Vaginal Fluid Creatinine Levels to Detect Rupture of Membranes.

Introduction: When amniotic fluid leaks from the vagina, due to rupture of membranes (ROM) before uterine contractions begin, at a gestational age shorter than 37 weeks, the condition is known as preterm premature rupture of foetal membranes. ROM before the onset of labour, after 37 weeks, is known as pre-labour rupture of foetal membranes. Our study sought to examine whether vaginal fluid creatinine levels might be utilised to diagnose women with ROM.

Objectives: To study the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of vaginal fluid creatinine in diagnosis of rupture of membranes.

Methods: The study included 60 pregnant women with singleton pregnancy who were admitted to MVJMC & RH and met the inclusion criteria with gestational age between 28 and 40 weeks. This was a hospital-based prospective comparative study. The study group included 30 pregnant women who complained of vaginal fluid leak (case group) and 30 pregnant women without ROM, who were randomly enrolled from the labour room (control group). If obvious 'leaking' was present then 3 ml of vaginal fluid sample was collected with a syringe. If the membranes were intact then 5 ml of sterile saline solution was instilled into the posterior vaginal fornix and 3 ml of the fluid was withdrawn with same syringe, and sent for vaginal fluid creatinine level estimation.

Results: In case and control groups, the mean and standard deviations of vaginal fluid creatinine was 1.50 ± 0.25 mg/dL and 0.52 ± 0.28 mg/dL, respectively. The ideal cutoff score was established using the receiver operator characteristic (ROC) curve coordinates by balancing sensitivity and specificity. The cutoff score of 1.050 mg/dL was selected, with a 93.1% sensitivity rate, a 90.3% specificity rate, 90.0% PPV, and 93.3% NPV.

Conclusion: A quick, easy test that can accurately diagnose ROM, is the detection of creatinine levels in vaginal fluid. It has high sensitivity, specificity, PPV, and NPV.