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Prelabour rupture of membranes (PROM) refers to the disruption of foetal membranes before the onset of labour, resulting in the leakage of amniotic fluid. PROM complicates 3% and 8% of preterm and term pregnancies, respectively. Accurate and timely diagnosis is crucial for effective management to prevent adverse maternal- and foetal-outcomes. The diagnosis of equivocal PROM cases with traditional methods often becomes challenging in current obstetrics practice; therefore, various novel biochemical markers have emerged as promising diagnostic tools. This narrative review is sought to review the published data to understand the current and emerging trends in diagnostic modalities in term and preterm pregnancies complicated with PROM and the potential role of various markers for predicting preterm PROM (pPROM) and chorioamnionitis in women with pPROM.

Failure to identify women with ruptured fetal membranes (RFM) is associated with subsequent infectious morbidity. To evaluate the diagnostic accuracy of AmnioQuick Duo in the detection of RFM, One hundred and twenty-five women (125) in the preterm premature rupture of fetal membranes/premature rupture of fetal membranes (PPRFM/PRFM) group were compared to one hundred and twenty women (120) controls in this study. On admission, after thorough history, the participants were examined by trans-abdominal sonography for evaluation of the amniotic fluid index (AFI), followed by sterile vaginal speculum examination to detect leaking amniotic fluid from the cervix, and for collection of samples for nitrazine, fern, and AmnioQuick Duo tests. The RFM were confirmed at delivery and compared using the recorded data of admission to evaluate the diagnostic accuracy of the AmnioQuick Duo in the detection of RFM (primary outcome). The AmnioQuick Duo test had 97.6% sensitivity, 98.3% specificity, 98.4% positive predictive value (PPV), 97.5% negative predictive value (NPV), and 97.95% overall accuracy in the detection of PPRFM/PRFM. The Nitrazine test had 64.8% sensitivity, 64.2% specificity, 65.3% PPV, 63.6% NPV, and overall accuracy 64.5% in the detection of PPRFM/PRFM. Fern test had 63.2% sensitivity, 59.2% specificity, 61.7% PPV, 60.7% NPV, and 61.2% overall accuracy in the detection of PPRFM/PRFM. The combined IGFBP-1/AFP (AmnioQuick Duo) test is an accurate bedside test with 97.6% sensitivity, 98.3% specificity, 98.4% PPV, 97.5% NPV, and 97.95% overall accuracy in the detection of PPRFM/PRFM. The sensitivity, specificity, PPV, NPV, and the overall accuracy of the AmnioQuick Duo were significantly higher than in the standard diagnostic nitrazine or fern tests in the detection of RFM.

