宫颈阴道分泌物中胰岛素样生长因子结合蛋白-1 在胎膜早破诊断中的价值

目的：探讨宫颈阴道分泌物中的胰岛素样生长因子结合蛋白－1（IGFBP－1）在胎膜早破诊断中的价值。方法：应用免疫层析法检测249例孕妇宫颈阴道分泌物中低磷酸化IGFBP－1的含量。结果：IGFBP－1诊断胎膜早破的敏感性为93.8%，特异性为94．5％，阳性预测值为97．6％，阴性预测值为86．3％。结论：检测宫颈阴道分泌物中的IGFBP－1是诊断胎膜早破快速、准确的方法。     

可溶性细胞间黏附分子-1快速检测方法在胎膜早破诊断中的价值

目的:探讨阴道液中可溶性细胞间黏附分子-1(s ICAM-1)快速检测方法在胎膜早破诊断中的临床应用价值。方法:采用胶体金免疫层析法对106例健康妊娠妇女和76例胎膜早破妇女阴道液中的s ICAM-1进行定性检测,并将s ICAM-1检测数据分别与本研究入选者分组诊断标准、羊水积液检测、阴道液p H值检测和羊齿植物叶状结晶检测数据相比较,进行一致性检验。结果:s ICAM-1对胎膜早破诊断的敏感性为100.00%,特异性为97.17%,阳性预测值为96.20%,阴性预测值为100.00%,准确度为98.35%;s ICAM-1检测结果与常规诊断方法、羊水积液检测、阴道液p H值检测和羊齿植物叶状结晶检测结果的一致性较好(kappa0.75,P=0.000)。结论:s ICAM-1是一个具有高敏感性和高特异性的胎膜早破诊断生物标志物,具有较强的临床应用价值。     

宫颈阴道分泌物绒毛膜促性腺激素和甲胎蛋白检测在胎膜早破诊断中的价值

目的　探讨宫颈阴道分泌物绒毛膜促性腺激素 (hCG)和甲胎蛋白 (AFP)检测 ,在胎膜早破诊断中的价值。方法　对 2 0 8例胎膜早破孕妇和 12 0例正常孕妇的宫颈阴道分泌物进行hCG和AFP检测。结果　hCG诊断胎膜早破的准确率 93 3 % ,敏感性 94 2 % ,特异性 91 7% ;AFP诊断胎膜早破的准确率 92 1% ,敏感性89 4% ,特异性 96 7%。二者差异无显著性 (P >0 0 5 )。结论　hCG和AFP对诊断胎膜早破均有较高的准确率、敏感性和特异性。对临床诊断均有较大的实用价值     

血清PCT、CRP对未足月胎膜早破并发绒毛膜羊膜炎的诊断意义

目的:探讨检测未足月胎膜早破(PPROM)孕妇血清降钙素原(PCT)及C-反应蛋白(CRP)浓度诊断绒毛膜羊膜炎的价值。方法:选取未足月胎膜早破患者55例,相同孕周健康孕妇40例,检测血清PCT、CRP。PPROM患者分娩后,对胎盘胎膜行病理学检查。结果:PPROM组孕妇血清中PCT、CRP阳性率高于对照组,差异有统计学意义(P<0.05);但PPROM组中有组织学绒毛膜羊膜炎与无绒毛膜羊膜炎的血清PCT、CRP无显著差异(P>0.05);PCT诊断绒毛膜羊膜炎的敏感性、特异性及阳性预测值、阴性预测值分别为60.00%、35.00%、61.76%、33.33%;CRP诊断绒毛膜羊膜炎的敏感性、特异性及阳性预测值、阴性预测值分别为57.14%、50.00%、66.67%、40.00%。结论:PPROM孕妇血清中PCT及CRP浓度升高,但其预测绒毛膜羊膜炎的价值尚需进一步研究。     

