Yıl 2019, Cilt 3 , Sayı 6, Sayfalar 421 - 427 2019-06-28

Erken memran rüptürü tespitinde vajinal kreatinin seviyelerinin kullanılması
Use of vaginal creatinine levels in detecting premature rupture of membranes

Yasin Serkan KURUOĞLU [1] , Fatma Devran BILDIRCIN [2] , Pervin KARLI [3] , Ayşe Zehra ÖZDEMİR [4]


Amaç: Erken membran rüptürü (EMR) bulunan hastaların teşhisinde yanılgılar sık görülebilmektedir. EMR tanısını en doğru şekilde koymak için güvenilir laboratuvar testleri gerekir. Altın standart bir tanı metodunun olmaması yüzünden bu konuda birçok yöntemler öne sürülmüştür Bu çalışmada EMR teşhisinde vajinal kreatinin ölçümlerinin %100 yakın güvenirlikle kullanılan vajinal Plasental Alfa mikroglobulin-1 (PAMG-1) testine göre kullanılabilirliği, güvenirliği ve cut off değerlerinin tespiti hedeflenmiştir

Yöntemler: Bu çalışmaya, Samsun Ondokuz Mayıs Üniversitesi Kadın Hastalıkları ve Doğum Kliniği’ne 15 Kasım 2012 – 15 Haziran 2013 tarihleri arasında başvuran toplam 63 EMR şüpheli hasta dahil edilmiştir. Tüm hastalara anamnezi takiben steril spekulum ile vajinal olarak PAMG-1 (AmniSure ® ROM) testi ve ardından vajene 5 cc serum fizyolojik enjekte edilip sonrasında 3 cc aynı enjektörle geri alınarak biyokimya tüpüne koyulmuştur. Hemen ardından materyal biyokimya laboratuvarına gönderilip santrifüj edildikten sonra dondurucuda -70 0C derecede tüm numuneler çalışılıncaya kadar saklanmıştır. Hastalar Plasental Alpha Mikroglobulin-1 (PAMG-1) testinin pozitif ve negatif olup olmamasına göre EMR olan ve EMR olamayan olarak sınıflandırıldı. Bu sınıflamanın ardından vajinal kreatinin değerine göre de hastalar EMR ve EMR olmayan olarak gruplandırıldı.

Bulgular: Olgularımızın ortalama maternal yaş değeri EMR olan hasta gurubunda 26,3 yaş, EMR olmayan gurupta 28,8 yaş idi. EMR olan hastalarda gebelik haftası ortalama değeri 30,8 hafta, EMR olmayan hastalarda ise 32,5 hafta idi. EMR tanısı amaçlı PAMG -1 testi uygulanan 20 hastanın 17 sinde PAMG-1 ve kreatinin pozitif, PAMG-1 negatif olan 3 hastada kreatinin pozitifti. PAMG-1 testi uygulanan 43 hastanın 42 sinde PAMG-1 negatif, 1 inde PAMG-1 pozitif ve kreatinin negatifti. Bu sonuçlara göre vajinal kreatinin EMR teşhisinde %94,4 sensitivite, %93,3 spesifisite, %85 pozitif prediktif değer, %97,7 negatif prediktif değer olarak hesaplandı. EMR olan ve olmayan gurupta ortalama kreatinin değerleri sırasıyla 0,39 (0,31)mg/dl ve 0,04 (0,10) mg/dl (p=0,05).

Sonuç: Vajinal yıkama sıvısında kreatinin ölçümü EMR tanısında daha ucuz, hızlı, kolay ulaşılabilir ve %94,4 sensitivite, %93,3 spesifisite ile yüksek doğruluk oranına sahip bir test olabilir.

Aim: Misdiagnosis is frequent in premature rupture of membranes (PROM) patients. The most accurate diagnosis of PROM requires reliable laboratory tests. Due to the lack of a gold-standard diagnostic method, many methods have been proposed in this regard. The aim of this study is to determine an easy diagnostic method in early membrane rupture and to determine the usability, reliability and cut-off values of vaginal creatinine measurements in the detection of PROM compared to vaginal placental alpha microglobulin-1 (PAMG-1) test.