Background: Premature rupture of membranes (PROM) refers to rupture of fetal membranes prior the onset of labor. If it occurs before 37 weeks of pregnancy, it is known as preterm premature rupture of membrane (PPROM). Prolonged duration from PROM till delivery is associated with increased maternal and neonatal morbidities, in term and preterm preg-nancies. This includes chorioamnionitis, fetal and neonatal sepsis, placental abruption, prematurity, umbilical cord pro-lapse, and increased rate of cesarean delivery. Pregnant women with history of vaginal leaking or ultra-sound evidence of diminished amniotic fluid should be care-fully evaluated to avoid adverse pregnancy outcomes. Accurate diagnosis helps obstetricians to optimize maternal and neonatal outcomes by early intervention to decrease morbidities. Diagnosis of PROM is may be easy by inspection of leaking through the cervix or fluid accumulation via speculum examination. However, with small rupture of membrane or rupture bag of hind-water, it is difficult to see amniotic fluid leakage clearly and diagnosis can't be easily made, which might lead to delay in diagnosis and management. Methods of PPROM diagnosis include fern and nitrazine which are two commonly used and traditional tests. They are rapid and easy tests but not completely reliable because of high false positive and negative results, which may be related to technical errors or contamination by blood, semen or cervical mucus. Ultrasound evaluation of amniotic fluid can't differentiate PROM from other causes of oligohydramnios. However, tampon or amnio-dye test is a test of accurate diagnosis through aspiration and dye injection into amniotic fluid under ultrasound guidance. It is an aggressive test with has a risk of bleeding, placental abruption infection, miscarriage, and iatrogenic uterine perforation. The Amnisure test for ROM is accurate but expensive and not available in many centers. Thus, a simple, non-invasive, and inexpensive method of detecting PROM is needed. Urea and creatinine are excreted by kidneys through glomerular filtration. Amniotic fluid also contains these markers and their determination in the vaginal can be used as a diagnostic test for PROM.Aim of Study: This study was conducted to evaluate the diagnostic value of urea and creatinine levels in vaginal wash in patients with suspected PROM. Patients and Method: The study was carried out at Ob-stetrics and Gynecology Department, Zagazig University Hospitals. A total of 228 pregnant women were included in study, between completed 24 weeks to completed 37 weeks' gestation. Divided into two equal groups: Group A with definite PROM, control Group is B. All pregnant women included in this study were subjected to: Full history taking, general, abdominal and speculum examination, fern test and nitrazine test. Vaginal wash urea measurement by enzymatic urease examination method and vaginal wash creatinine measurement by RATE JAFFE method. Results: The study showed that there is statistically significant difference between the two groups regarding vaginal wash urea and creatinine. The best cut-off value of vaginal wash urea in prediction of PROM is >!6.85mg/dl with AUC of 0.958, sensitivity of 98.2%, specificity of 70.2%, PPV of 76.7%, NPV of 97.6% and accuracy of 93%. The best cut-off value of vaginal wash creatinine in prediction of PROM is >!0.465mg/dl with AUC of 0.992, sensitivity of 100%, specificity of 80.7%, PPV of 83.8%, NPV of 100% and accuracy of 90.4%. Combined use of vaginal wash urea and creatinine in prediction of PROM had sensitivity of 98.3%, specificity of 91.2%, PPV of 91.8%, NPV of 98.1% and accuracy of 94.7%. Conclusion: This study concluded that urea and creatinine assay in vaginal fluid is cheaper, faster and more valid test, possible candidate for being a gold standard test for diagnosis of PROM.

The fern test is a method for assessing the characteristics of the nasal section in the treatment of patients with mucous dysfunction of the airway.The aim of this study was to investigate the role of the fern test in patients with rhinitis and to assess the classification of each type of rhinitis (types I-IV) in clinical practice.A cross-sectional study, which included consecutive patients from a third level Rhinology Unit, worked with 182 patients with rhinitis and 30 healthy subjects as control. The patients were subdivided according to their type of rhinitis: allergic rhinitis (59), infectious rhinitis (32), polyps (31), NARES (Non-allergic rhinitis with eosinophilia syndrome) (30) and NARNE (non-allergic rhinitis with neutrophils) (30).The control subjects had only type I or II rhinitis, whereas patients with rhinitis usually showed type III or IV. Allergic rhinitis and nasal polyps had the most serious deterioration according to the fern test (type IV).The fern test is effective for assessing mucus alterations in patients with rhinitis and it could be included as a new parameter in the study of rhinitis as a potential biomarker of the function of damaged epithelial cells.Antecedentes: La prueba de “helecho” es un método que sirve para evaluar las características de la secreción nasal en el tratamiento de pacientes con disfunción de la mocosa de la vía aérea. Objetivo: El objetivo del presente estudio fue investigar el papel de la prueba de helecho en pacientes con rinitis y evaluar la clasificación de cada tipo de rinitis (tipos I a IV) en la práctica clínica. Métodos: Estudio transversal en el que se incluyeron pacientes consecutivos de una unidad de rinología de tercer nivel. Se incluyeron 182 pacientes con rinitis y 30 sujetos sanos como controles. Los pacientes se subdividieron según el tipo de rinitis: alérgica (59), infecciosa (32), pólipos (31), rinitis eosinofílica no alérgica (30) y rinitis no alérgica con neutrófilos (30). Resultados: Los sujetos control solo presentaron rinitis tipo I o II, mientras que los pacientes con rinitis generalmente mostraban tipo III o IV. La rinitis alérgica y los pólipos nasales tuvieron el deterioro más grave según la prueba de helecho (tipo IV). Conclusiones: La prueba de helecho es efectiva para evaluar las alteraciones del moco en pacientes con rinitis y podría incluirse como un nuevo parámetro en el estudio de la rinitis como biomarcador potencial de la función de las células epiteliales dañadas.