宫颈阴道分泌物胰岛素样生长因子结合蛋白-1检测在胎膜早破诊断中的价值

目的:探讨宫颈阴道分泌物非磷酸化胰岛素样生长因子结合蛋白-1(IGFBP-1)在胎膜早破诊断中的临床价值。方法:2002年1月至2003年6月采用快速层析法对59例确诊或疑似胎膜早破孕妇和40例正常孕妇宫颈阴道分泌物进行IGFBP-1检测。结果:应用IGFBP-1诊断胎膜早破的准确率、敏感性和特异性分别为100.0％、100．0％、90．9％和98．3％。检测IGFBP-1的敏感性、阴性预测值和精确度均显著高于羊齿状结晶法和pH值法。结论:宫颈阴道分泌物IGFBP-1的检测可用于诊断胎膜早破，具有操作简便、快速和准确的特点，对临床确诊胎膜早破具有较大的实用价值.     

阴道冲洗液β-hCG水平在胎膜早破诊断中的临床价值

胎膜早破处理不当可危及母婴生命,快速、准确地作出诊断是正确处理胎膜早破的前提。我们探讨了检测阴道冲洗液中β-hCG水平对诊断胎膜早破的价值。1 资料与方法11 研究对象 选择1998年4月至9月在我院产科住院分娩胎膜早破孕妇73例,以及同期的早、中、晚期正常孕妇各85例为研究对象。胎膜早破组孕妇均系晚期妊娠,平均孕398±19周。12 方法121 胎膜早破的诊断标准 (1)病史：有液体自阴道流出;(2)视诊：见液体从阴道口流出或窥阴器检查见宫颈口有液体流出;(3)阴道分泌物pH值测定：pH值≥70为阳性;(4)结晶形成试验：从后…     

孕检试纸诊断胎膜早破的临床价值

本文通过对胎膜早破孕妇和正常孕妇的阴道液进行HCG定性检测，探讨孕检试纸诊断胎膜早破的价值。     

阴道唾液酸酶检测在细菌性阴道病及绒毛膜羊膜炎诊断中的价值

目的　探讨阴道唾液酸酶的检测在诊断细菌性阴道病及预测绒毛膜羊膜炎中的价值。方法　采用比色法对患细菌性阴道病孕妇 80例 (研究组 ) ,健康孕妇 6 0例 (对照组 )进行阴道唾液酸酶的检测 ,蓝色表示唾液酸酶阳性 ,颜色不变为阴性。绒毛膜羊膜炎的诊断以病理检测为准。结果　研究组孕妇中阴道唾液酸酶阳性率为 96 3% (77 80 ) ,明显高于对照组的 3 3% (2 6 0 ) ,两组比较 ,差异有极显著性 (P <0 0 0 1)。两组中阴道唾液酸酶阳性孕妇的绒毛膜羊膜炎、胎膜早破、早产及产褥感染的发生率分别是 2 6 6 %、39 2 %、2 1 5 %和 16 5 % ,明显高于阴道唾液酸酶阴性孕妇的 4 9%、9 8%、6 6 %和 3 3% ,两者比较 ,差异均有显著性 (P <0 0 1或P <0 0 5 )。阴道唾液酸酶预测绒毛膜羊膜炎的敏感性为 87 5 % (2 1 2 4 ) ,特异性为 5 0 0 % (5 8 116 )。结论　阴道唾液酸酶检测在细菌性阴道病中的阳性率高 ,尤其适用于孕期筛查 ;同时在早期预测绒毛膜羊膜炎等不良妊娠结局的发生中也有一定的实用价值。     

运动平板试验对诊断冠心病的价值分析

目的:评估运动平板试验在冠心病诊断中的价值。方法:选择有症状疑诊冠心病的病例100例,行心电图、运动平板试验及冠脉造影检查,以冠脉造影结果为对比分析,计算运动平板试验对冠心病患者诊断的敏感性、特异性、阳性预测值、阴性预测值、准确性指标。结果:运动平板试验对冠心病诊断的敏感性为81.63%,特异性为72.54%,阳性预测值为74.07%,阴性预测值为80.43%,准确性为77.00%。结论;运动平板试验对协助临床诊断冠心病有较高的价值。     

