Vaginal fluid creatinine for the detection of premature rupture of membranes

Aim: The aim of this study was to evaluate the reliability of vaginal fluid creatinine for the diagnosis of premature rupture of membranes (PROM). Material and Methods: A total of 180 pregnant women were enrolled in the study. Group I (confirmed group) consisted of 60 women with a diagnosis of rupture of membranes confirmed by visualization of fluid passing from the cervical canal. Group II (suspected group) consisted of 60 women with a complaint of vaginal fluid leakage but without obvious amniotic fluid flowing from the cervix or vaginal pooling with negative nitrazine test. The control group (group III) consisted of 60 women without any complaint or complication. All patients were sampled for vaginal fluid creatinine by speculum examination. One-way ANOVA, chi(2), and Kruskal-Wallis test, as well as receiver operating characteristic (ROC) curve analysis were used. Results: The mean vaginal fluid creatinine in groups I, II, and III were 1.74 +/- 0.8, 0.45 +/- 0.2 and 0.25 +/- 0.1 mg/dL, respectively. The creatinine level was significantly higher in the confirmed group (group I) than in the other two groups (P < 0.0010). The optimal cut-off value was 0.5 mg/ dL with 96.7% sensitivity, 100% specificity, 100% positive predictive value, and 96.8% negative predictive value. Conclusion: Vaginal fluid creatinine determination for the diagnosis of PROM is reliable, simple, rapid and inexpensive.