indigo-carmine and Fetal-Membranes--Premature-Rupture

One of the most common problems an obstetrician faces is evaluation of a patient for PROM. Proper assessment of the patient requires a careful integration of history, physical examination, and clinical testing. The most commonly used tests are analysis of vaginal pH with nitrazine paper and evaluation of vaginal secretions with the arborization test. When history, nitrazine, and arborization testing are used in combination, 90% of cases will be diagnosed correctly. When the diagnosis is questionable, other modalities, including ultrasound evaluation and intraamniotic dye injection, should be used as indicated.

Topics: Amniotic Fluid; Azo Compounds; Crystallization; Female; Fetal Membranes, Premature Rupture; Humans; Hydrogen-Ion Concentration; Indicators and Reagents; Indigo Carmine; Pregnancy; Vagina

To evaluate clinical outcomes of women with singleton pregnancies that underwent intra-amniotic dye instillation (amniodye test) following equivocal diagnosis of prelabor rupture of membranes (PROM).. Records of 34 pregnant women who underwent amniodye test for equivocal PROM were reviewed. Comparisons of characteristics, amniotic fluid (AF) cultures, AF interleukin (IL)-6 concentrations, and placenta pathology results between women who tested positive and those who tested negative were performed. A sub-analysis of women who were amniodye test-negative was also performed.. (1) Commonest indication for amniodye test was a typical history of PROM with positive conventional tests and persistently normal AF volume, (2) amniodye test-positive women had a shorter procedure-to-delivery interval (p = 0.008), and a greater proportion of histologic acute chorioamnionitis (p = 0.04) and funisitis (p = 0.01) than amniodye-negative women, and (3) in addition to similarities to women with amniodye-positive test, amniodye test-negative women who delivered <34 weeks, had a greater proportion of women with risk for preterm birth (p = 0.04), than their counterparts who delivered between 34 0/7 and 36 6/7 weeks.. Equivocal diagnosis of PPROM should warrant an amniodye test to avoid iatrogenic intervention in women with intact amniotic membranes. AF analysis should be performed in amniodye test-negative women.

Topics: Adult; Amnion; Amniotic Fluid; Chorioamnionitis; Coloring Agents; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Indigo Carmine; Injections; Interleukin-6; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Ureaplasma Infections; Ureaplasma urealyticum; Young Adult

The purpose of this study was to compare the diagnostic performance of an immunoassay for placental alpha microglobulin-1 (PAMG-1) in vaginal fluid with the intra-amniotic instillation of indigo carmine for the diagnosis of membrane rupture in patients with an equivocal status.. A prospective multi-site study was performed involving women reporting signs, symptoms, or complaints suggestive of rupture of membrane (ROM) between 21 and 42 weeks of gestation without obvious leakage of fluid from the cervical os during sterile speculum examination and without confirmation of ROM by traditional methods.. A total of 140 patients were recruited with a prevalence of ROM of 19.3%. The PAMG-1 test had a sensitivity of 100.0% [confidence interval (CI) 0.87-1.0], specificity of 99.1% [(CI) 0.95-0.99], positive predictive value of 96.3% [(CI) 0.82-0.99], negative predictive value of 100.0% [(CI) 0.97-1.0], and ± likelihood ratios of 74.6 [(CI) 20.31-274.51] and 0.0 [(CI) 0.00-0.98].. The PAMG-1 immunoassay in vaginal fluid yielded results that were comparable to those of the instillation of indigo carmine into the amniotic cavity; therefore, we propose that PAMG-1 is a sensitive and specific test to assess ROM in patients with an equivocal diagnosis based on simple tests. This finding prompts consideration for the use of the noninvasive PAMG-1 test in situations where the use of the invasive dye test is not practical.

Topics: Adolescent; Adult; Alpha-Globulins; Amniotic Fluid; Coloring Agents; Female; Fetal Membranes, Premature Rupture; Humans; Immunoassay; Indigo Carmine; Insulin-Like Growth Factor Binding Protein 1; Pregnancy; Prospective Studies; Vagina; Young Adult

Amniotic fluid contains a heavily glycosylated pregnancy-related isoform of fibronectin (fFN), which can be detected using FDC-6, a monoclonal antibody directed against a novel epitope specific to fFN. It has been identified in the amniotic fluid in various concentrations throughout the different pregnancy periods and is localised at the interface of the chorion and the uterine decidua. Because of the unique pregnancy-associated expression of fFN, we determined the utility of cervicovaginal appearance of fFN as a marker of membrane integrity or rupture of membranes. In a prospective study we compared 1) the detection of fFN in cervicovaginal samples by a membrane-immunoassay (ROM-Check, Mast Diagnostica, Reinfeld, FRG) with 2) the results of intraamniotic injection of Indigo Carmine (IC), followed by the observation of dye spill into the vagina to confirm rupture of membranes. 65 patients were examined, 12 patients had to be excluded from the study for various reasons. Examination results were identical in 50 patients, while in three cases the fFN results were positive with a simultaneous negative result of the intraamniotic dye injection. In the case of blood contamination, the fFN test results were not valid; testing of maternal blood and of urine samples was fFN negative in all cases. We conclude, that oncofoetal fibronectin is an excellent marker for rupture of membranes. The test is easy to perform and does not involve the risk of an intraamniotic injection of dye.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amnion; Amniotic Fluid; Female; Fetal Membranes, Premature Rupture; Fibronectins; Humans; Indigo Carmine; Infant, Newborn; Injections; Obstetric Labor, Premature; Pregnancy; Prospective Studies; Risk Factors

Amniocentesis during the third pregnancy trimenon in case of suspected premature rupture is performed for two reasons: on the one hand, the maturity parameters can be determined as usual from the amniotic fluid, and on the other hand it serves to determine the presence of germs that may have caused the premature rupture. At the same time, it is possible to confirm the suspicion of premature hydrorrhoea gravidarum by instillation of dyestuff into the amniotic cavity. Premature rupture was confirmed in 21 of 65 cases where clinical findings had not supplied safe evidence; in the remaining 44 cases this method permitted the exclusion of premature hydrorrhoea. An evaluation was performed by means of a retrospective study of parturitions between 1975 and 1985 with regard to late amniocenteses in cases of suspected premature rupture, the investigated parameters being the course of pregnancy and of birth, postpartal state of well-being, bacteriological findings in the amniotic fluid, and results of instillation of blue dyestuff.

Topics: Amniocentesis; Bacteria; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Fetal Organ Maturity; Humans; Indigo Carmine; Leukocyte Count; Lung; Pregnancy; Pregnancy Trimester, Third

Topics: Amniocentesis; Amnion; Female; Fetal Membranes, Premature Rupture; Humans; Indigo Carmine; Indoles; Injections; Pregnancy