الفهرس 
PHYSIOLOGYOFAMNIOTICFLUIDANDFETALMEMBRANESOnly 14 pages are availabe for public view
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Abstract
Objective: Preterm prelabor rupture of membranes (PPROM) affects up to 3% of all pregnancies and remains a leading cause of preterm delivery as it accounts for about one third of all preterm births. The interval from rupture of membranes to delivery is important in directing the need for specific interventions such as hospitilization, intensive monitoring, time of steroids administration. However, predicting the latency period remains a challenge in obstetric practice. The aim of this study is to evaluate the clinical usefulness of systemic inflammatory markers (including total leucocytic count (TLC) and C- reactive protein (CRP)) and cervical length (CL) as a novel predictive markers for the latency period within 48 hours after preterm prelabor rupture of membranes (PPROM) in multigravid women between 28- 34 weeks of gestation.
Study Design: This is a Prospective observational study to evaluate the clinical usefulness of systemic inflammatory markers (including total leucocytic count and CRP) and CL measurement in 52 singleton pregnancies with PPROM between 28-34 weeks in multigravid women. The independent predictability of significant characteristics for delivery within 48 hours was determined using multivariate logistic regression then, ROC curve was used to determine best cut off value of cervical length to determine latency of ≤ 48 hours after PPROM, Sensitivity, specificity, and predictive values were calculated.
Results: A total of 52 multigravid women with singleton pregnancy and history of PPROMs were included in the study, the number of women delivered ≤ 48 hours was 15, while 37 delivered after more than 48 hours, comparison between the two groups of women according to latency period after PPROM was performed using Student t-test and no difference was found regarding Age, body mass index (BMI) and haemoglobin concentration. However significant difference was noted between the two groups regarding cervical length, TLC and CRP, using Student t-test for cervical length and Mann-Whitney test for other parameters. Then univariate and multivariate regression analysis for the association between significant variables and spontaneous onset of labor within the first 48 hours after PPROMs were performed considering that All variables with p<0.05 was included in the multivariate and that Statistically significant values at p ≤ 0.05, Only the association between cervical length was noted and that cervical length measurement is more superior than serum markers in prediction of latency period after PPROM. So a ROC curve was performed to determine the accurate cut off value of cervical length measurement that can predict latency period after PPROM within 48 hours and detected a cut-off ≤2.5 cm (95% CI 0.61 – 0.859) for predicting latency period ≤ 48 hours, sensitivity of 86.67%, specificity of 45.95, Positive predictive value (PPV) of 45.95% and negative predictive value (NPV) of 89.5%.
Conclusion: Cervical length measurement with a cut-off value of ≤ 2.5 cm has a superior role over systemic inflammatory markers (TLC and CRP) in prediction of latency period for the next 48 hours after PPROM in multigravid women between 28- 34 weeks of gestation.