title: The diagnosis of rupture of fetal membranes (ROM): a meta-analysis.
abstract: OBJECTIVE
  The aim of this study was to compare the performance of tests based on the detection of insulin-like growth factor binding protein 1 (IGFBP-1) and placental α-microglobulin-1 (PAMG-1) in diagnosing rupture of fetal membranes (ROM) across different patient populations.
  
  
  METHODS
  A meta-analysis was conducted on prospective observational or cohort studies investigating ROM tests based on the detection of IGFBP-1 and PAMG-1 meeting the following criteria: (1) performance metrics calculated by comparing results to an adequate reference method; (2) sensitivity thresholds of the investigated tests matching those of the currently available tests; (3) study population, as a minimum, included patients between 25 and 37 weeks of gestation. Sensitivities, specificities, and diagnostic odds ratios were calculated.
  
  
  RESULTS
  Across all patient populations, the analyzed performance measures of the PAMG-1 test were significantly superior compared with those of the IGFBP-1 test. Of particular clinical relevance, PAMG-1 outperformed IGFBP-1 in the equivocal group, which comprised patients with uncertain rupture of membranes (sensitivity, 96.0% vs. 73.9%; specificity, 98.9% vs. 77.8%; PAMG-1 vs. IGFBP-1 tests, respectively).
  
  
  CONCLUSIONS
  Compared with its performance in women with known membrane status, the accuracy of the IGFBP-1 test decreases significantly when used on patients whose membrane status is unknown. In this latter clinically relevant population, the PAMG-1 test has higher accuracy than the IGFBP-1 test.
authors: Vivantes Hospital Neukolln, Perinatal Medicine, Rudowerstr. 48, D-12351 Berlin, Germany. ramsauer.publication@gmail.com
authors: Babett
authors: B
authors: Ramsauer
authors: Alex C
authors: AC
authors: Vidaeff
authors: Irene
authors: I
authors: Hösli
authors: Joong Shin
authors: JS
authors: Park
authors: Alexander
authors: A
authors: Strauss
authors: Zulfiya
authors: Z
authors: Khodjaeva
authors: Ángel Aguarón
authors: ÁA
authors: de la Cruz
authors: Txantón
authors: T
authors: Martínez-Astorquiza
authors: Jacques
authors: J
authors: Horovitz
authors: Frederic
authors: F
authors: Coatleven
authors: Hanns
authors: H
authors: Helmer
mesh_terms: D000653:Amniotic Fluid / Q000737:chemistry; D015415:Biomarkers / Q000032:analysis; D002584:Cervix Uteri / Q000378:metabolism; D003951:Diagnostic Errors; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000032:analysis* / Q000378:metabolism; D011247:Pregnancy; D014621:Vagina / Q000378:metabolism
chemical_list: D015415:Biomarkers; C032231:IGFBP1 protein, human; D018970:Insulin-Like Growth Factor Binding Protein 1