检测阴道液人绒毛膜促性腺激素诊断胎膜早破

胎膜早破为常见的产科并发症,如不能及时诊断和处理可危及母儿安全。临床上一般根据阴道流液,阴道积液,阴道液ｐＨ值测试,以及阴道液涂片检查作出诊断。近年来有报道,通过检测阴道液中的生化标记物,有助于胎膜早破的诊断[1]。我们就孕妇阴道液中人绒毛膜促性腺激素(ｈＣＧ)水平与胎膜早破的关系进行了前瞻性的研究,现报道如下。一、资料与方法1研究对象:在1998年1月至12月我院产科入院产妇中,随机选择临床初步诊断为胎膜早破者66例和正常晚期妊娠36例作为研究对象。胎膜早破者年龄为(28.1±2.5)岁,孕周为(38.9±3.0)周;正常妊娠者年龄为(29.…     

Qualitative human chorionicgonadotropin testing of cervicovaginal washings for the detection of preterm premature rupture of membranes

OBJECTIVE: This study was performed to determine whether a qualitative human chorionicgonadotropin (hCG) test using cervicovaginal washings obtained from pregnant women is a useful predictor of recent preterm premature rupture of the membranes (PPROM). STUDY DESIGN: A prospective observational analysis of qualitative hCG testing on cervicovaginal washings in patients with either known PPROM or with intact membranes was performed. Patients with singleton gestations between 24 and 34 completed weeks were included. PPROM patients had documented confirmatory tests, including visualized pooling of amniotic fluid in the vaginal vault that was nitrazine-positive and demonstrated ferning. Those with vaginal bleeding or an anomalous fetus were excluded. Before collection, all patients were screened for bacterial vaginosis and trichomoniasis. Washings were then collected from the posterior vaginal fornix with the use of a 5-mL sterile saline irrigation and aspiration technique. Samples were then agitated manually and applied to the Quickvue Onestep qualitative pregnancy test (Quidell, San Diego, Calif) with a threshold of 25 mIU/mL. Data were analyzed with the t test, chi 2, and Fischer exact tests. Sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values were calculated. When applicable, all 2-tailed P <.05 were considered significant. RESULTS: Fifty-two patients were enrolled in the study with 24 in the PPROM group and 28 in the control group. The 2 groups were similar with respect to demographic characteristics and wet preparation results. The mean gestation age was 31.4 +/- 2.4 (X +/- SD) and 30.8 +/- 2.7 weeks in the PPROM and control groups, respectively. The hCG test was positive in 19 (79%) of the PPROM patients and in 1 (3.6%) of the controls (sensitivity 79%, specificity 96%, PPV 95%, NPV 84%). CONCLUSION: Qualitative hCG testing of cervicovaginal washings appears to be an useful predictor of PPROM.     

Placental alpha microglobulin-1 (AmniSure<Superscript>®</Superscript> test) for detection of premature rupture of fetal membranes

Objectives

This study was designed to detect the accuracy of the placental alpha microglobulin-1 (PAMG-1) (AmniSure^® test) to diagnose premature rupture of the fetal membranes (PROM).

Study design

This comparative prospective study was carried out over 2 years in Al-Rashid Maternity Hospital, Kuwait from January 2006 till January 2008.

Patients and methods

One hundred and fifty (150) pregnant women after 37 weeks gestation were included in this study for induction of labor and divided into two groups according to the presence or absence of PROM; 75 patients with PROM were included in group I and 75 patients without PROM were included in group II as controls. Patients with multiple pregnancies or fetal distress or vaginal bleeding or preterm labor or chorioamnionitis were excluded from this study. Trans-abdominal ultrasound was done to detect the gestational age and the amniotic fluid index (AFI ≤5 cm in PROM) followed by sterile speculum examination to detect amniotic fluid pooling from the cervical canal and for the collection of samples.

