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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 287-290    DOI: 10.31083/j.ceog.2020.02.4986
Original Research Previous articles | Next articles
Evaluation of simple and low-cost diagnostic tests for premature rupture of membranes
R. Dias Nunes1, 2, *(), E. Traebert1, 2, M. Seemann1, J. Traebert2
1School of Medicine. University of Southern Santa Catarina – Palhoça/SC, Brazil
2Post-Graduate Program in Health Sciences, University of Southern Santa Catarina, Palhoça, Brazil
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Abstract  

Purpose of Investigation: To determine the accuracy from three diagnostic methods for premature rupture of membranes. Materials and Methods: Samples from 100 pregnant women were divided into two groups: intact and ruptured membranes. Samples of 2-5 ml were collected from the vaginal content and the exams were performed, analysing accuracy measures. Results: The pH demonstrated sensitivity of 100.0%, specificity of 96.0%, positive predictive value (PPV) of 96.2%, negative predictive value (NPV) of 100.0%, and accuracy of 96.0%. Iannetta test demonstrated sensitivity of 86.0%, specificity of 92.0%, PPV of 91.5%, NPV of 86.8%, and accuracy of 79.1%. Crystallization demonstrated sensitivity of 90.0%, specificity of 98.0%, PPV of 10.00%, NPV of 90.7% and accuracy of 88.2%. Conclusion: The most specific test with higher PPV was crystallisation, alone or in combination with others (pH and Iannetta test). The most sensitive test with higher NPV and accuracy was pH, alone or in association with others (Iannetta test and crystallization).

Key words:  Premature rupture of membranes      Diagnostics      Amniotic fluid     
Published:  15 April 2020     
*Corresponding Author(s):  R. Dias Nunes     E-mail:  rodrigo.dias.nunes@hotmail.com

Cite this article: 

R. Dias Nunes, E. Traebert, M. Seemann, J. Traebert. Evaluation of simple and low-cost diagnostic tests for premature rupture of membranes. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 287-290.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.02.4986     OR     https://ceog.imrpress.com/EN/Y2020/V47/I2/287

Figure 1.  — Pattern of the crystallization of cervical mucus (left) and amniotic fluid (right) after spontaneous stainning at a ×40 magnification with optical microscopy.