Methods: We designed a cross-sectional study. A total of 63 patients admitted to the Obstetrics and Gynecology Clinic of Samsun Ondokuz Mayıs University with suspected PROM between 15 November 2012 and 15 June 2013 were included in this study. Following anamnesis, all patients were vaginally subjected to PAMG-1 (AmniSure® ROM) test with sterile speculum and injected with 5 cc of saline into the vagina, and then, a 3 cc sample was retrieved with the same injector and put into a biochemistry tube. Immediately thereafter, the material was sent to the biochemistry laboratory, centrifuged and stored at -70 0C until all samples were studied. The patients were classified as PROM and non-PROM based on the positive or negative result of PAMG-1 test. Following this classification, the patients were also grouped as PROM and non-PROM according to their vaginal creatinine values.

Results: The mean maternal age of our patients was 26.3 years in the PROM group and 28.8 years in the non-PROM group. The mean gestational weeks were 30.8 weeks in the PROM patients and 32.5 weeks in the non-PROM patients. Of 20 patients subjected to PAMG-1 test for PROM diagnosis, 17 were PAMG-1 and creatinine positive while 3 were PAMG-1 negative and creatinine positive. Of 43 patients subjected to PAMG-1 test, 42 were PAMG-1 negative while 1 was PAMG-1 positive and creatinine negative. Accordingly, vaginal creatinine was found to have 94.4% sensitivity, 93.3% specificity, 85% positive predictive value, and 97.7% negative predictive value in PROM diagnosis. The mean creatinine values in the PROM and non-PROM groups were 0.39 (0.31) mg/dl and 0.04 (0.10) mg/dl, respectively (p=0.05).

Conclusion: Creatinine assessment in vaginal flushing fluid can be a cheaper, faster, easily accessible and highly accurate test with 94.4% sensitivity and 93.3% specificity in PROM diagnosis.

