INSULIN-LIKE GROWTH-FACTOR BINDING-PROTEI N-1 (IGFBP-1) AND FETAL FIBRONECTIN IN DIAGNOSTICS OF PREMATURE RUPTURE OF MEMBRANES

The diagnosis of a premature rupture of membranes presents no problem in the vast majority of cases. However, a reliable diagnosis is clinic ally not possible in about 10%. Most methods available lack the necess ary sensitivity and specificity. Since the clinical consequences of a false diagnosis are considerable (overtreatment for false-positive and risk of infection for false-negative results), it is essential to cli nically establish new, minimally invasive methods with higher predicti ve powers. In the present study we compared: the AMNI Check(R) for det ection of insulin-like growth-factor binding protein 1 (IGFBP-1); a me mbrane immunoassay for detection of fetal fibronectin (fFn); pH indica tor paper; and, to verify a rupture of membranes in unclear cases, amn iocentesis with installation of indigo carmine. The examination was pe rformed in a group of 75 patients, 35 with and 40 without rupture of t he membranes. The best results were obtained for the AMNI Check(R) (se nsitivity and negative correctness 100%, specificity and positive corr ectness 83%). With the same sensitivity and negative correctness, the membrane immunoassay for fFn achieved a specificity of 70% and a posit ive correctness of 74%. The pH indicator paper had the lowest predicti ve Value (sensitivity 94%, negative correctness 93%, specificity 63%, positive correctness 69%). Both the AMNI Check(R) and the test for det ection of fetal fibronectin can be recommended for reliable exclusion of premature rupture of membranes. Amniocentesis should however be per formed in uncertain cases with a positive test result. Nevertheless, c onsiderable reduction of this invasive method is possible.