Table 1  — Results of sensitivity and specificity of the diagnostic tests, isolated, and with associations.
Diagnostic tests (isolated) Sensitivity Specificity
pH 100.0% 96.0%
Iannetta test 86.0% 92.0%
Crystallization 90.0% 98.0%
Diagnostic tests (associations) Parallel Series Parallel Series
pH and Iannetta test 86.0% 100.0% 99.7% 88.3%
pH and crystallization 90.0% 100.0% 99.9% 94.1%
Iannetta test and crystallization 77.4% 98.6% 99.8% 90.2%
pH and Iannetta test and crystallization 59.9% 100.0% 99.9% 74.9%
Table 2  — Results of positive predictive values, negative predictive values, and accuracies of the diagnostic tests, isolated and with associations.
Diagnostic tests (isolated) PPV NPV Accuracy
pH 96.2% 100.0% 96.0%
Iannetta 91.5% 86.8% 79.1%
Crystallization 100.0% 90.7% 88.2%
Diagnostic tests (associations) Parallel Series
pH and Iannetta test 85.7% 88.3%
pH and crystallization 89.9% 94.1%
Iannetta and crystallization 77.3% 88.9%
pH and Iannetta test and crystallization 59.9% 74.9%
[1] Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 18.: “Rupture of Membranes”. Obstet. Gynecol., 2018, 131, e1.
doi: 10.1097/AOG.0000000000002664 pmid: 29794661
[2] Caloone J., Rabilloud M., Boutitie F., Traverse-Glehen A., Allias-Montmayeur F., Denis L., et al.: “Accuracy of several maternal seric markers for predicting histological chorioamnionitis after preterm premature rupture of membranes: a prospective and multicentric study.e of membranes at term on unfavourable cervix: immediate or delayed induction?”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2016, 205, 133.
doi: 10.1016/j.ejogrb.2016.08.022 pmid: 27591714
[3] Zelli P., Boussat B., Reynaud J.C., Pons J.C., Sergent F.: “Premature rupture of membranes at term on unfavourable cervix: immediate or delayed induction?” J. Gynecol. Obstet. Biol. Reprod., 2013, 42, 671.
doi: 10.1016/j.jgyn.2013.03.004
[4] Tajik P., van der Ham D.P., Zafarmand M.H., Hof M.H., Morris J., Franssen M.T., et al.: “Using vaginal Group B Streptococcus colonisation in women with preterm premature rupture of membranes to guide the decision for immediate delivery: a secondary analysis of the PPROMEXIL trials”. BJOG, 2014, 121, 1263.
doi: 10.1111/1471-0528.12889 pmid: 24862166
[5] Bahasadri S., Kashanian M., Khalili S.: “Evaluation of vaginal fluid β-human chorionic gonadotrophin for the diagnosis of preterm premature rupture of membranes”. J. Obstet. Gy-naecol. Res., 2013, 39, 777.
[6] Seelbach-Goebel B.: “Antibiotic therapy for premature rupture of membranes and preterm labor and effect on fetal outcome”. Geburtshilfe Frauenheilkd, 2013, 73, 1218.
doi: 10.1055/s-0033-1360195 pmid: 24771902
[7] Blanchon L., Accoceberry M., Belville C., Delabaere A., Prat C., Lemery D., et al.: “Rupture of membranes: pathophysiology, diagnosis, consequences and management”. J. Gynecol. Obstet. Biol. Reprod., 2013, 42, 105.
doi: 10.1016/j.jgyn.2012.12.012
[8] Doret M., Cartier R., Miribel J., Massardier J., Massoud M., Bordes A., et al.: “Premature preterm rupture of the membrane diagnosis in early pregnancy: PAMG-1 and IGFBP-1 detection in amniotic fluid with biochemical tests”. Clin. Biochem., 2013, 46, 1816.
doi: 10.1016/j.clinbiochem.2013.10.006
[9] Gallot D., Guibourdenche J., Sapin V., Goffinet F., Doret M., Langer B., et al.: “Which biological test to confirm rupture of membranes?” J. Gynecol. Obstet. Biol. Reprod., 2012, 41, 115.
doi: 10.1016/j.jgyn.2011.12.001
[10] Brooks C., Shand K., Jones W.R.: “A reevaluation of the ferning test to detect ruptured menbranes”. Aust. NZ. J. Obstet. Gynaecol., 1986, 26, 260.
doi: 10.1111/ajo.1986.26.issue-4
[11] Roberts D., Vause S., Martin W., Green P., Walkinshaw S., Bricker L., et al.: “Amnioinfusion in preterm premature rupture of membranes (AMIPROM): a randomised controlled trial of amnioinfusion versus expectant management in very early preterm premature rupture of membranes—a pilot study”. Health. Technol. Assess., 2014, 18, 1.
doi: 10.3310/hta18500 pmid: 25110830
[12] Iannetta O.: “A new simple test for detecting rupture of the fetal membranes”. Obstet. Gynecol., 1984, 63, 575.
pmid: 6700905
[13] Sirak B., Mesfin E.: “Maternal and perinatal outcome of pregnancies with preterm premature rupture of membranes (PROM) at Tikur Anbessa specialized teaching hospital, Addis Ababa, Ethiopia”. Ethiop. Med. J., 2014, 52, 165.
pmid: 26410989
[14] Gaddey H., Bailey J., Smith R.F.: “Clinical inquiry: Ferning in amniotic fluid: is it a useful indicator of ruptured membranes?” J. Fam. Pract., 2011, 60, 769.
pmid: 22163364
[15] Uriza R.B., Conde B.I., Zárate H., Alvarez O.: “Diagnostico de ruptura de las membranas ovulares - metodo colorimetrico com sulfato azul de Nilo”. Ginec. Obstet. Mex., 1970, 27, 569.
pmid: 4098340
[16] Gorodeski I.G., Haimovitz L., Bahari C.M.: “Reevaluation of the pH, ferning and nile blue sulphate staining methods in pregnant women with premature rupture of the fetal membranes”. J. Perinat. Med., 1982, 10, 286.
doi: 10.1515/jpme.1982.10.6.286 pmid: 7161689
[17] Liang D.K., Qi H.B., Luo X., Xiao X.Q., Jia X.Y.: “Comparative study of placental α-microglobulin-1, insulin-like growth factor binding protein-1 and nitrazine test to diagnose premature rupture of membranes: a randomized controlled trial”. J. Obstet. Gynaecol. Res., 2014, 40, 1555.
doi: 10.1111/jog.12381 pmid: 24888915
[18] Sugibayashi S., Aeby T., Kim D., Kaneshiro B.: “Amniotic fluid arborization in the diagnosis of previable preterm premature rupture of membranes”. J. Reprod. Med., 2012, 57, 136.
pmid: 22523873
[19] Mariona F.G., Cabero L.:“Are we ready for a new look at the diagnosis of premature rupture of membranes?” J. Matern. Fetal. Neonatal. Med., 2012, 25, 403.
doi: 10.3109/14767058.2011.581715 pmid: 21627549
[20] Rogers L.C., Scott L., Block J.E.: “Accurate point-of-care detection of ruptured fetal membranes: improved diagnostic performance characteristics with a monoclonal/polyclonal immunoassay”. Clin. Med. Insights. Reprod. Health, 2016, 10, 15.
doi: 10.4137/CMRH.S38386 pmid: 27199579
[21] Morris R.K., Meller C.H., Tamblyn J., Malin G.M., Riley R.D., Kilby M.D., et al.: “Association and prediction of amniotic fluid measurements for adverse pregnancy outcome: systematic review and meta-analysis”. BJOG, 2014, 121, 686.
doi: 10.1111/1471-0528.12589 pmid: 24738894
[22] Mooney S.J., Westreich D.J., El-Sayed A.M.: “Commentary: Epidemiology in the era of big data”. Epidemiology, 2015, 26, 390.
doi: 10.1097/EDE.0000000000000274 pmid: 25756221
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