From the Guidelines
Diagnostic Methods for Preterm Premature Rupture of Membranes (PPROM)
To diagnose Preterm Premature Rupture of Membranes (PPROM), a combination of clinical evaluation, laboratory tests, and imaging studies are recommended 1.
- A thorough medical history and physical examination should be performed to assess for signs and symptoms of PPROM, such as vaginal fluid leakage, uterine tenderness, and fetal distress.
- A sterile speculum examination should be conducted to visualize the cervix and vagina for pooling of fluid, and a sample of the fluid should be collected for testing.
- The fluid can be tested for the presence of placental alpha-microglobulin-1 (PAMG-1) using a rapid immunoassay test, which can provide results within 10-15 minutes.
- Additionally, a nitrazine paper test can be performed to check the pH of the vaginal fluid, as amniotic fluid typically has a higher pH than normal vaginal secretions.
- Ultrasound imaging should also be performed to confirm the presence of oligohydramnios (decreased amniotic fluid volume) and to assess fetal well-being.
- In cases where the diagnosis is still uncertain, an amniocentesis may be considered to analyze the amniotic fluid for the presence of vernix caseosa and fetal cells.
- It is essential to note that women with suspected PPROM should be started on broad-spectrum antibiotics to reduce the risk of infection, as recommended by the Society for Maternal-Fetal Medicine 1.
- Corticosteroids may also be administered to promote fetal lung maturity, but the decision to administer them should be made on a case-by-case basis, considering the gestational age and the risks and benefits of expectant management versus abortion care 1.
From the Research
Diagnostic Methods for Preterm Premature Rupture of Membranes (PPROM)
The diagnosis of PPROM is made by a combination of clinical suspicion, patient history, and some simple tests 2. The following are some of the diagnostic methods used:
- Sterile speculum examination to identify nitrazine positive, fern positive watery leakage from the cervical canal 3, 4
- Nitrazine test to detect the presence of amniotic fluid 3, 4
- Ferning test to detect the presence of amniotic fluid 3, 4
- Amnisure test, which detects the presence of placental alpha macroglobulin-1 (PAMG-1) in vaginal secretions 3, 4
- Actim test, which detects the presence of IGFBP-1 in vaginal secretions 3
- Vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1 4
- Amniocentesis to rule out infection and confirm the diagnosis of PPROM 4, 2
- Infusion of indigo carmine to confirm the diagnosis of PPROM 4
Diagnostic Challenges
The diagnosis of PPROM can be challenging, especially in cases where the rupture of membranes is not overt 4. In some cases, the diagnosis may be made based on clinical suspicion and patient history, rather than a positive test result 2. The use of sensitive biochemical tests, such as the Amniosure test, can help to confirm the diagnosis of PPROM in cases where the clinical presentation is uncertain 3, 4.