OBJECTIVES: The objective of this study was to determine the most accurate method to use for the diagnosis of membrane rupture as well as to compare the sensitivity, specificity, positive and negative predictive values of such different methods.

METHODOLOGY: This prospective, non-randomized, descriptive study included 100 subjects, 50 each for the control group or women with intact membranes documented by history and physical examination, and gold standard group or women with ruptured membranes documented by history and pooling of amniotic fluid on speculum examination. Endocervical samples for control group (no pooling) and vaginal/posterior fornix samples for gold standard group (with pooling of fluid) were obtained from each patient used to test for determination using Actim^TM PROM test kit, ferning test, and pH testing using litmus paper.

RESULT: Ferning's test, Litmus paper test and Actim^TM PROM test have sensitivity of 30%, 44% and 74%, respectively specificity of 100%, 96%, 96% and respectively; PPV of 100%, 91.7% and 94.9% respectively; and NPV of 58.8%, 63.2% and 78.7% respectively. Actim PROM test kit was noted to be superior in terms of accuracy, followed by Litmus paper test, and lastly, by Ferning test as shown by the Receiver Operating Characteristic curve.

CONCLUSIONS: Actim^TM PROM test was noted to have the highest accuracy, as evidenced by the result of ROC curve, with the highest probability of testing positive in patients with true rupture of membranes, and with the highest Kappa statistic value or lowest probability of having interobserver variability.

Human ; Female ; Adult ; Fetal Membranes, Premature Rupture-diagnosis ; Preterm Premature Rupture of the Membranes

Subchorionic hemorrhage is a common sonographic feature during early pregnancy. It appears as a hypoechoic area (half moon or rocket shape) between the chorion and uterine wall. It can be seen as early as 9 weeks until 20 weeks AOG. The most common presenting feature of subchorionic hemorrhage is vaginal bleeding. Some however, are asymptomatic. Clinical significance of subchorionic hemorrhage remains controversial. Some studies conducted showed association of subchorionic hemorrhage with spontaneous abortion, preterm delivery, pre-eclampsia, pregnancy-induced hypertension and placental abnormalities. Recent management options for subchorionic hemorrhage are bed rest and progesterone supplementation. Data on bed rest are limited. Studies on the use of progesterone in subchorionic hemorrhage is also limited. But because of the risk of spontaneous abortion, most clinicians opt to give progesterone to prevent abortion. A total of 210 patients were included in the study. Subjects were randomly assigned to either the bed rest group or dydrogesterone plus bed rest group. Results showed that after two weeks of treatment, 44 patients (41.5%) had resolution of subchorionic hemorrhage after receiving dydrogesterone while 48 patients (46.2%) resolved in the bed rest group. A total of 2 early fetal demise were noted on each arm. For patients treated with dydrogesterone and bed rest, 62 still had subchorionic hemorrhage and 56 of the patients with bed rest alone, still had subchorionic hemorrhage. There is no significant difference in the mean measurement of subchorionic hemorrhage of patients under the two groups who still have it, after two weeks of treatment. Management of subchorionic hemorrhage with dydrogesterone plus bed rest and bed rest alone in patients does not resolve the hemorrhage and does not reduce the incidence of abortion.

Human ; Female ; Dydrogesterone ; Progesterone ; Pre-eclampsia ; Bed Rest ; Hypertension, Pregnancy-induced ; Abortion, Spontaneous ; Uterine Hemorrhage ; Chorion ; Fetal Death