Premature rupture of membrane (PROM) is one of the most common antepartum complications of pregnancy, and it is estimated to be a factor in one third of all preterm deliveries.1 However, unless patient history and clinical suspicion require it, PROM is not always tested for as a routine part of prenatal care. This is due to the difficulties of accurately testing for the condition. Speculum examination, the most commonly used diagnostic method, is highly subjective and has a strong potential for false positives which can lead to unnecessary hospitalization.
Barriers to Making Regular PROM Testing Part of Antepartum Care
Other methods of diagnosing PROM include nitrazine (pH) testing, fern testing and the current gold standard for accuracy: dye infusion via amniocentesis. Several factors prevent the widespread use of these methods, however, including:
- Cost - Dye infusion in particular requires considerable resources to perform, including the requisition of a hospital bed, administration of anesthesia, and the use of expensive machinery many facilities do not have available.
- Invasiveness — Cervical digital testing presents a risk of infection which rules it out as a potential diagnostic method for PROM. Sterile speculum examinations, though safer, still require the dedicated use of hospital resources and considerable discomfort to both the mother and the fetus.
- Inaccuracy — Nitrazine and fern testing are both highly inaccurate, with low specificity and sensitivity, and a strong potential for false positives and negatives.1,2
Biomarker Testing for PROM
In order to make regular testing for antepartum conditions such as PROM a reality, diagnostic methods must be:
- Easy to administer
PROM and pPROM are serious antepartum complications that require accurate diagnoses and effective interventions to manage. With AmniSure®, it is easy and economical to make important care decisions that will protect fetal health.
- ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet. Gynecol. 2007 Apr;109(4):1007-19.
- Erdemoglu E, Mungan T. Significance of detecting insulin-like growth factor binding protein-1 in cervicovaginal secretions: comparison with nitrazine test and amniotic fluid volume assessment. Acta. Obstet. Gynecol. Scand. 2004;83:622–6.
- Abdelazim IA, Makhlouf HH. Placental alpha microglobulin-1 (AmniSure test) versus insulin-like growth factor binding protein-1 (Actim PROM test) for detection of premature rupture of fetal membranes. J. Obstet. Gynaecol. 2013;39,6:1129–1136