The document discusses various challenges in diagnosing premature rupture of membranes (PROM). Current diagnostic methods like nitrazine tests, ferning tests, ultrasound and amniotic dye infusion are inaccurate or invasive. There is a need for an easy and accurate diagnostic test to correctly identify PROM and prevent misdiagnoses that can harm both mother and baby. Research into proteins in amniotic fluid showed promise but failed to produce a reliable diagnostic due to variability between patients. The problems of inaccurate or difficult testing for PROM remain unresolved.

1. Advances in Amniotic Fluid detection Dr. B. K. Iyer

3. PROM overview Source: James Alexander et al, Seminars in Perinatology, Vol 20, No 5, 1996: pp 369-374; Mercer et al, Am J Obstet Gynecol, 1999 Premature ROM (PROM) Rupture of the amniotic sac and leakage of amniotic fluid beginning at least 1 hours before the onset of labor at any gestational age. (PPROM) is the rupture of membranes before 37 weeks of gestation. Occurs in 3 % of pregnancies & is responsible for 1/3 of preterm births 10% of pregnant women are diagnosed with PROM (responsible for 25- 30% of premature births

8. Current diagnostic approaches

15. PPROM diagnostic approaches Conclusions “ Nitrazine and Ferning tests indicated that these tests have high inaccuracy rates, which increase progressively when more than one hour has elapsed since the rupture of the membranes, and become unreliable after 24 hours. It is concluded that in cases of prolonged PROM these tests provide no better diagnostic information than that obtained by simple clinical evaluation.” Reference 3 Reference 1 Reference 2 “ We note that the fern test is neither sensitive nor specific enough for diagnostic determination of premature rupture of membranes. We recommend against routinely providing fern testing alone for the detection of ruptured membranes.” “ We note that the pH / nitrazine test when applied to patients suspected of having PROM, the test does not appear to be sufficiently sensitive or specific enough for diagnostic determination of premature rupture of membranes.” Source: Trovo S. et al.Minerva Ginecol.1998;50(12):519-512 Source: NACB. Laboratory Medicine Practice Guidelines 2007. p 142-143.