Results

In this study, the sensitivity and the specificity of PAMG-1 to diagnose PROM were 97.33 and 98.67%, respectively, compared with 84% sensitivity and 78.67% specificity for Ferning test and 86.67% sensitivity and 81.33% specificity for Nitrazine test. The positive predictive value (PPV) and negative predictive value (NPV) of PAMG-1 were 98.64 and 97.37%, respectively, compared with 79.74% PPV and 83.1% NPV for Ferning test and 82.28% PPV and 85.91% NPV for Nitrazine test. PAMG-1 was accurate (98%) for detection of PROM than Ferning (81.33%) or Nitrazine (84.0%) tests.

Conclusion

Detection of the PAMG-1 in the vaginal fluid using AmniSure^® test is an accurate method to diagnose rupture of the fetal membranes, with high sensitivity, specificity, negative and positive predictive values.

     

Use of beta subunit of human chorionic gonadotropin assay as a diagnostic tool for prelabor rupture of membranes

Purpose: The study aimed at assessment of the accuracy of the β-hCG test in vaginal washing fluid for diagnosis of prelabor rupture of membranes (PROM).

Patients and methods: Two groups of pregnant women from 17 to 38 weeks of gestation were recruited. The first group (PROM group) included 50 pregnant women with unequivocal PROM. The other group included 50 pregnant women with intact membranes. A sterile speculum examination was performed. If less than 5?cc was collected or no fluid found, 10?cc sterile saline was sprinkled on the vaginal wall and 5?cc were recollected in a sterile syringe. Two drops of collected fluid were used for qualitative testing of β-hCG. The remaining fluid was used for quantitative assessment of β-hCG.

Results: The quantitative β-hCG test results were significantly higher in PROM group (median and range: 138.5 (23–475) versus 13 (1–55); the difference in medians and 95% CI: 105 (91–166); p value: <.001). The qualitative β-hCG test was positive in 42/50 (84%) of the PROM group, while it was negative in 50/50 (100%) of the intact membranes group. Areas under receiver operating characteristics (AUC) for both the quantitative and qualitative β-hCG tests were high (0.97, 95% CI: 0.91–0.99, p value: <.001 and .92, 95% CI: 0.84–0.96, p value: <.001, respectively). The suggested cut-off of β-hCG for the quantitative test was 32 mIU/ml. The sensitivity of quantitative and qualitative tests are: 94, 95% CI: 83.5–98.7% and 84, 95% CI: 70.9–92.8%, respectively. The specificity of quantitative and qualitative tests are: 94, 95% CI: 83.5–98.7% and 100, 95% CI: 92.9–100%, respectively.

Conclusion: β-hCG test (either quantitative or qualitative) in vaginal washing fluid can be used in the diagnosis of PROM in both preterm and term cases.     

The application of magnetic cell sorter (MACS) to detect fetal cells in maternal peripheral blood

OBJECTIVES: The aim of the present study was to investigate the effectiveness of sorting fetal nucleated red blood cells (FNRBC) from maternal peripheral blood, particularly during early gestation periods, by a combination of specific gravity centrifugation and magnetic cell sorter (MACS). METHODS: Without prior knowledge of the gender of the fetus, we determined gender by analyzing a Y-chromosome specific sequence by nested-PCR, using 10 ml of the peripheral blood of healthy primigravida women at different stages of gestation (first trimester: n = 17, second trimester: n = 13, and third trimester: n = 19). The results of this prenatal sex determination were compared to the sex of newborns. RESULTS: The specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of the present method during the first trimester were 100, 81.8, 100, and 75%, respectively; during the second trimester, 80, 50, 80, and 50%, respectively; and during the third trimester, 25, 63.6, 53.8, and 33.3%, respectively. CONCLUSION: The results show that this prenatal sex determination method has a highly accurate diagnostic rate during the first trimester, suggesting that it could be developed as a practical, non-invasive prenatal diagnostic technique for use during early gestation periods.     

