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Preterm Prelabor Rupture Of Membranes
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Anna Locatelli, Sara Consonni, Annalisa Inversetti
Traditional confirmatory tests:Ferning test: The presence of arborization on a slide of amniotic fluid collected in a sterile way from the posterior vaginal fornix. Arborization represents the crystallization of amniotic fluid due to its high contents of salts and proteins. False-positive results for contamination by cervical-vaginal mucus, seminal fluid, fingerprints, and urine crystals. False-negative results for blood or meconium contamination or inadequacy in slide preparation.pH test (nitrazine test): The normal pH of vaginal secretions is generally 3.8–4.5, whereas amniotic fluid usually has a pH of 7.1–7.3. False-positive test results may occur in the presence of blood or semen, alkaline antiseptics, certain lubricants, Trichomonas, or bacterial vaginosis. Alternatively, false-negative test results may occur with prolonged membrane rupture and minimal residual fluid.
Prelabor rupture of the membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Lami Yeo, Francesca Gotsch, Eleazar Soto, Sonia S. Hassan, Juan Pedro Kusanovic, Ray Bahado-Singh
The biochemical properties of the amniotic fluid are the basis to distinguish it from other fluids that can be observed in the vagina (i.e., cervical secretions, urine, and semen). The normal pH of the vagina is 4.5 to 5.5 during gestation, and that of the amniotic fluid is 7.0 to 7.5. Nitrazine paper turns from yellow to blue when exposed to any alkaline fluid (i.e., pH of 7.0 or more) and the use of nitrazine paper has been reported to have an accuracy of 93.3% (136) to determine the presence of amniotic fluid in the vagina. False-positive results range from 1% to 17% and can result from alkaline urine, blood, semen, vaginal discharge in cases of BV, or Trichomonas infection (149). False negatives may occur in up to 10% of cases.
Amniotic Fluid Abnormalities
Published in Tony Hollingworth, Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
Dhivya Chandrasekar, Peter Muller
The diagnosis of ruptured membranes can readily be made based on clinical history and examination. Presence of pool of fluid in the vagina at sterile speculum examination is highly suggestive of ruptured membranes. Several tests have been used to confirm rupture of membrane; the most widely used tests are the nitrazine test,12 which detects pH change, and the ferning test, with a sensitivity of 90 per cent. False positive rate was 17 per cent for nitrazine test and 6 per cent for the ferning test.
The effect of serotonin reuptake inhibitors on the vaginal epithelium in postmenopausal women
Published in Climacteric, 2019
A. K. Shea, D. Meschino, W. Wolfman
Study participants completed the Female Sexual Function Index (FSFI)15. This self-rated questionnaire scores the domains of sexual functioning (arousal, orgasm, satisfaction, pain). All women underwent a physical examination as part of routine clinical care. The vaginal tissues were assessed using nitrazine paper (pH) and the ThinPrep cytobrush. The epithelial cells collected using the cytobrush were quantified using the standardized maturation index (MI) at the Mount Sinai Hospital Laboratory. The MI details the proportions of parabasal, intermediate, and superficial cells. These objective measures have been used in similar populations; a more alkaline pH (6.0–7.5) and a lower MI suggest atrophic changes of the vagina16.
Predicting previable preterm premature rupture of membranes (pPPROM) before 24 weeks: maternal and fetal/neonatal risk factors for survival
Published in Journal of Obstetrics and Gynaecology, 2022
Aylin Günes, Hüseyin Kiyak, Semra Yüksel, Gökhan Bolluk, Rabia Merve Erbiyik, Ali Gedikbasi
Patients who applied with complaints of amniotic fluid leakage were evaluated with anamnesis, a general physical examination, and laboratory testing. A sterile speculum examination was performed to diagnose PPROM. The presence of amniotic fluid flowing from the cervical canal, fluid pooling in the vaginal posterior fornix, and membrane prolapse were assessed. A diagnostic PAMG-1 assay (Amnisure®; Amnisure GmbH/QIAGEN, Wetzlar, Germany) was performed. In suspicious cases, we followed these patients for further leakage via sonography and nitrazine test. In addition to routine laboratory testing, the white blood cell count and C-reactive protein (CRP) level were determined.
Comparison of placental α microglobulin-1 protein assay (Amnisure) with speculum examination for the diagnosis of premature preterm rupture of membranes (PPROM): a clinical evaluation
Published in Journal of Obstetrics and Gynaecology, 2021
Sertac Esin, Yusuf Aytac Tohma, İsmail Alay, Mahmut Guden, Eser Colak, Nihal Demirel, Ahmet Yagmur Bas, Ethem Serdar Yalvac, Omer Kandemir
Preterm premature rupture of membranes (PPROM) refers to the rupture of membranes (ROM) before 37 weeks gestation (Salman et al. 2019). It is responsible for approximately one third of preterm births (Mercer 2005) and has substantial impact on neonatal mortality and morbidity. Therefore, diagnosis of PPROM is critical for foetal and maternal prognosis. Classically, the diagnosis is established clinically by speculum examination with direct visualisation of amniotic fluid leaking through the cervical canal. However, in 10–20% of patients (Friedman and McElin 1969; Gaucherand et al. 1997; Mercer 2003), the diagnosis of rupture of membranes is difficult especially when the leakage is intermittent and subtle. For those cases, laboratory tests can be used to confirm the presence of membrane rupture. Historically, Nitrazine or fern tests have been used for this purpose however; the results are adversely affected by the presence of infections, semen and blood and therefore, have limited value. Recently, several bedside commercial tests such as placental alpha microglobulin-1 protein assay (PAMG-1) (Amnisure), insulin-like growth factor binding protein 1 (IGFBP-1 [Actim PROM]) and placental protein 12 and alpha-fetoprotein (ROM Plus) have been developed for the diagnosis of ROM. Placental alpha microglobulin-1 protein assay uses immunochromatography method to detect trace amount of placental alpha microglobulin-1 protein in vaginal fluids and has high sensitivity and specificity for ROM diagnosis (Marcellin et al. 2011; Abdelazim and Makhlouf 2012; Birkenmaier et al. 2012; Abdelazim et al. 2014; Mariona and Roura 2016). However, to the best of our knowledge, the clinical outcome of ROM cases detected by classical speculum examination and by placental alpha microglobulin-1 protein assay has not been compared in the literature previously.