الفهرس 
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Abstract
Summary
Premature rupture of membranes (PROM) is the rupture of fetal membranes at least 24h before onset of labour ,while preterm premature rupture of membranes ( PPROM) is the rupture of fetal membranes which proceed the onset of labour for more than 24hours before 37 weeks of gestation (Deering et al., 2007).
Failure to identify women with PROM associated with failure to implement standard measures and infectious morbidities (Wang T et al., 2015).
The false diagnosis of membrane rupture can lead to inappropriate interventions such as hospitalization or induction of labor. Therefore, many diagnostic test has been discovered including many biochemical markers as B-HCG, urea, creatinine, thyroid hormones fetal fibronectin and ILGF-1 but none of them proved to be the golden standard in diagnosis of (PROM). (Kafali and Oksuzler 2007).
The absence of a non-invasive standard test for diagnosis of ROM leads to appearance of several biological tests based on alternative markers that highly present in amniotic fluid (Abdelazim and Makhlouf 2013).
These biochemical markers include vaginal prolactin, alpha feto-protein (AFP), fetal fibronectin and insulin-like growth factor binding protein–1 (IGFBP–1) , but It was suggested that the detection of Placental alpha microglobulin-1 (PAMG-1) in the vaginal fluid will provide qualitative results that will exceed the current diagnostic methods in sensitivity and specificity (Abdelazim and Makhlouf 2013)
Amnisure is the test used for detection of PAMG-1 in cervicovaginal discharge.
In this study the result of Amnisure test was compared to other diagnostic test as Nitrazine, pooling and AFI.
This prospective case-control study was carried out at Beni- Suef General Hospital.
100 pregnant women between 20-37 gestation weeks of gestational age were enrolled in this study and divided as follows:
• group I (case group): (n=50) pregnant women, with uncomplicated pregnancy, between 20-37weeks gestational age, with history of leaking of watery discharge from vagina.
• group II: (n=50) pregnant women with uncomplicated pregnancy, between 20-37weeks gestational age, with no history of leaking of any watery discharge from vagina.
All groups were subjected to
All pregnant women of the two groups were subjected to
1- Full history.
2- General examination.
3- Abdominal examination.
4- Sterile cusco speculum examination.
5- Trans abdominal U/S.
6- Patients lied in lithotomy position in good illumination.
7- Sterile vaginal examination using a sterile Cusco speculum was done then vaginal fluid sampling was done as follows:
8- Detection the presence of PAMG-1 in cervicovaginal discharge by the previously mentioned technique using the Amnisure kits.
9- To do Nitrazine test, Litmus paper is put in the posterior vaginal fornix, changes in colour indicate acidity or alkalinity.
Results revealed that:
1- It was found that there was no significant statistical difference between the confirmed, suspected and control groups as regard maternal age, parity, gestational age and history of vaginal deleivery or cesarean section .
2- The results of pooling and Nitrazine tests were used to divide the pregnant women into +ve and –ve for PROM and to reveal the accuracy of Amnisure kits .
3- Detection of PAMG-1 was proved to be of highest sensitivity and specificity between all used tests.
4- The sensitivity and specificity of the Amnisure test were 98% and 100% respectively in comparison to 91.8% and 90.2% for Nitrazine.
5- These result proved that the use of Amnisure test is better than other traditionally available technique for diagnosis of PROM.
So, it’s our conclusion is to use Amnisure test for diagnosis of PROM, although the cost of the test is high in comparison to other diagnostic test but the high accuracy and reliability of it is a great benefit .