Purpose: To evaluate and compare the reliability, accuracy and the cost benefit ratio of vaginal washing fluid urea, creatinine, Beta Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) for diagnosis of premature rupture of membranes (PROM). Material and Methods: A diagnostic study conducted on 70 patients. The patients were divided into three groups: Group A (n = 25): (Confirmed PROM group) patients who were either in labor or not in labor, Gestational age was from 24 weeks onwards and fulfilled the following criteria and/or two of these criteria with low AFI positive pooling, positive nitrazine paper test, positive fern test. Group B (n = 25): (Suspected PROM group) patients who fulfilled the following criteria: Patients with fluid leakage complaint with negative pooling and/or negative nitrazine paper test and/or negative fern test. Group C (n = 25): (Control group with no PROM) patients that were admitted to prenatal clinic for their regular prenatal control visit with 24 - 42 weeks of gestational age without any complaint or complication and with negative pooling, negative nitrazine paper test and/or negative fern test. The vaginal washing fluid urea, creatinine, Beta-Human Chorionic Gonadotropin (β-HCG) and placental alpha Microglobulin-1 (PAMG-1) were determined for diagnosis of premature rupture of membranes (PROM). Results: PAMG-1 detection in cervico vaginal discharge was a very good test for diagnosis of PROM with high sensitivity, specificity, positive predictive value, negative predictive value, accuracy and P-value (96%, 100%, 100%, 95.84%, 97.78% and

Background: Premature Rupture of Membrane (PROM) refers to the rupture of fetal membranes at least 1 hour before the onset of labor pain. The present study intended to determine the predictive value of maternal serum level of Procalcitonin in the early diagnosis of Chorioamnionitis in mothers with PPROM.Methods: In this prospective cohort study, a total of 48 patients with PPROM were selected as the intended sample size due limited financial resources and in accordance with previous articles in Kosar ward of Motahhari hospital of Urmia city, Iran. Inclusion Criteria were amniotic fluid leak, positive Nitrazine and Fern test, gestational age from 28 to 33 weeks and lack of fetal tachycardia. Exclusion Criteria were chronic and congenital heart disease as well as use of NSAIDs. Data were analyzed using SPSS 19 and descriptive statistics, independent t-test and Pearson test were performed.Results: The present study was conducted on 48 pregnant women and their neonates. About %39.6 of mothers was pathologically infected with Chorioamnionitis while %60.4 of the patients were not infected with the disease. Moreover, %68.8 of the neonates had a five-minute Apgar score of ≥7. There was a significant correlation between infection of mothers with histopathologic Chorioamnionitis and neonatal hospitalization in NICU (P

Objectives: Rupture of membranes prior to the onset of labor is known as Premature Rupture of Membranes (PROM). Early and correct diagnosis is crucial in order to prevent fetal and maternal risks that can be life threatening. We aimed to investigate the diagnostic ability of the tests in PROM. Materials and Methods: Nitrazine test, fern test, amnio-dye test, biochemical tests (insulin-like growth factor binding protein-1 and placental alpha microglobulin-1) were evaluated in terms of effectiveness in diagnosis of PROM. Results: A gold standard method has not yet been defined in PROM. Diagnostic tests (nitrazine test, fern test, Insulin-like Growth Factor Binding Protein-1 “IGFBP-1” and Placental Alpha Microglobulin-1 “PAMG-1”) should be used when the diagnosis is not certain following history, examination with sterile speculum and ultrasonography evaluation. Conclusion: IGFBP-1 and PAMG-1 are tests based on bedside immunochromatographic method. Especially, PAMG-1 comes into prominence with its high sensitivity and specificity.

