International Journal of Clinical Obstetrics and Gynaecology

Aim: To evaluate vaginal fluid creatinine and AFI for diagnosis of Premature rupture of membranes.

Material and Methods: A total of 80 pregnant women were enrolled in the study Group 1 (control group) consisted of 40 healthy women with no history of leaking per vaginum or leak detected per speculum or per vaginum examination and Group 2 (case group) consisted of 40 women with history of leaking per vaginum or leak detected per speculum or per vaginum examination. All patients subjected to ultrasonography for Amniotic Fluid Index (AFI) measurement. All patients were sampled for vaginal fluid creatinine by speculum examination. Sample processed. AFI & Vaginal fluid creatinine level was estimated & compared for its significance. Receiver operating characteristic (ROC) curve analysis was used to establish the optimal cut-off concentrations for vaginal fluid creatinine & AFI, its accuracy, sensitivity & specificity.

Result: The mean vaginal fluid creatinine in case group was 0.42+0.1 mg/dl and 0.18+0.08 mg/dl in control group respectively and its difference was statistically significant (p<0.001).The optimal cut off value was >0.25 mg/dl with 90% sensitivity, 87.5% specificity & 91.6% accuracy for diagnosis of PROM. The mean value of amniotic fluid index (AFI) was significantly lower in the case group than in the control group (5.3±1.7 vs. 11.3±1.5, p < 0.001). AFI was found to have highly significant association between the groups. (<0.001). The sensitivity & the specificity of amniotic fluid index (AFI) to diagnose PROM (case) were 97.5% & 92.5% respectively, while it’s over all accuracy was 99.3% respectively, with a cut-off value of ≤ 7.5 cm.

Conclusion: So to conclude that if on clinical examination diagnosis of PROM is doubtful or suspicious, USG for AFI can be first screening investigation that can be done to confirm leaking per vaginum, however there are other causes of reduced AFI or oligohydramnios such as placental insufficiency etc, so by adding vaginal fluid creatinine which is one of the diagnostic test for PROM we can increase the sensitivity and specificity to diagnose PROM. In patients with insignificant leaking and decreased AFI and with suspicion of PROM, vaginal fluid creatinine estimation may be useful for definitive diagnosis & institute appropriate management. Estimating vaginal fluid creatinine levels and AFI may be useful to make an accurate diagnosis of PROM even at rural health care facilities and ensure early referral to tertiary care centres if needed.