Comparative study of three amniotic fluid markers in premature rupture of membranes: prolactin, beta subunit of human chorionic gonadotropin, and alpha-fetoprotein

OBJECTIVE: To evaluate whether prolactin, alpha-fetoprotein (AFP) or B-human chorionic gonadotropin (BHCG) is the most effective marker in vaginal fluid for diagnosing prelabor rupture of membranes (PROM). These proteins are present in amniotic and vaginal fluid and have been reported to be potent markers of PROM, but have not been used clinically nor compared to each other. STUDY DESIGN: A total of 100 pregnant women between 28 and 37 weeks of gestation were recruited for the study. Patients were divided into 2 groups. The first group consisted of 50 pregnant women diagnosed with ruptured membranes. The second group consisted of 50 normal pregnant women seen during routine antenatal clinic visit (control) group. All women underwent speculum examination aiming to sample prolactin, BHCG and AFP in the vaginal fluid. Ultrasonographic examination for gestational age and amniotic fluid index measurement was performed. The electrochemoluminescence (ECLIA) method was used for quantitative measurement of the three proteins (the total duration of the assay was 18 min). RESULTS: Vaginal fluid concentrations of the three markers were significantly higher in the PROM group than in the control group (p < 0.001). Receiver operator curve analysis indicated that AFP had 94% specificity, sensitivity, positive and negative predictive values, and efficiency. The other two markers have lower specificity, sensitivity, positive and negative predictive values, and efficiency: 70, 76, 71.7, 74.5 and 73% for prolactin and 72, 84, 75, 81.8 and 78% for BHCG, respectively. CONCLUSION: This work demonstrates that of the three markers investigated AFP has the highest diagnostic performance. Using the ECLIA method it can be an ideal marker for diagnosing PROM particularly in equivocal cases. The technique could be introduced into laboratory tests to meet clinical needs. Basel.     

Lamellar bodies as a diagnostic test of fetal lung maturity.

OBJECTIVES: To determine the number of lamellar bodies in the amniotic fluid indicating fetal lung maturity and to define the effectiveness of a diagnostic test in a healthy pregnant population. METHODS: The study took place at the Hospital General de Zona #16 Centro Médico Nacional del Instituto Mexicano del Seguro Social. Torreón, Coahuila, México, where 264 pregnant women were followed-up from August 1997 to October 1998. The women presented in labor between 26 and 41 weeks of gestation. Amniotic fluid was obtained during cesarean section or from the vaginal pool and lamellar bodies were counted without prior centrifugation in Cell-Dyn 3000's channel for blood platelets. Results were masked for neonatologists. RESULTS: The prevalence of respiratory distress syndrome (RDS) was found to be 14.9%. At the 8200/microl threshold, sensitivity was: 15.4% (95% CI=5.9-30.5%), specificity: 99.6% (95% CI=97.5-99.9%), positive predictive value (PPV): 85.7, negative predictive value (NPV): 87.1, likelihood ratio for a negative test (LR-): 0.85, and likelihood ratio for a positive test (LR+): 85.7. At the 57 000/microl level, sensitivity was: 92.3% (95% CI=79.1-98.3%), specificity: 70.9% (64.4-76.7%), PPV: 35.6, NPV: 98.1, LR-: 0.11, and LR+: 3.17. When the cut-off point was 79000/microl, sensitivity was: 100.0%, specificity: 43.0% (95% CI=36.5-49.8%), PPV: 23.5, NPV: 100.0, LR+: 34.3, and LR-: less than 0.001. CONCLUSIONS: Counting lamellar bodies is a quick, readily available, and very effective test.     

Use of oral glucose tolerance test in early pregnancy to predict late-onset gestational diabetes mellitus in high-risk women

