رود ﻢﻫﺪﻔﻫ ة / هرﺎﻤﺷ 77 / هﺎﻣ نﺎﺑآ 1389 ناﺮﻳا ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ﻪﻠﺠﻣ
17
ﻲﺳرﺮﺑ – HCG
بآ ﻪﺴﻴﻛ ﻲﮔرﺎﭘ ﺺﻴﺨﺸﺗ ياﺮﺑ لﺎﻨﻳژاو ﻊﻳﺎﻣ β
يرﺪﺻ ءﺎﻬﺑ هﺮﻬﺷ ﺮﺘﻛد I
نﺎﻴﻧﺎﺷﺎﻛ ﻢﻳﺮﻣ ﺮﺘﻛد*
II
ﻲﻠﻴﻠﺧ ﻪﻓﻮﻜﺷ ﺮﺘﻛد III
هﺪﻴﻜﭼ
فﺪﻫ و ﻪﻨﻴﻣز :
زا كﻮﻜﺸـﻣ دراﻮـﻣ ﺺﻴﺨﺸـﺗ و ﺖـﺳا ﻲﮕﻠﻣﺎـﺣ رد ﻢـﻬﻣ تﻼﻜﺸﻣ زا ﻲﻜﻳ بآ ﻪﺴﻴﻛ سردوز ﻲﮔرﺎﭘ
هﮋﻳو ﺖﻴﻤﻫا
ﺖﺳا رادرﻮﺧﺮﺑ يا .
ﻣز رد تﺎﻘﻴﻘﺤﺗ ﺪـﻴﻳﺄﺗ رﻮـﻈﻨﻣ ﻪﺑ دﺎﻤﺘﻋا ﻞﺑﺎﻗ و ﻊﻳﺮﺳ ، هدﺎﺳ نﻮﻣزآ ﻚﻳ ﻲﻳﺎﺳﺎﻨﺷ ﻪﻨﻴ
دراد ﻪﻣادا بآ ﻪﺴﻴﻛ ﻲﮔرﺎﭘ .
ﻲﺳرﺮﺑ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ زا فﺪﻫ β-HCG
بآ ﻪﺴـﻴﻛ ﻲﮔرﺎـﭘ ﺺﻴﺨﺸـﺗ ياﺮﺑ لﺎﻨﻳژاو ﻊﻳﺎﻣ
(Premature Rupture Of Membrane-PROM) ﺖﺳا
.
شور رﺎﻛ : يور ﺮﺑ ﻲﻌﻄﻘﻣ ترﻮﺻ ﻪﺑ ﻪﻌﻟﺎﻄﻣ 123
ﻲـﮕﻤﻫ ﻪﻛ ﻪﻠﻣﺎﺣ نز ﺪـﻧدﻮﺑ ﻲﮕﻠﻣﺎـﺣ مﻮـﺳ ﺮﺘﺴـﻤﻳﺮﺗ رد
) ﻦـﺳ
زا ﺮﺘﺸﻴﺑ ﻲﮕﻠﻣﺎﺣ 28
ﻪﺘﻔﻫ ( ﺖﻓﺮﮔ مﺎﺠﻧا .
ﻪﺑ ﻼﺘﺒﻣ هوﺮﮔ ﻪﺳ رد نارﺎﻤﻴﺑ
) PROM
41 ﺮـﻔﻧ ( ﻪـﺑ كﻮﻜﺸـﻣ ،
) PROM
42
ﺮﻔﻧ ( ﻢﻟﺎﺳ بآ ﻪﺴﻴﻛ و )
40 ﺮﻔﻧ (
ﺪﻧﺪﺷ ﻪﺘﻓﺮﮔ ﺮﻈﻧ رد .
5 ﻲﺳ ﻲﺳ cc) ( ﻲـﻔﻠﺧ ﺲﻜﻴﻧرﻮـﻓ ﻪـﺑ ﻦﻴﻟﺎـﺳ لﺎﻣﺮﻧ ﻞﻳﺮﺘﺳا ﻊﻳﺎﻣ
ﺷ ﻊﻳﺎﻣ ﺲﭙﺳ و ﺪﺷ دراو نژاو ﻲـﻤﻛ ﻦﻴـﻴﻌﺗ ياﺮـﺑ و هﺪﻳدﺮﮔ هﺮﻴﭙﺳآ نژاو يﻮﺸﺘﺴ
β-HCG لﺎـﺳرا هﺎﮕﺸـﻳﺎﻣزآ ﻪـﺑ
ناﺰﻴﻣ و ﺪﻳدﺮﮔ β-HCG
ﺪﺷ ﻪﺴﻳﺎﻘﻣ هوﺮﮔ ﻪﺳ رد .
ﻪﺘﻓﺎﻳ
مﺮـﻧ زا هدﺎﻔﺘـﺳا ﺎـﺑ هﺪﻣآ ﺖﺳد ﻪﺑ يﺎﻫ راﺰـﻓا
SPSS V.11.5
ﺖـﻓﺮﮔ راﺮـﻗ ﻞـﻴﻠﺤﺗ و ﻪـﻳﺰﺠﺗ درﻮﻣ .
