Prospective cohort study investigating the reliability of the AmnioSense method for detection of spontaneous rupture of membranes

[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]

OBJECTIVE

To provide guidelines for the pelvic clinical exam in gynecology and obstetrics.

MATERIAL AND METHODS

A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized.

METHODS

The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology.

RESULTS

The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature.

CONCLUSIONS

The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.

[Diagnosis of rupture of fetal membranes: CNGOF Preterm Premature Rupture of Membranes Guidelines]

OBJECTIVE

To describe clinical and paraclinical tests diagnosing rupture of fetal membranes (ROM).

METHODS

Bibliographic search over the period 1980-2017 considering articles in French and English as well as guidelines from national obstetrical societies.

RESULTS

Typical amniotic fluid leakage occurs in ¾ of cases. In this situation, no additional test is required (Professional consensus). For ambiguous cases, a speculum examination can demonstrate pooling of amniotic fluid but suspicion can persist in 50% of cases (evidence level IV). In this context, we recommend to consider performing an IGFBP-1 or PAMG-1 test of vaginal fluid (evidence level III). Ability of these tests to reduce maternal or neonatal morbidity has never been demonstrated (Professional consensus). An isolated positive test should be considered cautiously as false positive does exist (Professional consensus).

CONCLUSION

Symptoms suggestive of ROM and speculum examination demonstrating pooling of amniotic fluid are sufficient to diagnose ROM. If pooling is not observed, we recommend to consider performing an IGFBP-1 or PAMG-1 test of vaginal fluid.

Women's expectations and experiences of rupture of membranes and views of the potential use of reagent pads for detecting amniotic fluid

AIMS

To explore first-time mothers' expectations and experiences regarding rupture of membranes at term and their views on the potential use of reagent pads that detect amniotic fluid.

BACKGROUND

There is little information available on women's experiences of spontaneous rupture of membranes, or interest in using methods to confirm rupture of membranes (e.g. reagent pads).

DESIGN

Descriptive qualitative study, using focus groups and telephone interviews with women during pregnancy and after the birth of their first baby. Thematic analysis was undertaken to analyse women's responses.

METHODS

Ethics committee approval was obtained. Twenty-five women participated in the study of whom 13 contributed both during pregnancy and postpartum between October 2015-March 2016.

FINDINGS

Three overarching themes were identified from the data from women's expectations and experiences: uncertainty in how, when and where membranes may rupture; information which was felt to be limited and confirmation of rupture of membranes. The potential use of reagent pads met with varied responses.

CONCLUSION

Women were interested in having facts and figures regarding rupture of membranes, such as characteristics of liquor; volume and probability of membranes rupturing spontaneously at term. Use of a pad as a means of confirmation was viewed as helpful, although the potential for increasing anxiety was raised.

Vision Amniotic Leak Detector (ALD) to Eliminate Amniotic Fluid Leakage as a Cause of Vaginal Wetness in Pregnancy: A NICE Medical Technology Guidance

In prelabour rupture of membranes (PROM) or preterm PROM the amniotic membranes rupture prior to labour. Where this is not overt a speculum examination is undertaken to confirm diagnosis. The Vision Amniotic Leak Detector (ALD) is a panty liner that can diagnose amniotic fluid as a cause of vaginal wetness. It was evaluated by the UK National Institute for Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme. The sponsor (CommonSense Ltd) identified five studies, of which three were deemed within scope by the External Assessment Centre (EAC). Two of these three used an inappropriate comparator. The EAC recalculated the diagnostic accuracy of Vision ALD using speculum examination as the comparator: sensitivity of 97% (95% CI 93-99%), negative predictive value of 96% (95% CI 92-98%). A negative result would therefore allow patients to be discharged with confidence. In the sponsor's cost-consequence model only patients with a positive Vision ALD result would have a speculum examination, producing a cost saving of around £10 per patient. The EAC felt that some costs were unjustified and the model did not include infection outcomes or use in a community setting. The EAC revised the sponsor's model and found the results were most sensitive to clinician costs. Vision ALD was associated with savings of around £15-£25 per patient when administration in lower-cost community healthcare avoided a referral to a higher-cost secondary-care centre. NICE published guidance MTG15 in July 2013 recommending that the case for adopting Vision ALD was supported by the evidence.

Diagnosis of premature rupture of membranes: inspiration from the past and insights for the future

OBJECTIVE

To review the diagnostic methods described to confirm premature rupture of membranes during pregnancy, and to assess their effectiveness in establishing the diagnosis.

DATA SOURCES AND EXTRACTION

The medical literature was searched to identify all relevant studies and reviews on methods for diagnosis of membrane rupture published in English up to January 31, 2009. Medline and the Cochrane databases were searched, and reference lists in identified articles were also examined. Articles not available through journals' online editions were retrieved by manual search.

STUDY SELECTION

We identified 71 original studies and reviews on diagnostic methods of chorioamniotic membrane rupture published in English. These articles were reviewed and results were summarized based on the diagnostic test assessed.

CONCLUSION

Recognition of the importance of and difficulties in confirmation of rupture of the chorioamniotic membranes pervades past and present obstetric publications. The subjectivity and poor sensitivity of early diagnostic techniques for confirmation of ruptured membranes sparked technical advancements using biochemical markers. None of these biochemical tests have gained popularity, although novel techniques involving placental markers such as placental alpha microglobulin-1 may provide a future solution to the problem of diagnosing chorioamniotic membrane rupture.