Practicability of Vaginal Fluid Alfa-fetoprotein and Creatinin Levels for Detecting Premature Rupture of Membranes

Objective: Premature rupture of membranes (PROM) is one the most common problem occurring during pregnancy. Its early prediction and diagnosis has a vital importance in reduction of complications and appropriate treatment. This study was designed to evaluate the practicability and sensitivity of creatinin and alfa-fetoprotein (AFP) in vaginal washing on PROM diagnosis in pregnant women in Imam Hossein Hospital.
 
Material & Methods:In this prospective diagnostic clinical trial study 112 pregnant women were included. The patients were 18-37 years old. 56 women with 22-36 weeks of gestational age and obvious leakage, positive Fern test, and definite PROM diagnosis were included in the case group (G I). Control group (GII) consisted of 56 normal pregnant women with 31-41 weeks of pregnancy, without any signs and symptoms of fluid leakage. AFP and creatinin values in vaginal fluid of both groups were measured. Sensitivity, specificity, positive and negative predictive values of both parameters were calculated, and comparison was made between both groups and also with Fern test. Sampling was done by washing the posterior vaginal fornix with 5 ml sterile water and aspiration of 3 ml to send to the laboratory.
 
Results: Mean gestational age was 33.07±5.6 weeks in PROM group and 36.46±5.5 in the control group. AFP was 24.76±23.0 IU/ml in PROM versus 3.0±3.8 IU/ml in GII (P value<0.001). Creatinin was 0.52±1.1 mg/dl in Group I vs 0.32±0.4 in the other group, respectively. There was no significant difference in Cr in both groups. Sensitivity, specificity of AFP were 100%, 100% compared with 14% and 96.2% in creatinin, respectively. Positive and negative predictive values were 98.2%, 100% in AFP and 80% and 51.51% in Cr, respectively. Sensitivity, specificity, PPV and NPV for Fern test was 100%, 88.6%, 90.2%, and 100%.
 
Conclusion:AFP is a useful diagnostic tool with high diagnostic power for PROM detection. Thus, this valuable and noninvasive method provides appropriate treatment and reduces maternal and fetal complications of PROM.