Dr. Porreco Interview

Richard Porreco, MD:

Hi, my name is Rich Porreco; I am Director of Maternal Fetal Medicine at Presbyterian St. Luke's Medical Center in Denver, Colorado. I am here with Andy Combs. Andy?

Andrew C. Combs, MD, PhD:

Hi, I am a perinatologist with Obstetrix Medical Group and I am the Chairman of Ob/Gyn at Good Samaritan Hospital in San Jose. We are here today to talk about AmniSure, which is an exciting new development in the diagnosis of rupture of membranes. The test is based on the appearance of placental-associated micro globulin protein which occurs only in amniotic fluid, so the test is very highly sensitive and specific for the diagnosis of ruptured membranes and also offers a number of other advantages.

Richard Porreco, MD:

Well, it is important to make a diagnosis, don't you think? Not only at term, it has impacted care every day in this country, but also pre-term when these fetuses are at high risk for problems and to miss the opportunity to know how the fetus is because of premature rupture of the membranes would be a disaster. So having a gold standard, if you will, an accurate test that is easily applied can make a big difference in care.

Andrew C. Combs, MD, PhD:

That is absolutely right. Both false positives and false negatives are both a huge problem with clinical and economic consequences. Typically, traditionally in our specialty, we have had to put a speculum in and we have had to look for amniotic fluid issuing from the cervix, we have done a variety of bedside tests on it to make the diagnosis. It would be much more applicable and resource-friendly if we could get a test that was equally as sensitive or better for bedside nurses, experienced labor and delivery and bedside nurses or nurse practitioners or physicians to make the diagnosis without putting a speculum in. That is uncomfortable for the patients, to be sure, and I think that the advent of the technology to do that is really at hand.

Richard Porreco, MD:

Absolutely.

Andrew C. Combs, MD, PhD:

Our experience is that both at our hospital, which is a community level- three hospital, but also the neighboring hospitals in our community, the diagnosis of ruptured membranes oftentimes is the nurse placing a piece of nitrozene paper on whatever discharge is coming out and the fern test is oftentimes not even done as a confirmation. So we see a lot of false positives and false negatives. So the availability of a test that can be done by a nurse and doesn't require the doctor to come and actually perform the test is huge.

Richard Porreco, MD:

You know, the other thing is, we are a referral center from a relatively rural area and when a small rural hospital has a patient with pre-term rupture of the membranes or any question of it, they are quickly given incentive to try to move that patient to a tertiary center and sometimes the patients do not have ruptured membranes. They make a long trip, sometimes with adverse weather circumstances, and it would be really important if they could hang their hat on a test and say, you know, you really do not have ruptured membranes, you do not need to leave our community and be re-evaluated at a distance and at great expense. So the ease and applicability of this test for family practice doctors, certified nurse midwives, obstetricians who are in more rural settings, has a lot of impact in care and also resource allocation.

Andrew C. Combs, MD, PhD:

In terms of accuracy, I know we both read the paper by Cousins in the American Journal of Perinatology that showed the test was as accurate as fern and nitrozene in combination and in a few cases where there was disagreement, the conclusion was that it was actually the AmniSure that was correct rather than the fern and nitrozene test. But you have done a trial on your own confirming the accuracy.


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