نﻮـﻣزآ زا يرﺎـﻣآ يﺎـﻫ One way ANOVA, t-student
Kroskal-Walisو
ﺪﻳدﺮﮔ هدﺎﻔﺘﺳا .
ﻪﺘﻓﺎﻳ ﺎﻫ : ناﺰﻴﻣ β-HCG بآ ﻪﺴﻴﻛ ﻲﮔرﺎﭘ نوﺪﺑ هوﺮﮔ رد mIU/ml
7 /
±15 71 / 7 بآ ﻪﺴﻴﻛ ﻲﮔرﺎﭘ ﺎﺑ هوﺮﮔ رد ،
mIU/ml 34
/
±366 06 / 468 ﻪﺑ كﻮﻜﺸﻣ هوﺮﮔ رد و PROM mIU/ml
37 /
±316 43 / 176 ﻪﻛ ﺪﻳدﺮﮔ شراﺰﮔ
ﻲﻨﻌﻣ توﺎﻔﺗ ﻲﻣ نﺎﺸﻧ هوﺮﮔ ﻪﺳ ﻦﻴﺑ ار يراد
داد ) 000 / 0 p=( .(
ﻚﻳ ﻦﻴﻴﻌﺗ رﻮﻈﻨﻣ ﻪﺑ Cut off value
ياﺮـﺑ β-HCG زا
ﻲﻨﺤﻨﻣ (Receiver Operating Characteristics ) ROC ﻪﻛ ﺪﺷ هدﺎﻔﺘﺳا
Cut off value دوﺪﺣ
mIU/ml 5 / 79 ﺎﺑ
ﺖﻴﺳﺎﺴﺣ 93 % ﻲﮔﮋﻳوو 84 % ﺪﻣآ ﺖﺳد ﻪﺑ .
ﻪﺠﻴﺘﻧ يﺮﻴﮔ β-HCG : ﻪﺑ كﻮﻜﺸﻣ دراﻮﻣرد لﺎﻨﻳژاو يﻮﺸﺘﺴﺷ زا هﺪﻣآ ﺖﺳد ﻪﺑ ﻊﻳﺎﻣ
و PROM
ﻲـﻌﻄﻗ PROM
ﻲﻣ و ﺖﺳا ﻢﻟﺎﺳ بآ ﻪﺴﻴﻛ دراﻮﻣ زا ﺮﺗدﺎﻳز
ﺺﻴﺨﺸـﺗ رد ﻊﻳﺮـﺳ و ﺐـﺳﺎﻨﻣ دﺎـﻤﺘﻋا ﻞـﺑﺎﻗ ﺖﺴـﺗ ﻚـﻳ ناﻮـﻨﻋ ﻪـﺑ ﺪﻧاﻮﺗ
PROM دﺮﻴﮕﺑ راﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ .
هژاو ﺪﻴﻠﻛ ﺎﻫ : 1 - بآ ﻪﺴﻴﻛ سردوز ﻲﮔرﺎﭘ 2
β-HCG- ، 3 - ﻚﻴﺗﻮﻴﻨﻣآ يﺎﻫﺎﺸﻏ 4
- لﺎﻨﻳژاو ﻊﻳﺎﻣ 5
- ﻲﮕﻠﻣﺎﺣ
ﺖﻓﺎﻳرد ﺦﻳرﺎﺗ :
25 / 5 / 89
، شﺮﻳﺬﭘ ﺦﻳرﺎﺗ :
14 / 6 / 89
ﻪﻣﺪﻘﻣ بآ ﻪﺴـﻴﻛ سردوز ﻲﮔرﺎﭘ Premature Rupture Of
the fetal Membranes (PROM)
ﻲﮔرﺎﭘ ﻪﺑ يﺎﻫﺎﺸـﻏ ﺎﻫ
ﻞﺒﻗ ﺖﻋﺎﺳ ﻚﻳ زا ﺶﻴﺑ ﻚﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎﻣ جوﺮﺧو ﻚﻴﺗﻮﻴﻨﻣآ
ﻲﻣ قﻼﻃا نﺎﻤﻳاز يﺎﻫدرد عوﺮﺷ زا
دﻮـﺷ
).
1
PROM(
ﻪـﺑ
ﻪﺘﺳد ود مﺮﺗ PROM
PROM) ﻪﺘﻔﻫ زا ﺪﻌﺑ 37
ﻣﺎﺣ ﻲﮕﻠ (
مﺮﺗ هﺮﭘ و (PPROM)
) ﻪﺘﻔﻫ زا ﻞﺒﻗ 37
ﻲﮕﻠﻣﺎـﺣ (
ﻢﻴﺴـﻘﺗ
ﻲﻣ ﻮﺷ د
).
1
PPROM(
رد 3 % ﻲﮕﻠﻣﺎﺧ
ﻲـﻣ قﺎـﻔﺗا ﺎﻫ
و ﺪـﺘﻓا
نﺎﻤﻳاز ﻪﻤﻫ مﻮﺳ ﻚﻳ لﻮﺌﺴﻣ
ﺖـﺳا سردوز يﺎـﻫ
).