Dry eye disease (DED) is a multifactorial disease of the tears and ocular surface that causes tear film instability with potential damage to the ocular surface. The prevalence of dry eye in the world population ranges from 6 to 34 %. It is more common in those aged over 50, and affects mainly women. Since the introduction of the Schirmer's test in 1903, other tests have been developed to evaluate dry eye, such as biomicroscopy, the tear film breakup time (BUT), vital dyes (lissamine green and rose bengal), fluorescein, leaf fern test, corneal sensitivity test, conjunctiva impression cytology, optical coherence tomography (OCT), and tear osmolarity measurement. Although there is no gold standard, it is advisable to combine at least two tests. Strategies for treating DED have recently been modified and include patient education, tear substitute, corticosteroids, secretagogues, fatty acids, immunomodulators, occlusion of lacrimal puncta surgery and, tarsorrhaphy. Biological therapy and new topical immunomodulators such as tacrolimus, tofacitinib and IL-1 receptor inhibitor are being tested. In this review, the evaluation tests for dry eye are compared and the main studies on treatment are presented, with emphasis on studies in patients with Sjögren's syndrome. The authors propose an approach for the management of dry eye.

Objective Accurate and timely diagnosis of rupture of membranes (ROM) is imperative to allow for gestational age-specific interventions. This study compared the diagnostic performance characteristics between two methods used for the detection of ROM as measured in the same patient. Methods Vaginal secretions were evaluated using the conventional fern test as well as a point-of-care monoclonal/polyclonal immunoassay test (ROM Plus®) in 75 pregnant patients who presented to labor and delivery with complaints of leaking amniotic fluid. Both tests were compared to analytical confirmation of ROM using three external laboratory tests. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Results Diagnostic performance characteristics uniformly favored ROM detection using the immunoassay test compared to the fern test: sensitivity (100% vs. 77.8%), specificity (94.8% vs. 79.3%), PPV (75% vs. 36.8%), NPV (100% vs. 95.8%), and accuracy (95.5% vs. 79.1%). Conclusions The point-of-care immunoassay test provides improved diagnostic accuracy for the detection of ROM compared to fern testing. It has the potential of improving patient management decisions, thereby minimizing serious complications and perinatal morbidity.

Point-of-care testing (POCT) is defined as analytic testing performed outside the central laboratory using a device or devices that can be easily transported to the vicinity of the patient. This article discusses rules and regulations concerning POCT, especially those covering provider-performed microscopy (PPM). Types of PPM are also covered, including the fern test, tests for the presence on fecal leukocytes and pinworms, and examinations of urine sediment and seminal fluid. The coordination of PPM within a hospital is also covered.

Our objective was to assess the value of insulin-like growth factor binding protein-1 (IGFBP-1) and other tests for the diagnosis of rupture of the membranes (ROM). We included 49 women with suspected ROM. The gold standard for membranes status was defined based on clinical examination, ultrasonography, tests results (except IGFBP-1) and labour information. Sensitivity, specificity, positive predictive value and negative predictive value of each test were as follows, respectively: IGFBP-1 (86, 74, 73 and 87%); bromothymol (64, 100, 100 and 77%); fern test (62, 96, 93 and 75%) and ultrasonography (19, 100, 100 and 61%). The detection of IGFBP-1 in vaginal secretions has high sensitivity for the diagnosis of ROM.

The examinations of labile specimens under the bright-field or phase contrast microscope are classified as provider-performed microscopy (PPM). With a PPM certificate issued by the Centers for Medicare and Medicaid Services Administration, a physician, nurse practitioner, nurse midwife, physician assistant, or dentist may perform PPM and waived procedures. Provider-performed microscopy procedures use specimens, such as body fluids or skin scrapings. Because quality control material is not available for PPM procedures, quality assurance assessment is complicated. Policies and procedures must be written for each test procedure. Provider-performed microscopy procedures include wet mounts, KOH preparations, pinworm detection, fern test, postcoital test, microscopic urinalysis, fecal leukocytes, semen analysis for presence of sperm and motility, and eosinophils in nasal smears. The quality of PPM is dependent on adequate training and retraining to achieve optimal skills.

