title: Significance of detecting insulin-like growth factor binding protein-1 in cervicovaginal secretions: comparison with nitrazine test and amniotic fluid volume assessment.
abstract: OBJECTIVE
  The diagnosis of premature rupture of membranes (PROM) is sometimes challenging, and common diagnostic tests are of limited value in the diagnosis. We aimed to study the accuracy of detecting insulin-like growth factor binding protein-1 (IGFBP-1) in vaginal fluid by a rapid dipstick method in comparison with the nitrazine test and amniotic fluid index (AFI) and we studied the predictivity of these methods on the latency of pregnancy in patients with suspected PROM.
  
  
  METHODS
  One hundred and fifty-one patients (36 definite PROM, 35 no PROM and 80 suspected PROM) at 20-42 weeks' gestation were included in the study. Patients with preterm labor and PROM, patients at <20 gestational weeks, and those with multiple pregnancies were excluded. IGFBP-1 in the cervicovaginal fluid was measured by a rapid dipstick method (PROM test). AFI was measured by the four-quadrant method and an AFI of <80 mm was considered as oligohydroamnios.
  
  
  RESULTS
  The sensitivity, specificity and accuracy of the nitrazine test, the PROM test and AFI were 97, 16 and 56%, 97, 97 and 97% and 94, 91 and 92%, respectively. The nitrazine test results were affected by vaginal discharge but the PROM test results were not affected. Only a positive PROM test was associated with delivery within 7 days [odds ratio (OR) 12; 95% confidence interval (CI) 4.2-35, p < 0.001].
  
  
  CONCLUSIONS
  The dipstick method of detecting IGFBP-1 in the vaginal fluid is a rapid, reliable and noninvasive method. The PROM test is the most accurate diagnostic test and predictor of latency in patients with suspected PROM.
authors.affiliation: Zekai Tahir Burak Women's Health Research and Education Hospital, Ankara, Turkey. evrimmd@yahoo.com
authors.forename: Evrim
authors.initials: E
authors.lastname: Erdemoglu
authors.forename: Tamer
authors.initials: T
authors.lastname: Mungan
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000737:chemistry*; D001391:Azo Compounds; D015415:Biomarkers / Q000032:analysis; D002584:Cervix Uteri / Q000737:chemistry* / Q000378:metabolism; D016001:Confidence Intervals; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000032:analysis* / Q000378:metabolism; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011446:Prospective Studies; D011934:Reagent Strips; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D014621:Vagina / Q000737:chemistry* / Q000378:metabolism
chemical_list: D001391:Azo Compounds; D015415:Biomarkers; D018970:Insulin-Like Growth Factor Binding Protein 1; D011934:Reagent Strips; C013617:nitrazine yellow