Value ofVaginal wash Urea andCreatinineConcentration for Diagnosis of Premature Rupture of Membranes

Abstract

Prelabourruptureoffetalmembranes(PROM)referstofetalmembranerupturebeforetheonsetofuterinecontractions;pretermPROM(PPROM)isthetermusedwhenthepregnancyislessthan37completedweeksofgestation(Patricketal.,2012). PROM occurs in 10% of all gestation and about 2-4% of preterm pregnancies, with complications such as infection andpretermbirth (Modena et al., 2004). Correct diagnosis of PROM has a great importance because failure of diagnosiscan leadto unwantedobstetric complication, as chorioamnionitis, cord prolapse and placental abruption (Kim et al., 2005). Approximately one-third of women with PPROM develop potentially serious infections, such as intraamniotic infection (chorioamnionitis), endometritis, or septicemia (De Tejada, 2014). Serious complications of PROM that have been reported with conservative management of PROM occurring early in pregnancy are retained placenta or postpartum haemorrhage(Modena et al., 2004). The fetus and neonate are at greater risk of PPROM related morbidity and mortality than the mother. Preterm infants are especially vulnerable to a variety of problems, such as respiratory distress syndrome, intraventricular haemorrhage, periventricular leukomalacia, infection (eg, sepsis, pneumonia, meningitis), and necrotizing enterocolitis. The rates ofthesemorbidities vary with gestational age and are higher in the setting of chorioamnionitis(Soraisham et al., 2009). The risk to the fetus is greatly increased if PPROM occurs before the limit of viability. With prolonged oligohydramnios, there is significant risk for maldevelopment of the alveolar tree (pulmonary hypoplasia)as well as fetal compression resulting in malformations similar to those in Potter syndrome (DeFranco et al., 2007). The false diagnosis of membranes rupture can lead to inappropriate intervention such as hospitalization or induction of labor. Therefore, it is highly desirable to establish a definite diagnosis of rupture of membranes in uncertain cases without delay (Singh and Bhat, 2014).