Context: Pre-labour rupture of membranes (PROM) is a common obstetric complication which presents a diagnostic challenge, especially in equivocal cases. Standard methods of diagnosis are limited by high false positives and negatives. This study compared the accuracy of a biomarker placental alpha microglobulin-1 (PAMG-1) with the traditional methods of diagnosis. Objective: To compare the accuracy of PAMG-1 in cervicovaginal secretions with other standard methods in the diagnosis of PROM. Materials and Methods: A longitudinal prospective study was conducted among women with symptoms and signs of PROM at the Lagos State University Teaching Hospital. Standard tests and PAMG-1 assay were compared with the reported final diagnosis at delivery. Descriptive analysis was done using the Statistical Package for Social Sciences (SPSS) version 19. Results: A total of 140 consenting pregnant women were recruited in the study. An initial diagnosis of PROM was made in 67 patients (47.9%) using the standard methods of diagnosis whereas PAMG-1 immunoassay using Amnisure ROM test diagnosed PROM in 86 patients (61.4%). Upon review of patients' clinical records, 88 women (62.8%) had a final diagnosis of PROM. In the final analysis, PAMG-1 assay had a sensitivity of 97.7%, specificity 100%, PPV 100% and NPV 96.7%. The standard methods had a sensitivity 76.1%, specificity 92.2%, PPV 90.1% and NPV 70.4%. PAMG-1 had a highest accuracy of 98.6%, followed by nitrazine test 89.3%, pooling of liquor 83.5% and fern test 51.4%. Conclusion: The immunoassay of PAMG-1 had a higher diagnostic accuracy and is recommended for the diagnosis of PROM.

Objective: To identify methods used to diagnose premature rupture of membranes (PROM). Methods: A 14-item questionnaire was mailed to 1992 registered nurses certified in inpatient obstetrics to determine information on practice facility, obstetric services, procedures used to obtain vaginal fluids for testing, and methods used to diagnose PROM. Results: A total of 812 (40.8%) surveys were available for analysis. Of tests used to confirm PROM, observation of pooling fluid in the posterior fornix and fern tests were much more likely to be used in teaching and military hospitals and in facilities with tertiary obstetric services than in private hospitals (all P values < .001). To obtain vaginal fluids for fern and nitrazine testing, the dry glove method (ie, insertion of a gloved hand or nitrazine strip into the vagina) was used significantly more often in private hospitals than in teaching or military facilities (P < .001). In addition, the dry glove method was used significantly more often (P < .001) and the speculum examination was used less often (P < .001) to collect vaginal fluids for testing when private physicians performed more than 75% of deliveries at a particular hospital. In contrast, vaginal fluid was obtained during a sterile speculum examination more often in facilities in which more than 75% of deliveries were performed by residents (P < .001), and/or when more than 75% of speculum examinations were performed by nursing personnel (P < .001). Multiple linear regression analyses indicated that observation of pooling fluid and use of the fern test were significantly associated with hospital type, percentage of deliveries by private physicians, and percentage of speculum examinations performed by nursing personnel (all P values < .001). Conclusion: A sterile speculum examination is used more often to obtain vaginal fluids for testing and to diagnose ruptured membranes in teaching or military facilities and when nursing personnel have been trained in speculum examinations.

Objective. To determine the diagnostic accuracy of placental alpha microglobulin-1 assay and standard diagnostic methods for detecting rupture of membrane.Study Design. Prospective diagnostic study, between June 2011 to November 2011 at a tertiary centre. Initial evaluation included both the standard diagnostic methods for rupture of membranes and placental alpha microglobulin-1 immunoassay. The actual rupture of membranes was diagnosed on review of the medical records after delivery (absence of membrane or a positive pad chart).Main Outcome Measures. Placental alpha microglobulin-1 immunoassay and standard diagnostic methods for diagnosis of rupture of membrane.Results. A total of 211 patients were recruited. At initial presentation, 187 patients (88.6%) had ruptured membranes, while 24 patients (11.4%) had intact membranes. Placental alpha microglobulin-1 immunoassay confirmed rupture of membranes at initial presentation with a sensitivity of 95.7% (179 of 187), specificity of 100% (24 of 24), positive predictive value of 100% (179 of 179), and negative predictive value of 75.0% (24 of 32). By comparison, the conventional standard diagnostic methods had a sensitivity of 78.1% (146 of 187), specificity of 100% (24 of 24), positive predictive value of 100% (146 of 146), and negative predictive value of 36.9% (24 of 65) in diagnosing rupture of membrane.Conclusion. Placental alpha-microglobulin-1 immunoassay is a rapid and accurate method for confirming the diagnosis of rupture of membrane. It was superior to conventional standard diagnostic methods (pooling, nitrazine, and ferning), the nitrazine test alone or fern test alone.

