Vaginal fluid creatinine as a promising alternative to existing diagnostic test for premature rupture of membranes (PROM)

• Author Details:   
• Neetu Singh
• Rashmi Verma
• Devyani Misra
• Manish Raj Kulshrestha
• Vandana Tiwari
• Rupita Kulshrestha ^*

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Background: Premature rupture of membranes (PROM) is associated with complications such as preterm birth, chorioamnionitis etc. The incidence of PROM at term gestation is about 10% and that of preterm premature rupture of membrane is 3% globally. Normal vaginal fluid does not contain creatinine so only when the membranes ruptures creatinine is detected in vagina. So, the present study aims to detect the correlation between vaginal fluid creatinine levels and PROM.

Materials and Methods: The women admitted between 28 to 37 weeks of pregnancy fulfilling inclusion and exclusion criteria were enrolled in our study after their informed consent. They were categorised as group 1 (cases) and group 2 (controls) (n=140 each, on the basis of history of leaking per vaginum). They were investigated by doing relevant investigations and clinical examination. Vaginal fluid was collected & sent to Department of Biochemistry for creatinine estimation. All patients participating in this study were followed till delivery to record maternal and fetal outcomes.

Results:  Data so gathered was analysed on IBM SPSS 21.0 software. Parametres such as age, parity, BMI, gestation age, occupation and social background did not show any statistical significance among cases and controls.  Cases had significantly higher creatinine levels in vaginal fluid & lower Amniotic fluid index (AFI) as those in controls. Cases had higher risk of chorioamnionitis, prolonged hospital stay & surgical site infections. Neonatal Intensive care unit (NICU) admission and still births were significantly higher in cases than controls.

Conclusion:  PROM is associated with increased maternal and neonatal complications. Vaginal fluid creatinine estimation might prove cost effective and feasible method as there is no need for extra equipment & reagent for detection of PROM.

Keywords: Vaginal fluid creatinine, Premature rupture of membranes (PROM), Chorioamnionitis, Surgical site infections, Still births, NICU.