2
ﻪـﺑ (
ياﺮـﺑ ﻲﺘﻳﺪـﻴﺑرﻮﻣ ندﺮﻛدﺎـﻳز ﻞـﻴﻟد ﻪـﺑ ﺰﻴﻧ و ﻞﻴﻟد ﻦﻴﻤﻫ هﮋﻳو ﺖﻴﻤﻫا زا دازﻮﻧ و ﻦﻴﻨﺟ و ردﺎﻣ ﺖﺳا رادرﻮﺧﺮﺑ يا
.
PPROM ﺎﺑ
ﻪـﺑ دازﻮﻧ و ﻦﻴﻨﺟ ، ردﺎﻣ ﻢﻬﻣ ﺮﻴﻣو گﺮﻣ
و ﺖـﻔﺟ ﻲﮔﺪـﻨﻛ ،فﺎـﻧ ﺪـﻨﺑ يور ﺮـﺑ رﺎﺸـﻓ ،ﺖﻧﻮﻔﻋ ﺖﻠﻋ
ﺖـﺳا هاﺮـﻤﻫ ﻦﻴﻨﺟ ندﻮﺑ سرﺎﻧ
).
3
ﻲﺘﻟﻮـﻣ نآ يژﻮـﻟﻮﻴﺗا (
ﻢﻬﻣ ﻲﻟو ﺖﺳا لﺎﻳرﻮﺘﻛﺎﻓ
رﻮﺘﻛﺎـﻓ ﻚﺴـﻳر ﻦﻳﺮـﺗ
نآ يﺎـﻫ
و ﻲﻠﺒﻗ سردوز نﺎﻤﻳاز PPROM
ﺖﺳا ﻲﻠﺒﻗ
).
3
(
ﺺﻴﺨﺸﺗ PPROM
و رﺎـﻤﻴﺑ ﻪﻘﺑﺎـﺳ ،ﻲﻜﻴﻨﻴﻠﻛ ﻚﺷ ﺎﺑ
ﻳا ﻲﺗﺎﻘﻴﻘﺤﺗ حﺮﻃ ﺐﻟﺎﻗ رد ﻪﻟﺎﻘﻣ ﻦ )
ﺪﻛ هژوﺮﭘ 571 ( ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد يروآ ﻦﻓ و تﺎﻘﻴﻘﺤﺗ ﺖﻧوﺎﻌﻣ ﻲﻟﺎﻣ ﺖﻳﺎﻤﺣ ﺎﺑ و ﺖﺳا هﺪﻳدﺮﮔ ﻪﻴﻬﺗ ناﺮﻳا
.
ﻪﺻﻼﺧ ﻪﻟﺎﻘﻣ ﻦﻳا نﺎﻳﺎﭘ زا ﺖﺳا يا
يرﺎﻤﻴﺑ ﻲﺼﺼﺨﺗ ياﺮﺘﻛد ﻪﺟرد ﺖﻓﺎﻳرد ﺖﻬﺟ ﻲﻠﻴﻠﺧ ﻪﻓﻮﻜﺷ ﺮﺘﻛد ﻪﻣﺎﻧ هﺮﻬﺷ ﺮﺘﻛد ﻲﻳﺎﻤﻨﻫار ﻪﺑ نﺎﻤﻳاز و نﺎﻧز يﺎﻫ
لﺎﺳ ،يرﺪﺻ ءﺎﻬﺑ 1387
.
(I
يرﺎﻤﻴﺑ ﺺﺼﺨﺘﻣ و رﺎﻳدﺎﺘﺳا
ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،يدﺎﺑآﺮﺒﻛا ﺪﻴﻬﺷ نﺎﺘﺳرﺎﻤﻴﺑ ،ﻲﺋﺎﻣﺎﻣ و نﺎﻧز هوﺮﮔ ،نﺎﻤﻳاز و نﺎﻧز يﺎﻫ -
،ناﺮـﻳا ﻲﻧﺎـﻣرد
ناﺮﻳا ،ناﺮﻬﺗ (II
يرﺎﻤﻴﺑ ﺺﺼﺨﺘﻣ و رﺎﻴﺸﻧاد
ﻴﻬﺷ نﺎﺘﺳرﺎﻤﻴﺑ ،ﻲﺋﺎﻣﺎﻣ و نﺎﻧز هوﺮﮔ ،نﺎﻤﻳاز و نﺎﻧز يﺎﻫ و ﻲﻜـﺷﺰﭘ مﻮـﻠﻋ هﺎﮕﺸﻧاد ،يﻮﻟﻮﻣ هاررﺎﻬﭼ ،يﻮﻟﻮﻣ نﺎﺑﺎﻴﺧ ،يدﺎﺑآﺮﺒﻛا ﺪ
ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ -
ناﺮﻳا ،ناﺮﻬﺗ ،ناﺮﻳا ﻲﻧﺎﻣرد
*) لﺆﺴﻣ ﻒﻟﺆﻣ (
يرﺎﻤﻴﺑ رﺎﻴﺘﺳد (III ﻲﺘﺷاﺪﻬﺑ تﺎﻣﺪﺧ و ﻲﻜﺷﺰﭘ مﻮﻠﻋ هﺎﮕﺸﻧاد ،يدﺎﺑآﺮﺒﻛا ﺪﻴﻬﺷ نﺎﺘﺳرﺎﻤﻴﺑ ،ﻲﺋﺎﻣﺎﻣ و نﺎﻧز هوﺮﮔ ، نﺎﻤﻳاز و نﺎﻧز يﺎﻫ
- ﺮﻬﺗ ،ناﺮﻳا ﻲﻧﺎﻣرد ناﺮﻳا ،نا
ﺖﺴﺗ ﻲﻣ ترﻮﺻ ﻲﺼﻴﺨﺸﺗ يﺎﻫ دﺮﻴﮔ
. ياﺮـﺑ رﺎـﻤﻴﺑ ﻪﻘﺑﺎﺳ
ﺺﻴﺨﺸﺗ PPROM
ﺖﺤﺻ 90 % ﻪﺘﻓﺮﮔ هﺪﻳدﺎﻧ ﺪﻳﺎﺒﻧ و دراد
دﻮﺷ
).