Objectives: To compare insulin-like growth factor binding protein-1/alpha-fetoprotein (IGFBP-1/AFP) to placental alpha microglobulin-1 (PAMG-1) for diagnosis of premature fetal membranes rupture (PROM). Methods: 220 pregnant women ≥ 37 and Results: The sensitivity and specificity of AmnioQuick® Duo+ test to detect PROM was 93.6% and 86.4%; respectively compared to 95.5% and 89.1%; respectively for AmniSureR test, 72.7% and 80.9%; respectively for fern test and 76.4% and 83.6%; respectively for nitrazine test. PPV, NPV and accuracy of AmnioQuick® Duo+ test to detect PROM were 87.3%, 93.1% and 90%; respectively compared to 89.7, 95.1% and 92.3%; respectively for AmniSureR test, 79.2%, 74.8% and 76.8%; respectively for fern test and 82.4%, 77.97% and 80%; respectively for nitrazine test. AmnioQuick® Duo+ and AmniSure® tests had higher sensitivity, specificity, predictive values and accuracy to detect PROM compared to conventional diagnostic tests. Conclusion: AmnioQuick® Duo+ test for detection of IGFBP-1/AFP was rapid, accurate bedside test better than the individual conventional diagnostic tests and has same accuracy and performance like AmniSure® test.

The strength of the fern test to differentiate between amniotic and nonamniotic fluid in vaginal discharge was determined in 51 term women in labor with ruptured membranes and compared with that in a group of 120 nonlaboring subjects, presenting with nonspecific vaginal fluid loss. Sensitivity and specificity in the laboring group were 98.0 and 88.2%, respectively, in agreement with previous reports. In contrast, in the non-laboring group sensitivity and specificity were only 51.4 and 70.8%, respectively. The result of the fern test predicted the actual state of the membranes correctly in 63% and incorrectly in 29% of these patients. In 16 or 39 subjects with ruptured membranes (approximately 40%), the outcome of the fern test was negative. The modest diagnostic strength of the fern test in the present study compared with previously reported data is at least in part due to differences in study population (laboring versus nonlaboring) and to the fact that observers were deprived of relevant clinical information. It is concluded that the fern test should be granted supportive rather than conclusive value in diagnosing ruptured membranes in nonlaboring women presenting with nonspecific vaginal fluid loss.

Objective: To assess changes of tear film function in patients with pterygium after pterygium excision combined with limbal-conjunctival autograft transplantation. Methods: Sixty eyes of 60 patients were entered in the study. The Schirmer test, tear breakup time (BUT) and mucus fern test (MFT) were evaluated in the patients before and after pterygium excision combined with limbal-conjunctival autograft transplantation. Results: Compared with the opposite healthy eyes, the BUT and MFT in the eyes with pterygium were significantly different before the operation (p < 0.05); however, there was no significant difference in the results of the Schirmer test (p > 0.05). The results of the BUT and MFT in the eyes with pterygium were significantly different before and 4 weeks after the operation (p < 0.05). The BUT was prolonged from 9.89 ± 3.95 to 12.78 ± 4.12 s, and the ratio of normal crystallization in the MFT increased from 46.7 to 80.0%. There was no significant difference in the Schirmer test results before and after the operation (p > 0.05). Conclusion: Tear functions were abnormal in the eyes with pterygium. Pterygium excision combined with limbal-conjunctival autograft transplantation can partially restore the tear film function into normal state, and the tear film function was stable 4 weeks after surgery.

