الفهرس 
The Fetal MembranesOnly 14 pages are availabe for public view
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Abstract
ABSTRACT
Background: When diagnosing premature rupture membranes is query, choosing the appropriate management needs additional confirmatory test. Based on their metabolomics, some biochemical markers have been proposed as diagnostic aids. A perfect test could be composed of combining more than one marker. Combining markers is not arbitrary as some combinations could inversely impact the diagnostic accuracy of the test.
Aim of The Work: Improving sensitivity & specificity of diagnosis of preterm premature rupture of membranes by combining quantitative insulin like growth factor binding protein 1 (IGFBP-1) with quantitative βHCG and/or quantitative prolactin in cervico-vaginal fluid.
Patients and Methods: It is a cross sectional study.
IGFBP-1, prolactin and β-HCG concentrations in vaginal fluid were examined in 180 patients with sure membrane state and the diagnostic accuracy of each marker and each combination was determined.
The study was conducted between January 2018 and September 2018 in Ain Shams university maternity hospital after the approval of the institutional ethics committee. Informed consent has been obtained from the patients before participation.
Results: The sensitivity, specificity, PPV, and NPV of Prolactin with cutoff point 11 µIU/ml are 84.4, 73.2, 73.8, and 79.5 respectively gives accuracy percentage 75.4%. The sensitivity, specificity, PPV, and NPV of ILGFBP-1 with cutoff point 102 µIU/ml are 88.3, 93.5, 100, and 69.4 respectively gives accuracy percentage 81.5%. The sensitivity, specificity, PPV, and NPV of Β-HCG with cutoff point 104 mIU/mL are 85.1, 83.9, 96.2, and 72.8 respectively gives accuracy percentage 79.9%. The sensitivity, specificity, PPV, and NPV of the combination of IGFBP-1 and β-HCG are 78.4, 100, 100 and 64 respectively gives accuracy percentage 89.7
The sensitivity, specificity, PPV, and NPV of the combination of IGFBP-1 and prolactin are 78.4, 100, 100 and 68.7 respectively gives accuracy percentage 84.2. The sensitivity, specificity, PPV, and NPV of the combination of β-HCG and prolactin are 79.8, 100, 100 and 63.6 respectively gives accuracy percentage 77.2.
Conclusion: Combining IGFBP-1 and β-HCG is the best diagnostic combination to detect amniotic fluid presence in vaginal fluid. Combined IGFBP-1 and prolactin offered very little improvement compared to IGFBP-1 alone. Adding prolactin to β-HCG, decreased accuracy than each of the other two markers alone.