Using β hCG, prolactin and IGFBP I single or in Pairs to diagnose PROM

Background: When diagnosing premature rupture membranes is query, choosing the appropriate management needsadditional confirmatory test. Based on their metabolomics, some biochemical markers have been proposed as diagnosticaids. A perfect test could be composed of combining more than one marker. Combining markers is not arbitrary as somecombinations could inversely impact the diagnostic accuracy of the test.Aim: Improving sensitivity and specificity of diagnosis of preterm premature rupture of membranes by combining quantitativeinsulin like growth factor binding protein 1 (IGFBP-1) with quantitative βHCG and/or quantitative prolactin in cervicovaginalfluid.Materials and Methods: It is a cross sectional study. IGFBP-1, prolactin and β-HCG concentrations in vaginal fluid wereexamined in 180 patients with sure membrane state and the diagnostic accuracy of each marker and each combination wasdetermined. The study was conducted between January 2018 and September 2018 in Ain-Shams University MaternityHospital after the approval of the institutional ethics committee. Informed consent has been obtained from the patientsbefore participation.Results: The sensitivity, specificity, PPV, and NPV of Prolactin with cutoff point 11 μIU/ml are 84.4, 73.2, 73.8,and 79.5, respectively, gives accuracy percentage 75.4%. The sensitivity, specificity, PPV, and NPV of ILGFBP-1 withcutoff point 102 μIU/ml are 88.3, 93.5, 100, and 69.4 respectively gives accuracy percentage 81.5%. The sensitivity,specificity, PPV, and NPV of Β-HCG with cutoff point 104 mIU/mL are 85.1, 83.9, 96.2, and 72.8 respectively givesaccuracy percentage 79.9%. The sensitivity, specificity, PPV, and NPV of the combination of IGFBP-1 and β-HCGare 78.4, 100, 100 and 64 respectively gives accuracy percentage 89.7. The sensitivity, specificity, PPV, and NPV of thecombination of IGFBP-1 and prolactin are 78.4, 100, 100 and 68.7, respectively, gives accuracy percentage 84.2. Thesensitivity, specificity, PPV, and NPV of the combination of β-HCG and prolactin are 79.8, 100, 100 and 63.6 respectivelygives accuracy percentage 77.2.Conclusion:Combining IGFBP-1 and β-HCG is the best diagnostic combination to detect amniotic fluid presence invaginal fluid. Combined IGFBP-1 and prolactin offered very little improvement compared to IGFBP-1 alone. Addingprolactin to β-HCG decreased accuracy than each of the other two markers alone.