women were sent home after a false negative speculum examination. The value of biochemical methods in the management of women not in labor with rupture of the membranes after thirty-four weeks of gestation could be questioned.
确定无菌窥器检查对于未临产且窥器检查时未见明显羊水的女性胎膜破裂诊断的假阴性率。此外，分析疑似胎膜破裂后对母亲和婴儿可能存在的风险。
对妊娠34至42周疑似胎膜破裂的未临产女性进行无菌窥器检查。若未见羊水，则进行二胺氧化酶检测。产科医生和这些女性均不知检测结果。若窥器检查未见羊水，这些女性可回家，无需进一步检查。前瞻性记录新生儿和产科结局。
在27502例分娩中，2099例未临产女性在34周后因疑似胎膜破裂入住分娩病房。1580例女性可见羊水。在519例窥器检查未见羊水的女性中，二胺氧化酶检测456例为阴性，63例为阳性。二胺氧化酶检测阴性组有11名儿童（2.4%）使用了抗生素，二胺氧化酶检测阳性组有1名婴儿（1.6%）使用了抗生素（p>0.05）。产科结局未见差异。
以二胺氧化酶作为胎膜破裂的诊断标准时，窥器检查对于窥器检查未见羊水的女性胎膜破裂诊断的假阴性率为12%。本研究未显示假阴性窥器检查后让女性回家对母亲和婴儿有任何不利影响。妊娠34周后胎膜破裂的未临产女性管理中生化方法的价值可能值得质疑。
