Practicability of using vaginal fluid markers in detecting premature rupture of membranes

Ann Clin Biochem 2003;40:542-545
doi:10.1258/000456303322326461
© 2003 Association for Clinical Biochemistry

 

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Original Articles


Chen Yi Ni,
Wang Xue Jia,
Wu Min Yi,
Lu Hai Feng and
Lin Zhi Yu


The Central Laboratory, Guang Zhou Red Cross Hospital, Guang Zhou 510220, P.R. China;
Department of Gynaecology and Obstetrics, Guang Zhou Red Cross Hospital, Guang Zhou 510220, P.R. China;
The Central Laboratory, Guang Zhou Red Cross Hospital, Guang Zhou 510220, P.R. China;
The Central Laboratory, Guang Zhou Red Cross Hospital, Guang Zhou 510220, P.R. China;
The Central Laboratory, Guang Zhou Red Cross Hospital, Guang Zhou 510220, P.R. China


Background: Premature rupture of membranes (PROM) may cause intra-uterine infection and fetal death. A diagnostic tool that is non-invasive, specific and quick is needed to predict PROM. Human chorionic gonadotrophin (hCG), {alpha}-fetoprotein (AFP) andinterleukin 6 (IL-6), which are present in vaginal fluid, werereported to be potential markers for PROM but have not yet beenused in the clinic. This study was designed in a daily routinesemi-emergency setting to evaluate the clinical practicabilityof using these markers in diagnosing PROM.

Methods: Using a random-access automated luminescence immunoassay system, 81 vaginal washing samples collected from third trimester pregnant women (43 from PROM patients, 38 from patients with intact membranes) were analysed for β-hCG, AFP and IL-6 in a semi-emergency setting. The Mann-Whitney U-test was usedto test the difference between the two groups. Receiver operatorcurve (ROC) analysis was used to evaluate the performance ofthe three markers and to determine the cut-off value for a positivediagnosis.

Results: Vaginal fluid concentrations of the three markers were significantly different (P < 0.001) between the two groups. ROC analysis indicated that AFP had a 97.7% diagnostic sensitivity and 100% specificity; the other two markers had lower diagnostic sensitivity and specificity (95.3% and 89.5% for β-hCGand 83.7% and 78.9% for IL-6, respectively).

Discussion: This work demonstrates that, of the three markersinvestigated, AFP has the highest diagnostic sensitivity andspecificity. Using the ‘stat’ function provided by the automatedluminescence immunoassay system, the reporting time of the resultswas less than 1h. We conclude that vaginal fluid AFP measuredby random-access automated luminescence immunoassay is an idealmarker for the diagnosis of PROM. The technique could be introducedinto the laboratory as a semi-emergency service to meet clinicalneeds.


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