2 و 4
(
ﻦﺘـﺷاﺬﮔ ﺺﻴﺨﺸـﺗ و يرﺎـﻤﻴﺑ دﺎـﻳز ﺖـﻴﻤﻫا ﻞـﻴﻟد ﻪﺑ ﺖﺴــﺗ نآ ياﺮــﺑ ﺢﻴﺤــﺻ ياﺮــﺑ يدﺪــﻌﺘﻣ ﻲﺼــﻴﺨﺸﺗ يﺎــﻫ
ﻲﺑﺎﻳزرا PPROM
ﺖﺳا هﺪﺷ دﺎﻬﻨﺸﻴﭘ .
ﻦﻳزاﺮﺘﻴﻧ ﺖﺴﺗ
) 4 و 5
،(
نﺮﻓ ﺖﺴﺗ
) 4 و 5
(
ﺪﻧﻮـﺳاﺮﺘﻟوا و ،
) 3
(
شور زا ﻲﺼـﻴﺨﺸﺗ يﺎـﻫ
ﻲﻣ ﺐﺳﺎﻨﻣ رﺎﻴﺴﺑ ﺪﻨﺷﺎﺑ
).
3
(
ﺖﺴــﺗ ﺺﻴﺨﺸــﺗ ياﺮــﺑ يدﺪــﻌﺘﻣ ﻲﻳﺎﻴﻤﻴــﺷﻮﻴﺑ يﺎــﻫ
PROM
هﺪﺷ دﺎﻬﻨﺸﻴﭘ
ﻲﻣ رﺎﻛ ﻪﺑ يدراﻮﻣ رد و ﺪﻧا
ﻪﻛ ﺪﻧور
ﺺﻴﺨﺸﺗ PROM
ﺖﺴﺗ و ﺖﺳا كﻮﻜﺸﻣ رﺎﻴﺴﺑ
هدﺎﺳ يﺎﻫ
ﺪﻨﺷﺎﺒﻧ ﺖﺳرد ﺺﻴﺨﺸﺗ ﻦﺘﺷاﺬﮔ ﻪﺑ ردﺎﻗ ﻲﻠﺒﻗ .
ﺺﻴﺨﺸﺗ
PROM
ﭘ ﻪﻛ ﻲﺗرﻮﺻ رد ،ﺪﺷﺎﺑ ﺢﺿاو ﻲﮔرﺎ
ﺖـﺳا ﻚـﭼﻮﻛ ﻲﮔرﺎـﭘ ﻪـﻛ يدراﻮـﻣ رد ﻲـﻟو ﺖـﺳا نﺎﺳآ
ﻲـﻣ ﻦـﻜﻤﻣ ﺮـﻴﻏ ﻲﺘﺣ و ﻞﻜﺸﻣ
ﺪـﺷﺎﺑ . نآ ﺺﻴﺨﺸـﺗ مﺪـﻋ
ﻲﻣ مﺪـﻋ ﻪﻠﻤﺠﻨﻣ مزﻻ تﺎﻣاﺪﻗا يراﺮﻗﺮﺑ مﺪﻋ ﻪﺑ ﺮﺠﻨﻣ ﺪﻧاﻮﺗ
رﺎﻤﻴﺑ لﺎﻨﻳژاو ﻪﻨﻳﺎﻌﻣ
) 6
دﻮﺷ (
.
بذﺎـﻛ ﺺﻴﺨﺸـﺗ ﺲـﻜﻋ ﺮﺑ
ﻲﻣ ﺎﻫ ءﺎﺸﻏ ﻲﮔرﺎﭘ
ﻞـﺜﻣ ﺐﺳﺎﻨﻣﺎﻧ تﻼﺧاﺪﻣ ﻪﺑ ﺮﺠﻨﻣ ﺪﻧاﻮﺗ
يﺮﺘﺴــﺑ ﺎــﻘﻟا ﺎــﻳ نﺎﺘــﺳرﺎﻤﻴﺑ رد ندﺮــﻛ دﻮــﺷ نﺎــﻤﻳازﺀ
.
ﺖﺳا يروﺮﺿ كﻮﻜﺸﻣ دراﻮﻣ ﺺﻴﺨﺸﺗ ﻦﻳاﺮﺑﺎﻨﺑ .
