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Vaginal fluid creatinine for the detection of pre-labor rupture of membranes

Feliza Vida D. Cortez, MD and Minnou S. Ocampo-Tapia, MD, FPOGS, FPSMFM, FPSUOG
Department of Obstetrics and Gynecology, San Juan de Dios Educational Foundation, Inc. Hospital

Introduction: Prelabor rupture of membranes (PROM) occurs in 8% of all pregnancies and is a major cause of preterm birth and perinatal morbidity and mortality. In 47% of cases, clinicians are uncertain regarding the diagnosis of PROM based on examination and history alone. A misdiagnosis often leads to unnecessary interventions that may be detrimental to mother and fetus. There is currently no ideal noninvasive diagnostic test that can diagnose prelabor rupture of membranes with certainty.
Objective: This study aims to determine if a quantitative assay of vaginal fluid creatinine can correctly diagnose prelabor rupture of membranes in women with singleton pregnancies at 28-42 weeks age of gestation
Methodology: A prospective study was performed at a tertiary hospital from December 2015 to August 2017 with a computed sample size of 180 patients (60 per group). If a history of watery discharge was confirmed by egress of fluid, then the patient was included in the Ruptured membranes group. If despite a history of watery discharge, no egress is noted, then she was included in the Unsure membrane status group. 60 women with normal pregnancies were randomly chosen for the control group. Vaginal fluid was collected for Litmus Paper, Fern, and Vaginal Fluid Creatinine Tests.
Results and Conclusion: Vaginal fluid creatinine at 1.00 mg/dL has higher sensitivity, specificity, positive and negative predictive values, and a higher positive likelihood ratio than the litmus paper or ferning tests. High accuracy values, with a low false negative rate of 0, and a large AUC make vaginal fluid creatinine an excellent test for the detection of PROM, in accordance with previous studies.