  • 1. Gabbe SG, Neebly JR, Simpson JL Obstetrics; Normal and problem pregnancies. Third Edition. 1996;743-820.
  • 2. Scott JR, Disaina J, Hammond CB, Spellacy WN. Danforth's Obstetrics and Gynecology. Seventy Edition. 1994;305-16.
  • 3. Ferguson SE, Smith GN, Salenieks ME, Windrim R, Walker MC. Premature rupture of the fetal membranes: Nutritional and Socioeconomic Factors. Obstet. Gynecol. 2002;100:1250-6.
  • 4. Cousin LM, Smok DP, Lovett SM, Poeltler SM. Amnisure Placental Alpha Microglobulin-1 Rapid Immunoassay versus standart Diagnostic Methods for Detection of rupture of membranes. Am J perinatal. 2005;22(6):317-20.
  • 5. Mercer BM. Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am. 2005 Sep;32(3):411-28.
  • 6. Mercer BM, Goldenberg RL, Das A, Moawad AH, Iams JD, Meis PJ, et al. The preterm prediction study: a clinical risk assessment system. Am J Obstet Gynecol. 1996 Jun;174(6):1885-93.
  • 7. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol. 2003;101:178-93.
  • 8. Lockwood CJ, Wein R, Chien D, Ghidini A, Alvarez M, Berkowitz RL. Fetal membrane rupture is associated with the presence of insulin-like growth factor-binding protein-1 in vaginal secretions. Am J Obstet Gynecol. 1994 Jul;171(1):146-50.
  • 9. Kim YH, Park YW, Kwon HS, Kwon JY, Kim BJ. Vaginal fluid beta-human chorionic gonadotropin level in the diagnosis of premature rupture of membranes. Acta Obstet Gynecol Scand. 2005 Aug;84(8):802-5.
  • 10. Lockwood CJ, Wein R, Chien D, Ghidini A, Alvarez M, Berkowitz RL. Fetal membrane rupture is associated with the presence of insulin-like growth factor-binding protein-1 in vaginal secretions. Am J Obstet Gynecol. 1994 Jul;171(1):146-50.
  • 11. Medina TM, Hill DA. Preterm premature rupture of membranes: diagnosis and management. Am Fam Physician. 2006 Feb 15;73(4):659-64.
  • 12. Gurbuz A, Karateke A, Kabaca C. Vaginal fluid creatinine in premature rupture of membranes. Int J Gynaecol Obstet. 2004 Jun;85(3):270-1.
  • 13. Gaucherand P, Guibaud S, Rudigoz RC, Wong A. Diagnosis of premature rupture of the membranes by the identification of alpha-feto-protein in vaginal secretions. Acta Obstet Gynecol Scand. 1994 Jul;73(6):456-9.
  • 14. Anai T, Tanaka Y, Hirota Y, Miyakawa I. Vaginal fluid hCG levels for detecting premature rupture of membranes. Obstet Gynecol. 1997 Feb;89(2):261-4.
  • 15. Phocas I, Sarandakou A, Kontoravdis A, Chryssicopoulos A, Zourlas PA. Vaginal fluid prolactin: a reliable marker for the diagnosis of prematurely ruptured membranes. Comparison with vaginal fluid alpha-fetoprotein and placental lactogen. Eur J Obstet Gynecol Reprod Biol. 1989 May;31(2):133-41.
  • 16. Sekhavat L, Firouzabadi RD, Mojiri P. Practicability of vaginal washing fluid creatinine level in detecting premature rupture of membranes. Arch Gynecol Obstet. 2012 Jul;286(1):25-8. doi: 10.1007/s00404-012-2233-6.
  • 17. Gorodeski IG, Haimovitz L, Bahari CM. Reevaluation of the pH, ferning and nile blue sulphate staining methods in pregnant women with premature rupture of the fetal membranes. J Perinat Med. 1982;10(6):286-92.
  • 18. Waters TP, Mercer B. Preterm PROM: prediction, prevention, principles. Clin Obstet Gynecol. 2011 Jun;54(2):307-12. doi: 10.1097/GRF.0b013e318217d4d3
  • 19. Kafali H, Öksüzler C. Vaginal fluid urea and creatinine in diagnosis of premature rupture of membranes. Arch Gynecol Obstet. 2007 Mar;275(3):157-60.
  • 20. Zanjani MS, Haghighi L. Vaginal fluid creatinine for the detection of premature rupture of membranes. J Obstet Gynaecol Res. 2012 Mar;38(3):505-8. doi: 10.1111/j.1447-0756.2011.01692.x.
  • 21. Alberto FB. Estudo comparativo das dosagens de sodio, potassio, ureia, creatinina e acido urico no liquido amniotico de gestantes entre 15-20 semanas Revista da Associação Médica Brasileira e 38-42 semanas. 1992.
  • 22. Garite TJ. Premature rupture of the membranes: the enigma of the obstetrician. Am J Obstet Gynecol. 1985 Apr 15;151(8):1001-5.
  • 23. Abdelazim IA, Makhlouf HH. Placental alpha microglobulin-1 (AmniSure(®) test) for detection of premature rupture of fetal membranes. Arch Gynecol Obstet. 2012 Apr;285(4):985-9. doi: 10.1007/s00404-011-2106-4.
  • 24. Petrunin DD, Griaznova IM, Petrunina IuA, Tatarinov IuS. [Immunochemical identification of organ specific human placental alphal-globulin and its concentration in amniotic fluid]. Akush Ginekol (Mosk). 1977 Jan;(1):62-4.
  • 25. Marcellin L, Anselem O, Guibourdenche J, De la Calle A, Deput-Rampon C, Cabrol D, Tsatsaris V. [Comparison of two bedside tests performed on cervicovaginal fluid to diagnose premature rupture of membranes]. J Gynecol Obstet Biol Reprod (Paris). 2011 Nov;40(7):651-6. doi: 10.1016/j.jgyn.2011.06.007.
  • 26. Darj E, Lyrenäs S. Insulin-like growth factor binding protein-1, a quick way to detect amniotic fluid. Acta Obstet Gynecol Scand. 1998 Mar;77(3):295-7.
  • 27. Ramsauer B, Vidaeff AC, Hösli I, Park JS, Strauss A, Khodjaeva Z, et al. The diagnosis of rupture of fetal membranes (ROM): a meta-analysis. J Perinat Med. 2013 May;41(3):233-40. doi: 10.1515/jpm-2012-0247.
  • 28. Dale PO, Tanbo T, Bendvold E, Moe N. Duration of the latency period in preterm premature rupture of the membranes. Maternal and neonatal consequences of expectant management. Eur J Obstet Gynecol Reprod Biol. 1989 Mar;30(3):257-62.
  • 29. Li HY, Chang TS. Vaginal fluid creatinine, human chorionic gonadotropin and alpha-fetoprotein levels for detecting premature rupture of membranes. Zhonghua Yi Xue Za Zhi (Taipei). 2000 Sep;63(9):686-90.
Birincil Dil en
Konular Kadın Hastalıkları ve Doğum
Bölüm Araştırma makalesi
Yazarlar