ﺢﻴﺤـﺻ ﺺﻴﺨﺸـﺗ ﺖﻴﺒﺜﺗ ياﺮﺑ ﻪﻛ ﻲﺼﻴﺨﺸﺗ ﺖﺴﺗ ﺮﻫ
PROM
ﻲﻣ رﺎﻛ ﻪﺑ
ﻊﻳﺮـﺳ و دﺎـﻤﺘﻋا ﻞـﺑﺎﻗ ،هدﺎﺳ ﺪﻳﺎﺑ دور
ﺪﺷﺎﺑ
).
7
ﺮـﺑ بآ ﻪﺴـﻴﻛ ﻲﮔرﺎـﭘ ﺺﻴﺨﺸﺗ لﻮﻤﻌﻣ ﺖﻟﺎﺣ رد (
ﻚـﻴﺗﻮﻨﻴﻣآ ﻊﻳﺎﻣ جوﺮﺧ هﺪﻫﺎﺸﻣ و رﺎﻤﻴﺑ شراﺰﮔ سﺎﺳا زا
ﻲﻣ ترﻮﺻ ﺲﻜﻳوﺮﺳ
رد ﻚـﻴﺗﻮﻨﻴﻣآ ﻊﻳﺎﻣ هﺪﻫﺎﺸﻣ و دﺮﻴﮔ
ﻲـﻣ ﺪـﻴﻳﺄﺗ ار نآ مﻮﻟﻮﻜﭙـﺳا نداد راﺮﻗ زا ﺲﭘ نژاو
ﺪـﻨﻛ .
ﻊﻳﺎــﻣ جوﺮــﺧ ﻪــﭽﺨﻳرﺎﺗ رﺎــﻤﻴﺑ ﻪــﻛ دراد دﻮــﺟو يدراﻮــﻣ
ﻲـﻣ ار ﻚﻴﺗﻮﻨﻴﻣآ
ﻲـﻟو ﺪـﻫد Pooling
رد ﻚـﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎـﻣ
ﻲﻤﻧ هﺪﻳد مﻮﻟﻮﻜﭙﺳا
ﻲﻣ قﺎﻔﺗا ﻲﺗرﻮﺻ رد ﻪﻛ ،دﻮﺷ
ﻪﻛ ﺪﺘﻓا
ﺎﭘ زا ﻲﺗﺪﻣ ﺪﺷﺎﺑ ﻪﺘﺷﺬﮔ ﻲﮔر
.
زا ﺲﭘ ﻦﻳزاﺮﺘﻴﻧ ﺖﺴﺗ 48
رﻮـﻃ ﻪـﺑ ﺖﺳا ﻦﻜﻤﻣ ﺖﻋﺎﺳ
ﺪــﺷﺎﺑ ﻲــﻔﻨﻣ بذﺎــﻛ )
4 / 9
)(%
4
،ﺖﻴﺴــﻳوﺮﺳ دﻮــﺟو ﺰــﻴﻧ و (
زا هدﺎﻔﺘـﺳا و نﻮـﺧ و ﻦﻤﻴـﺳ ،راردا ﺎﺑ ﻲﮔدﻮﻟآ ،ﺖﻴﻨﻳژاو ﻚﻴﺘﭙــﺳ ﻲــﺘﻧآ
ﻲــﻣ ﺎــﻫ ﺪــﻨﻛ دﺎــﻳز ار ﻲــﻔﻨﻣ بذﺎﻛﺪــﻧاﻮﺗ
).
4 و 7 (
شور زا هدﺎﻔﺘﺳا ﻦﻳاﺮﺑﺎﻨﺑ ﻲﮔرﺎـﭘ ﻲـﺳرﺮﺑ ياﺮﺑ ﺮﮕﻳد يﺎﻫ
ﻛ ﻪﺘﻓﺮﮔ راﺮﻗ ﻖﻴﻘﺤﺗ درﻮﻣ بآ ﻪﺴﻴ ﺪﻧا
.
ﻚـﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎـﻣ رد ﻲﻳﻻﺎﺑ ﺖﻈﻠﻏ ﻪﻛ ﻲﻳﺎﻴﻤﻴﺷﻮﻴﺑ داﻮﻣ
ﻦﻴﻛﻮﻟﺮﺘﻨﻳا ﻞﺜﻣ ﺪﻧراد -
)6
8
،(
-α
ﻦﻴﺌﺗوﺮﭘ ﻮﺘﻓ
) 10 - 8
ﻦﻴﻣﺎﻳد ،(
زاﺪﻴﺴـــﻛا
) 11 و 12
ﻦﻴﺘﻛﻻوﺮـــﭘ ،( )
13 و 14
ﻦﻴﻨﻴﺗاﺮـــﻛ و هروا ( )
15
،(
ﻲــﻨﻴﻨﺟ ﻦﻴﺘﻜﻧوﺮــﺒﻴﻓ
) 16
و (
Insulin like growth factor
binding protein I
) 19 - 17
(
ﻪـﺘﻓﺮﮔ راﺮـﻗ ﻲﺑﺎﻳزرا درﻮﻣ ﺪـﻧا
.