An approach to automatic prediction and detection of ovulation is described. It is based on the application of image processing techniques to the cervical mucus fern test, a popular clinical diagnostic method. The sequence of histogram equalization, filtering, edge detection, binarization, labeling, thinning, Hough transform, and automatic pattern recognition in a feature space is applied to microscopic images of the ferning patterns. This method permits decisions to be made based on quantitative data instead of the subjective evaluations that are presently used. >

PubMed: 11340392 The purpose of this study was to determine whether there is any abnormality in the tear function in patients with pterygium. Eighty-four patients with pterygia (56 with unilateral and 28 with bilateral involvement) and 45 healthy controls were entered in the study. Schirmer's test, breakup time test and mucus fern test were applied to both eyes of the subjects. This was a prospective, comparative and interventional study. Tear function test results between the eyes with pterygium and controls were compared. They were similar in the eyes with or without pterygium. There were no tear function abnormalities in pterygium. Copyright © 2001 S. Karger AG, Basel.

OBJECTIVE To evaluate the diagnostic value of insulin-like growth factor binding protein-1 (IGFBP-1) as an indicator of ruptured fetal membranes. METHODS IGFBP-1 concentrations were measured on 42 paired cervicovaginal samples before and after membrane rupture, using an immunoenzymatic assay. A PROM test [dipstick detecting IGFBP-1 with a cutoff value of 25 micrograms/l (A)], a BTB test (B), a ROM-Check (C), and a fern test (D) were compared in diagnosing ruptures of the membranes in 48 patients. RESULTS The optimal cutoff concentration was between 20.1 micrograms/l and 148.4 micrograms/l by receiver operating characteristic curve analysis. The PROM test had the highest sensitivity (94.7%) and highest specificity (93.3%) (sensitivity of A-D, B-D, C-D and specificity of A-B: p < 0.05 by chi 2-test). Unlike the other tests, the PROM test is unaffected by contamination, cervical dilatation, or uterine contraction. CONCLUSIONS The measurement of IGFBP-1 in vaginal fluids is useful for the diagnosis of ruptured fetal membranes.

To assess the utility of a latex agglutination test for alpha-fetoprotein in vaginal fluid for diagnosing rupture of the fetal membranes, we tested 91 pregnant women, including 32 with an established rupture, 19 with no evidence of rupture and 40 with a suspected rupture. Results were compared with those of the pH indicator and the fern tests. The latex agglutination test had better sensitivity, specificity, or both, than the pH indicator and the fern tests. We conclude that the latex agglutination test is more accurate than either the pH indicator or the fern test for diagnosing premature rupture of fetal membranes.

This paper gives the authors experience with the synthetic progestational steroids norlutin(17-alpha-ethinyl-19-nortestosterone) and methalutin(17-alpha-methyl-19-nortesterone) in the control of anovulatory cycles. The diagnosis of anovulation was made by curettage or endometrial biopsy prior to uterine bleeding in older patients and by pregnanediol determination or basal body temperature in younger. A fern test was usually done on the cervical mucus prior to therapy. Negative fern tests indicate different therapy. Amernorrhea in patients treated had varied from 35 days to 2 years. Each compound was given 2 mg orally over a 4-day period in cases of dysfunctional bleeding due to anovulation. Some patients received a second course when they had gone 5 weeks without another menstrual flow. Withdrawal flow followed promptly after cessation of medication in 20 of 22 patients treated. No side effects were noted. Also these drugs in doses used converted an estrogen-primed endometrium into a secretory pattern with withdrawal flow after cessation of therapy.

Literature on the various tests for detecting ovulation is reviewed. The tests discussed include: direct methods (flushing of ova from the tubes) recording of basal body temperature the benzidine test for uterine bleeding the Kraus method cervical mucus tests (fern test and spinnbarkeit) cold pressor test conjunctiva test measurement of electric potentials endometrial biopsy determination of plasma and urinary estrogens the hypermic response of the immature rat ovary to morning urine (Farris test) glucose test glucoseamine test determination of urinary gonadotropins determination of hydrogen ion concentrations in vaginal secretions pregnanediol determinations determination of the reduction time of oxyhemoglobin in the blood (Samuels test) mittleschmerz Takata test urinary sedimentation test analysis of vaginal smears and the Vitamin-C test (Pillay test). Since there is no good reliable single test it is suggested that a combination of several tests would afford a better estimation of when ovulation occurs.