Orcid: 0000-0002-9299-5249
Yazar: Yasin Serkan KURUOĞLU
Kurum: ONDOKUZ MAYIS ÜNİVERSİTESİ
Ülke: Turkey


Orcid: 0000-0003-4907-6250
Yazar: Fatma Devran BILDIRCIN
Kurum: ONDOKUZ MAYIS ÜNİVERSİTESİ
Ülke: Turkey


Orcid: 0000-0003-4907-5890
Yazar: Pervin KARLI
Kurum: AMASYA UNIVERSITY
Ülke: Turkey


Orcid: 0000-0003-4232-4794
Yazar: Ayşe Zehra ÖZDEMİR
Kurum: ONDOKUZ MAYIS ÜNİVERSİTESİ
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 28 Haziran 2019

Bibtex @araştırma makalesi { josam571409, journal = {Journal of Surgery and Medicine}, issn = {}, eissn = {2602-2079}, address = {jsurgmed@gmail.com}, publisher = {Fatih BAŞAK}, year = {2019}, volume = {3}, pages = {421 - 427}, doi = {10.28982/josam.571409}, title = {Use of vaginal creatinine levels in detecting premature rupture of membranes}, key = {cite}, author = {Kuruoğlu, Yasin Serkan and Bıldırcın, Fatma Devran and Karlı, Pervin and Özdemir, Ayşe Zehra} }
APA Kuruoğlu, Y , Bıldırcın, F , Karlı, P , Özdemir, A . (2019). Use of vaginal creatinine levels in detecting premature rupture of membranes . Journal of Surgery and Medicine , 3 (6) , 421-427 . DOI: 10.28982/josam.571409
MLA Kuruoğlu, Y , Bıldırcın, F , Karlı, P , Özdemir, A . "Use of vaginal creatinine levels in detecting premature rupture of membranes" . Journal of Surgery and Medicine 3 (2019 ): 421-427 <http://jsurgmed.com/tr/pub/issue/45558/571409>
Chicago Kuruoğlu, Y , Bıldırcın, F , Karlı, P , Özdemir, A . "Use of vaginal creatinine levels in detecting premature rupture of membranes". Journal of Surgery and Medicine 3 (2019 ): 421-427
RIS TY - JOUR T1 - Use of vaginal creatinine levels in detecting premature rupture of membranes AU - Yasin Serkan Kuruoğlu , Fatma Devran Bıldırcın , Pervin Karlı , Ayşe Zehra Özdemir Y1 - 2019 PY - 2019 N1 - doi: 10.28982/josam.571409 DO - 10.28982/josam.571409 T2 - Journal of Surgery and Medicine JF - Journal JO - JOR SP - 421 EP - 427 VL - 3 IS - 6 SN - -2602-2079 M3 - doi: 10.28982/josam.571409 UR - https://doi.org/10.28982/josam.571409 Y2 - 2019 ER -
EndNote %0 Journal of Surgery and Medicine Use of vaginal creatinine levels in detecting premature rupture of membranes %A Yasin Serkan Kuruoğlu , Fatma Devran Bıldırcın , Pervin Karlı , Ayşe Zehra Özdemir %T Use of vaginal creatinine levels in detecting premature rupture of membranes %D 2019 %J Journal of Surgery and Medicine %P -2602-2079 %V 3 %N 6 %R doi: 10.28982/josam.571409 %U 10.28982/josam.571409
ISNAD Kuruoğlu, Yasin Serkan , Bıldırcın, Fatma Devran , Karlı, Pervin , Özdemir, Ayşe Zehra . "Use of vaginal creatinine levels in detecting premature rupture of membranes". Journal of Surgery and Medicine 3 / 6 (Haziran 2019): 421-427 . https://doi.org/10.28982/josam.571409
AMA Kuruoğlu Y , Bıldırcın F , Karlı P , Özdemir A . Use of vaginal creatinine levels in detecting premature rupture of membranes. J Surg Med. 2019; 3(6): 421-427.
Vancouver Kuruoğlu Y , Bıldırcın F , Karlı P , Özdemir A . Use of vaginal creatinine levels in detecting premature rupture of membranes. Journal of Surgery and Medicine. 2019; 3(6): 421-427.
IEEE Y. Kuruoğlu , F. Bıldırcın , P. Karlı ve A. Özdemir , "Use of vaginal creatinine levels in detecting premature rupture of membranes", Journal of Surgery and Medicine, c. 3, sayı. 6, ss. 421-427, Haz. 2019, doi:10.28982/josam.571409