داﻮـﻣ ﻦـﻳا زا ﺮـﮕﻳد ﻲﻜﻳ β-HCG
ﻲـﻣ ًاﺮﺼـﺤﻨﻣ ﻪـﻛ ﺪـﺷﺎﺑ
لﻮﻠﺳ ﻂﺳﻮﺗ
ﻪﺘﺧﺎـﺳ ﺖﻔﺟ ﺖﺳﻼﺑﻮﻓوﺮﺗ ﻮﻴﺸﻴﺳ ﻦﺳ يﺎﻫ
ﻲﻣ راردا و نﻮـﺧ ﺮـﺑ هوﻼﻋ ﺰﻴﻧ ﻚﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎﻣ رد و دﻮﺷَ
دراد دﻮــﺟو ردﺎــﻣ
) 13 و 20
ﻲﺑﺎــﻳزرا ﺖــﻬﺟ ﻲﺗﺎــﻌﻟﺎﻄﻣ رد و (
ﻔﺘﺳا درﻮﻣ بآ ﻪﺴﻴﻛ ﻲﮔرﺎﭘ ﺖﺳا ﻪﺘﻓﺮﮔ راﺮﻗ هدﺎ
).
6 و 20
(
ﻲﺼـﻴﺨﺸﺗ شزرا ﻲـﺳرﺮﺑ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ زا فﺪﻫ β-
ﺺﻴﺨﺸـﺗ ياﺮـﺑ نژاو يﻮﺸﺘﺴﺷ زا هﺪﻣآ ﺖﺳد ﻪﺑ HCG
ﺖﺳا PROM .
رﺎﻛ شور
ﻲــﻌﻄﻘﻣ ترﻮــﺻ ﻪــﺑ ﻪــﻌﻟﺎﻄﻣ -
هﺪﻫﺎﺸــﻣ (Cross يا
sectional observational) ﺪﻴﻬـــــﺷ نﺎﺘـــــﺳرﺎﻤﻴﺑ رد
ﻲﻧﺎـــﻣز ﻪﻠـــﺻﺎﻓ رد و ناﺮـــﻬﺗ يدﺎـــﺑآﺮﺒﻛا 1388
- 1387
ﮔ ترﻮــﺻ ﺖــﻓﺮ
. نﺎــﻧز زا هوﺮــﮔ ﻪــﺳ ار ﺶﻫوﮋــﭘ ﻪــﻌﻣﺎﺟ
ﻲﻣ ﻞﻴﻜﺸﺗ يرادرﺎﺑ
هدﺮـﻛ ﻪﻌﺟاﺮﻣ نﺎﺘﺳرﺎﻤﻴﺑ ﻪﺑ ﻪﻛ ﺪﻧداد
ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ و .
سردوز ﻲﮔرﺎـﭘ ﻪـﺑ كﻮﻜﺸـﻣ ﻪـﻠﻣﺎﺣ نﺎـﻧز لوا هوﺮﮔ رد بآ ﻪﺴﻴﻛ (PROM)
) 42 ﺮﻔﻧ ( ﻪـﻠﻣﺎﺣ نﺎـﻧز مود هوﺮﮔ رد ،
بآ ﻪﺴﻴﻛ ﺢﺿاو ﻲﮔرﺎﭘ ﺎﺑ (PROM)
) 41 ﺮﻔﻧ ( هوﺮـﮔ رد و
مﻮﺳ ﻢﻟﺎﺳ بآ ﻪﺴﻴﻛ ﺎﺑ ﻪﻠﻣﺎﺣ نﺎﻧز )
40 ﺮﻔﻧ ( ﺪﻨﺘﻓﺮﮔ راﺮﻗ .
ﻲﮕﻠﻣﺎﺣ ﻦﺳ ﻪﻠﻣﺎﺣ نﺎﻧز ﻪﻴﻠﻛ 28
ﺮﺗﻻﺎﺑ و ﻪﺘﻔﻫ )
سﺎـﺳا ﺮﺑ
ﺎــﻳ ﻲﮔﺪــﻋﺎﻗ ﻦﻳﺮــﺧآ زور ﻦﻴــﻟوا
ﺪــﻴﻳﺄﺗ و ﻦﺌــﻤﻄﻣ LMP
لوا ﺮﺘﺴــﻤﻳﺮﺗ رد ﻲﻓاﺮﮔﻮﻧﻮــﺳ (
ترﻮــﺻ رد و ﺪﻨﺘــﺷاد ار
ﻪﻘﺑﺎـﺳ ،ﺢـﺿاو ﺖﻧﻮﻔﻋ ﻪﻘﺑﺎﺳ ،لﺎﻨﻳژاو يﺰﻳﺮﻧﻮﺧ ﻪﻧﻮﮔﺮﻫ
ا هدﺎﻔﺘـﺳا و سﻮﺘﻳﻮﻛ
هﺪﻨﻳﻮـﺷ ز
ﻪـﻌﻟﺎﻄﻣ زا لﺎـﻨﻳژاو يﺎـﻫ
ﻞﻳﺮﺘــﺳا مﻮﻟﻮﻜﭙــﺳا ﻚــﻳ نارﺎــﻤﻴﺑ مﺎــﻤﺗ ياﺮــﺑ اﺪــﺘﺑا زا ﻚﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎﻣ جوﺮﺧ ﻲﺳرﺮﺑ ﻦﻴﻟوا ردو هﺪﺷ هدادراﺮﻗ
مﻮﻟﻮﻜﭙﺳا رد نآ نﺪﺷ ﻊﻤﺟ و ﺲﻜﻳوﺮﺳ (Pooling)
درﻮﻣ
ﺖﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ .
هوﺮـﮔ رد ﻊﻳﺎـﻣ ﺪـﻳﺎﺑ ،ﻲـﻌﻄﻗ PROM
رﻮﻃ ﻪﺑ ﻚﻴﺗﻮﻨﻴﻣآ
ﻲـﻣ هﺪـﻳد مﻮﻟﻮﻜﭙﺳا رد ﺢﺿاو
ﺪـﺷ . رد
نوﺪﺑ هوﺮﮔ PROM
ﻲﻤﻧ هﺪﻳد ﻲﺷﺰﻳﺮﺑآ ﻪﻧﻮﮔ ﭻﻴﻫ ،
و ﺪـﺷ
ﻪﻘﺑﺎـــﺳ ﺰـــﻴﻧ رﺎـــﻤﻴﺑ ار ﻚـــﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎـــﻣ جوﺮـــﺧ زا يا
ﻲﻤﻧ )داد و ﺮﮕﻳد ﻞﻠﻋ ﻪﺑ يﺮﺘﺴﺑ دراﻮﻣ زا هوﺮﮔ ﻦﻳا نارﺎﻤﻴﺑ
ﺪﻧﺪـﺷ بﺎﺨﺘﻧا ﻲﻳﺎﻣﺎﻣ هﺎﮕﻧﺎﻣرد رد ﻲﻳﺎﭘﺮﺳ ﺎﻳ .(
هوﺮـﮔ رد
ﻳد ﺢﺿاو ﻚﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎﻣ ،كﻮﻜﺸﻣ ﻲﻤﻧ هﺪ
رﺎـﻤﻴﺑ ﻲـﻟو ﺪـﺷ
ﻲﻣ ﺮﻛذ نژاو زا ار ﻊﻳﺎﻣ جوﺮﺧ ﻪﻘﺑﺎﺳ
دﺮـﻛ . ﺖﺴـﺗ ﺲﭙـﺳ
نارﺎـﻤﻴﺑ مﺎـﻤﺗ رد ﻲﻔﻠﺧ ﺲﻜﻴﻧرﻮﻓ تﺎﺤﺷﺮﺗ يور ﺮﺑ نﺮﻓ ﻲﻣ مﺎﺠﻧا
يور ﺮـﺑ ﺰـﻴﻧ ﻦﻳزاﺮـﺘﻴﻧ ﺖﺴﺗ ﺰﻴﻧ نﺎﻣﺰﻤﻫ و ﺪﺷ
ﻲﻣ مﺎﺠﻧا ﻲﻔﻠﺧ ﺲﻜﻴﻧرﻮﻓ تﺎﺠﺷﺮﺗ ﺖﻓﺮﮔ
.
ﻲﻣ ترﻮﺻ ﻖﻘﺤﻣ دﺮﻓ ﻂﺳﻮﺗ ﻞﺣاﺮﻣ ﻦﻳا مﺎﻤﺗ
و ﺖﻓﺮﮔ
ﻲـﻣ ﺖـﺒﺛ ﺞﻳﺎـﺘﻧ ﮔ
ﺪـﻳدﺮ .
ﺎـﺑ نژاو يﻮﺸـﺘﺴﺷ ﺲﭙـﺳ 5 cc
ﮓﻧﺮـﺳ ﻚـﻳ ﺎﺑ ﻞﻳﺮﺘﺳا ﻦﻴﻟﺎﺳ لﺎﻣﺮﻧ لﻮﻠﺤﻣ 5cc
و مﺎـﺠﻧا
زا ﺲﭘ 4 - 3
ﻪﻧﻮﻤﻧ ﻪﻘﻴﻗد
نﺎـﻤﻫ ﺎﺑ ﻲﻔﻠﺧ ﺲﻜﻴﻧرﻮﻓ زا يﺮﻴﮔ
ﻪـﺘﺨﻳر ﺶﻳﺎـﻣزآ ﻪـﻟﻮﻟ ﻞﺧاد ﻪﺑ ﻪﻧﻮﻤﻧ و ﺪﺷ مﺎﺠﻧا ﮓﻧﺮﺳ ﻲﻔﻴﻛ ﺖﺴﺗ و هﺪﺷ β-HCG
يﺎﻫراﻮﻧ ﻂﺳﻮﺗ Baby check
ﻪﻧﺎﺘــﺳآ ﺎــﺑ (Threshold)
mIU/ml 35
رد مﺎــﺠﻧاﺎﻫ ﻪــﻧﻮﻤﻧ
ﺪــﻳدﺮﮔ ﺖـﺒﺛ ﻲـﻔﻨﻣ ﺎــﻳ ﺖـﺒﺜﻣ ترﻮـﺻ ﻪــﺑ ﻪـﺠﻴﺘﻧ و هﺪـﺷ .
