Pregnant Woman With Premature Rupture of Amnion Membranes Clinical Trial
Official title:
A Comparison of Rapid Immunoassay Tests for the Detection of Ruptured Membranes
Specific objectives include analysis of performance of ROM Plus® in diagnosing ROM, as compared to Amnisure® and the conventional clinical assessment confirmed by a thorough chart review after delivery.
Premature rupture of membranes (PROM), defined as spontaneous rupture of membranes (ROM)
before the onset of uterine contractions, is one of the most common diagnostic dilemmas in
contemporary obstetric practice. Premature rupture of membranes can occur at any gestational
age, and preterm PROM (PPROM, defined as PROM before 37 weeks) is responsible for 20-40% of
preterm births. Early and accurate diagnosis of PROM would allow for gestational
age-specific obstetric interventions designed to optimize perinatal outcome and minimize
serious complications such as cord prolapse, preterm delivery, fetal distress and infectious
morbidity (chorioamnionitis, neonatal sepsis). Conversely, a false-positive diagnosis of
PROM may lead to unnecessary obstetric interventions, including hospitalization,
administration of antibiotics and corticosteroids, and even induction of labor. Therefore,
the correct and timely diagnosis of this disorder is of critical importance to the clinician
because PROM and PPROM may be associated with serious maternal and neonatal consequences.
The diagnosis of fetal membrane rupture is conventionally made using a clinical assessment.
First, by speculum examination, the clinician looks for amniotic fluid leaking from the
cervical os. If clear fluid is visualized leaking from the cervical os, the diagnosis is
positive for fetal membrane rupture. More commonly, leaking is absent, and a more extensive
workup is required, which includes nitrazine/pH testing, visual inspection of pooling of
fluid in the posterior fornix, and a microscopic evaluation of the collected specimen
(ferning). Although this approach is considered the standard of care, it is fraught with
inaccuracies, requires an intrusive examination and may not provide a rapid diagnosis.
Rapid, point of care, qualitative immunochromatographic tests (ie., Amnisure®, ActimProm®,
Amnioquick®) that detect proteins found in amniotic fluid at high concentrations, have been
used to diagnose the rupture of membranes (ROM) for several years. In many hospitals,
Amnisure® has replaced the sterile speculum exam as the standard of care for diagnosing ROM.
It identifies Placental Alpha Microglobulin-1 (PAMG-1), a 34 kd fetal glycoprotein, in
cervicovaginal secretions.
Recently a new, rapid, point of care, qualitative immunochromatographic test was introduced
to the market, ROM Plus®. Unlike the other immunoassay tests, ROM Plus® uses a unique
monoclonal/polyclonal antibody approach to detect two different proteins found in amniotic
fluid at high concentrations. ROM Plus® detects Placental Protein-12 (also known as
Insulin-like Growth Factor Binding Protein-1) as well as Alpha Fetoprotein (AFP). The
combination of PP12 and AFP were chosen not only because of their robust historical
literature support as ideal protein markers for amniotic fluid5-22, but also their unique
characteristics. PP12 is synthesized by the decidua of the placenta and reaches a very high
concentration level in the amniotic fluid early in the first trimester and stays at that
level until delivery. However, AFP, synthesized by the fetal liver and yolk sac, reaches its
peak concentration late in the second trimester/early third trimester. This increases the
chance that the proteins will be detected, especially in the preterm patients, when the
diagnosis of ROM is most crucial.
This study is designed to assess the performance (sensitivity, specificity, PPV, NPV) of ROM
Plus® and Amnisure®.
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Observational Model: Cohort, Time Perspective: Prospective