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Is Amnisure ® useful in the management of women with prelabour rupture of the membranes?
Author(s) -
NEIL Peter R. L.,
WALLACE Euan M.
Publication year - 2010
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.2010.01238.x
Subject(s) - prom , medicine , rupture of membranes , prospective cohort study , obstetrics , confidence interval , pregnancy , pediatrics , cohort study , intensive care medicine , surgery , gestational age , biology , genetics
Aims: Prelabour rupture of membranes (PROM), whether at term or preterm, can be a difficult diagnosis to confirm. Clinician uncertainty often leads to unnecessary intervention for risk management reasons. Amnisure ® is a bedside immunoassay for placental alpha macroglobulin‐1 (PAMG‐1), which has been shown to have high sensitivity and specificity in the diagnosis of PROM. However, whether the use of Amnisure ® alters clinical management remains untested. The objective of this study was to assess the clinical utility of Amnisure ® . Methods: A prospective cohort study of 184 women presenting with a history of PROM to a tertiary maternity hospital. Before and after Amnisure ® , the attending clinician assessed and recorded membrane status (PROM or intact), his/her level of confidence in this diagnosis, and the intended management plan. Results: There was clinician uncertainty regarding the diagnosis of PROM in 83 (47%) women. Amnisure ® significantly increased clinician confidence and led to a change of intended management in 23 (13%) women. In 33 women presenting with possible preterm PROM, seven thought to have PROM before Amnisure ® had a negative test, leading to a change of management in these women. Conclusions: Amnisure ® is clinically useful when the clinician is uncertain about the diagnosis but not useful when the clinician is confident about the diagnosis. The use of Amnisure ® in women where the diagnosis is uncertain is likely to significantly change management, including reduced hospitalisation for women with preterm PROM.