Analysis of cervicovaginal fluid in the diagnosis of premature rupture of membranes

Abstract

Abstract Premature rupture of membranes (PROM) complicates approximately 8% of all pregnancies, however in 3% of the cases the membrane rupture occurs before 37 weeks of gestation (preterm PROM – PPROM). The consequences of such an early loss of amniotic fluid are very serious. Serious complications and mortality of neonates born prematurely due to PPROM is very high and inversely proportional to gestational age. The diagnosis of PROM is based on medical history and physical examination. In case of doubt, a test determining the pH of vaginal secretions and ultrasonography with assessment of amniotic fluid index may be applied. In difficult cases vaginal fluid diagnostic markers are very helpful. Proposed markers include: beta-human chorionic gonadotropin (beta-HCG), placental alpha-microglobulin-1 (PAMG-1), insulin-like growth factor binding protein-1 (IGFBP-1) and alpha-fetoprotein (AFP). Other markers were also proposed, namely interleukin 6 (IL-6), prolactin, creatinine and lactates. Several tests for the analysis of cervico-vaginal secretions are already commercially available. In Poland various tests based on the analysis of vaginal pH and a test Actim Prom® based on the analysis of IGFBP-1 are available. In clinical practice, approximately 10% of cases of PROM require additional confirmation, which can be difficult, especially in the outpatient setting. Various types of bedside tests, the so-called point-of-care testing – POCT. are increasingly used in contemporary medical practice. Their implementation does not require a laboratory, specialized equipment or trained personnel. This paper presents only those markers that either are already used in the diagnosis of PROM in the form of POCT testing, or could be relatively easily adapted for this purpose.