AIM: To evaluate if any single plasma glucose level from the four values of the normal 100-g oral glucose tolerance test (OGTT) in early pregnancy (< or =20 weeks of gestation) could predict gestational diabetes mellitus (GDM) diagnosed from a second OGTT in late pregnancy (28-32 weeks). METHODS: Glucose levels of pregnant women at high-risk for GDM, who had had a normal early OGTT, and who underwent the second test in late pregnancy, were studied. Each of the four plasma glucose values of the early OGTT was determined for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver operating characteristic curves of these four OGTT values were then constructed to find the optimal value to predict late-onset GDM. RESULTS: Of 193 pregnant women who had had a normal early OGTT, 154 also had a normal OGTT in late pregnancy while 39 had an abnormal test and were diagnosed with GDM. Among the four glucose values of the early OGTT, the 1-h value yielded the best diagnostic performance to predict late-onset GDM. The sensitivity, specificity, PPV, NPV, and area under the curve achieved from its optimal cutoff level of > or =155 mg/dL (8.6 mmol/L) were 89.7%, 64.3%, 38.9%, 96.1%, and 0.77, respectively. CONCLUSIONS: A 1-h glucose value > or =155 mg/dL at the early OGTT yielded the best diagnostic performance. However, the low specificity and PPV rendered it suboptimal to predict late-onset GDM. Nevertheless, a considerable number of high-risk women could avoid the second OGTT in late pregnancy due to its high sensitivity and NPV.     

Diagnostic power of the vaginal washing-fluid prolactin assay as an alternative method for the diagnosis of premature rupture of membranes.

OBJECTIVE: The purpose of this study was to determine the reliability of the vaginal washing-fluid prolactin assay for the diagnosis of premature rupture of membranes (PROM) and to determine a diagnostic cut-off value. STUDY DESIGN: Seventy pregnant women between 11 and 40 weeks of gestation who were admitted with vaginal fluid leakage were included in the study group, and were then further subdivided into two subgroups according to amniotic fluid pooling and nitrazine paper test results. Group 1 was the 'confirmed PROM group', positive for both pooling and nitrazine (38 patients). Group 2 was the 'suspected but unconfirmed PROM group' which had possible pooling and/or nitrazine (32 patients). Seventy pregnant women between 11 and 40 weeks of gestation without any complaint and complication were included in the control group (group 3). All patients underwent vaginal washing-fluid sampling and prolactin level determination. For the statistical analysis one-way analysis of variance, Tukey multiple comparison test, chi2 test and receiver operating characteristic (ROC) curve analysis were used. RESULTS: Geometric mean values of vaginal washing-fluid prolactin levels were 616.59 microIU/ml for group 1, 23.98 microIU/ml for group 2 and 10 microIU/ml for group 3 (p < 0.0001). The optimal diagnostic cut-off value was found to be 30 microIU/ml with 95% sensitivity, 78% specificity, 84% positive predictive value, 93% negative predictive value, 87% accuracy and 11.30 relative risk. CONCLUSIONS: We recommend vaginal washing-fluid prolactin level determination as an alternative diagnostic method for PROM.     

The clinical value of combining maternal serum screening and uterine artery Doppler in prediction of adverse pregnancy outcome.

Uterine artery Doppler waveform analysis is not offered in routine antenatal care in the UK. The aim of this study is to evaluate a policy of offering uterine artery Doppler ultrasound, in the setting of a District General Hospital, to women who are judged to be at high risk of adverse pregnancy outcome, based on their mid-trimester biochemical serum screening. Data from 73 cases with abnormal serum screening were collected and analysed. Abnormal outcome occurred in 11 cases (16%) including two perinatal deaths. The positive predictive value of adverse outcome was 13% for abnormal serum screening, 26% for human chorionic gonadotropin (hCG) >3 multiples of the median (MOM) and 8% for alfa-fetoprotein (AFP) >2.5 MOM. A total of 56 cases of the study group had uterine artery Doppler at 22 weeks' gestation. Evaluation of the performance of uterine artery Doppler in prediction of adverse pregnancy outcome revealed a sensitivity of 43%, specificity of 70%, a positive predictive value (PPV) of 18% and a negative predictive value (NPV) of 89%. When the presence of diastolic notch was taken to define a positive result the sensitivity remained unchanged, however the specificity, PPV and NPV improved to 91%, 43% and 91%, respectively. In conclusion, the combination of serum markers and abnormal uterine artery Doppler ultrasound improves the identification of women at risk of subsequent pregnancy complications. Raised serum hCG has a better predictive value for adverse pregnancy outcome as opposed to raised serum AFP. In the absence of diastolic notch, the accuracy of abnormal uterine artery Doppler ultrasound is markedly reduced.