Daily leukocyte alkaline phosphatase activity (LAP), basal body temperature (BBT), fern test (FT) and serum luteinizing hormone (LH) were determined during 15 normal menstrual cycles and 10 cycles treated with clomiphene citrate. A rise in LAP activity, as determined by LAP-relative score (LAP-RS), was observed during the midcycle period. This rise reached peak values on the day of serum LH surge in 60% of cycles. In the remaining cycles, LAP-RS showed peak values 1 day before (8%) or after (32%) LH peak. The mean LAP-RS peak value in clomiphene treated cycles was 13.2, 5-6 times higher than the basic value. The low point of the BBT coincided with the LH SURGE in only 32% of cycles. In 32% the span was more than 1 day before or after LH peak. The day of ovulation as determined by FT corresponded to the LH surge in only 40% of cycles. In 20% of cases, the ovulatory FT reponse occurred more than 1 day before or after LH surge. The results in this study indicated that LAP-RS is a rapid, simple and reliable test for timing of ovulation when carried out daily. It may be valuable in monitoring follicular activity during human chorionic gonadotropin therapy.

The accuracy rates of 3 diagnostic methods, namely pH determination, fern test and nile blue sulphate (NBS) staining, in the evaluation of women with prolonged premature rupture of fetal membranes (PRM), were investigated in a prospective study. Two hundred and sixty-two women, divided into control and test groups, were examined. A total of 1725 tests were performed. The results indicate 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 PRM these tests provide no better diagnostic information than that obtained by clinical evaluation.

Cervical mucus viscosity (CMV) and fern test (FT), leukocyte alkaline phosphatase (LAP) activity, basal body temperature (BBT) and serum luteinizing hormone (LH) levels were determined during 31 normal menstrual cycles of 29 volunteers. The day of the serum LH surge was taken as a reference point in evaluating the reliability and sensitivity in predicting ovulation of the other tests studied. Serum LH surge was accompanied by a sudden decrease in CMV, an increase in LAP activity, a gradual increase in FT and biphasic changes of BBT. In about 95% of cycles studied, the lowest values of CMV and peak values of LAP activity appeared on the day of the serum LH surge or one day before or one day after. The lowest point of the BBT coincided with the LH surge in only 26% of cycles. In 53% of cycles, the span was greater than one day before or after the LH peak. The FT corresponded to the LH surge in only 33% of the cycles, while in an additional 33% the preovulatory FT response occurred more than one day before or after the LH surge. The results indicate that CMV and LAP tests are rapid, simple and reliable for monitoring follicular maturation and the timing of ovulation when carried out daily, and may be of value in monitoring treatment during the induction of ovulation.

1. Examination of the cervical mucus for chlorides by the use of a “spot” test on a test paper parallels the fern test as a means of appraising ovarian hormone activity. 2. The test paper method is simpler, more accurate, easier to interpret, more economical, more rapid, and can be done readily by the doctor in his office. 3. The patient may take tests in sequence at home and bring the record to her physician for analysis. 4. The test paper technique has been found a valuable indicator for the determination of ovulation, ovarian hormone activity, the diagnosis of pregnancy, and observing the response to estrogen.

Samples of cervical mucus were obtained from 4 women for tests to determine specific cyclic changes. The tests performed determined the quantity viscosity acidity crystallization (fern test) length of the mucus thread (Spinnbarkeit) cellularity sperm penetration and protein electrophoresis of the cervical mucus. Samples were obtained and tested on the average of every 2 days during untreated normal cycles and during cycles of Norlestrin (2.5 mg norethindrone acetate and .05 mg ethinyl estradiol) administration. The results are graphed and discussed. General findings on Norlestrin-induced changes showed pronounced inhibition of sperm transmission through the cervical mucus absence of crystallization lowered Spinnbarkeit and a modified normal protein pattern.

Summary The total urinary oestrogen output has been compared with the indirect signs of oestrogen production using cervical mucus and vaginal smears. Two tests were carried out on cervical mucus (fern test and spinnbarkeit or thread length), and the karyopyknotic index was estimated in the vaginal smear. The indirect indices failed to exhibit any constantly increasing change when the output of oestrogens exceeded 50 μg./day. Reference to the tables will indicate that although these indices rose up to a level of 50 μg. and thence forward to 80 μg., they did not give any sign that such a 30 fig. rise had taken place.