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Article Type

Original Study

Abstract

Objective The aim of this article was to evaluate the reliability of vaginal fluid urea and creatinine levels for diagnosis of premature rupture of membranes (PROMs) and its relation to gestational age. Background PROMs occurs in 8–10% of all pregnant women at term. The risk of maternal and fetal infection increases as the time between the rupture of membrane and the onset of labor increases. It is therefore important to achieve accurate diagnosis by identifying the presence of specific amniotic fluid markers in vaginal environment. Vaginal fluid urea and creatinine levels may be helpful in the diagnosis of PROM because fetal urine is the most important source of amniotic fluid in the second half of pregnancy. Patients and methods A prospective case–control study was conducted. The study was performed on pregnant women in the third trimester between 28 and 42 weeks of gestation with a history of possible leakage of amniotic fluid, attending Menoufia University Hospitals and Quesina General Hospital during the period from January 2013 to December 2015. A total of 90 cases were subdivided into three groups: group I (30 cases) – confirmed PROM, group II (30 cases) – suspected PROM, and group III (30 cases) – control group. All patients underwent speculum examination, nitrazine paper test, and ultrasonography. Results The creatinine levels were 0.64 ± 0.018, 0.28 ± 0.013, and 0.14 ± 0.006 mg/dl in confirmed cases, suspected cases, and controls, respectively. The urea levels were 29.67 ± 3.75, 5.51 ± 0.87, and 1.63 ± 0.50 mg/dl in confirmed cases, suspected cases, and controls, respectively. There was a highly significant difference regarding creatinine level and urea level between the studied groups (P < 0.001). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for creatinine level as a screening test for PROM were 98, 45, 40, 100, and 60%, respectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for urea level as a screening test for PROM were 100, 100, 55, 100, and 70, respectively, with a cut-off value of 0.52 mg/dl for creatinine level and 11.8 mg/dl for urea level. Conclusion Urea and creatinine level assays are reliable methods and have a higher sensitivity and specificity to establish accurate diagnosis.

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