ﻪﻧﻮﻤﻧ ﻊﻤﺟ يﺎﻫ
فﺮـﻇ ﺲﭙـﺳ هﺪﺷ يروآ 2
- 1 ﻪـﺑ ﺖﻋﺎـﺳ
لﺎـﭽﺨﻳ يﺎـﻣد رد و هﺪـﺷ ﻞـﻘﺘﻨﻣ هﺎﮕﺸﻳﺎﻣزآ 4
- 0 ﻪـﺟرد
ژاﺮــﺘﻴﺗ ﺪــﻌﺑ و يراﺪــﻬﮕﻧ داﺮــﮔ ﻲﺘﻧﺎــﺳ β-HCG
يور ﺮــﺑ
ﻪﻧﻮﻤﻧ
ﻲﻣ ترﻮﺻ ﺎﻫ
ﻪﻧﻮﻤﻧ ﻪﻛ ترﻮﺻ ﻦﻳا ﻪﺑ ؛ﺖﻓﺮﮔ
ﻪـﺑ ﺎـﻫ
تﺪﻣ 3
ﺎﺑ ﻪﻘﻴﻗد 1500rpm
ژاﺮـﺘﻴﺗ و هﺪـﺷ ژﻮﻔﻳﺮﺘﻧﺎـﺳ β-
شور ﺎــــــــــﺑ HCG
ECLIA (Electro-Chemi
Luminescence Immunoassay) هزاﺪــﻧا
ﺪــﺷ يﺮــﻴﮔ .
ﻞــﻛ
ﺖﺴﺗ مﺎﺠﻧا تﺪﻣ 20
- 18 ﻲﻣ لﻮﻃ ﻪﻘﻴﻗد ﺪﻴﺸﻛ
.
ژاﺮــﺘﻴﺗ مﺎــﺠﻧا نﻮــﻣزآ β-HCG
و هﺎﮕﺸــﻳﺎﻣزآ ﻚــﻳ رد
ﻲﻣ ترﻮﺻ ﻦﻴﺴﻨﻜﺗ و هﺎﮕﺘﺳد ﻚﻳ ﻂﺳﻮﺗ ﺖﻓﺮﮔ
. ﻪﻴﻠﻛ ياﺮﺑ
اﺮﮔﻮﻧﻮــﺳ نارﺎــﻤﻴﺑ ﻚــﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎــﻣ ﺲﻛﺪــﻧا ﻦﻴــﻴﻌﺗ ﻲﻓ
(Amniotic fluid index) ﻊﻳﺎـﻣ ترﻮﺻ ﻪﺑ ﻪﻛ هﺪﺷ مﺎﺠﻧا
ﻲﻣ شراﺰﮔ لﺎﻣﺮﻧ ﺎﻳ ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ ﻚﻴﺗﻮﻨﻴﻣآ
ﺪـﻳدﺮﮔ . ﺖﺴـﺗ
Pooling ﺮـﻈﻧ رد بآ ﻪﺴـﻴﻛ ﻲﻌﻄﻗ ﻲﮔرﺎﭘ ناﻮﻨﻋ ﻪﺑ ﺖﺒﺜﻣ
هوﺮﮔ رد نارﺎﻤﻴﺑ و هﺪﺷ ﻪﺘﻓﺮﮔ ﺪـﻨﺘﻓﺮﮔ راﺮـﻗ PROM
) 41
ﺮﻔﻧ .(
ﻪﺘﻓﺎﻳ ﺲﭙﺳ هﺪﻣآ ﺖﺳد ﻪﺑ يﺎﻫ
مﺮﻧ زا هدﺎﻔﺘﺳا ﺎﺑ راﺰﻓا
SPSS V.11.5 ﺖــﻓﺮﮔ راﺮــﻗ ﻞــﻴﻠﺤﺗ و ﻪــﻳﺰﺠﺗ درﻮــﻣ
. زا
نﻮـﻣزآ يرﺎـﻣآ يﺎـﻫ One way ANOVA, t-student,
و
Kroskal-walis ﺪﻳدﺮﮔ هدﺎﻔﺘﺳا
.
ﻪﺘﻓﺎﻳ ﺎﻫ عﻮﻤﺠﻣ رد 123
راﺮـﻗ يرﺎـﻣآ ﺰﻴﻟﺎـﻧآ درﻮﻣ رادرﺎﺑ نز
ﻪــﻛ ﺖــﻓﺮﮔ 40
،لﺎــﻣﺮﻧ هوﺮــﮔ رد ﺮــﻔﻧ 41
هوﺮــﮔ رد ﺮــﻔﻧ
و PROM
42 ﺮــﻔﻧ ﻪــﺑ كﻮﻜﺸــﻣ هوﺮــﮔ رد راﺮــﻗ PROM
ﺪﻨﺘﻓﺮﮔ ) 83 هوﺮﮔ رد ﺮﻔﻧ ﻪـﺑ كﻮﻜﺸـﻣ و PROM
PROM
ﺪﻨﺘﻓﺮﮔ راﺮﻗ .(
ﻪﻌﻟﺎﻄﻣ درﻮﻣ داﺮﻓا ﻲﻨﺳ ﻦﻴﮕﻧﺎﻴﻣ 59
/
±5 79 / 25 لﺎـﺳ
دﻮــﺑ . 56 ﺮــﻔﻧ ) 1 / 49 (%
،لوا يرادرﺎــﺑ 35
ﺮــﻔﻧ ) 7 / 30 (%
و مود يرادرﺎﺑ 18
ﺮـﻔﻧ ) 8 / 15 (%
، مﻮـﺳ يرادرﺎـﺑ 4
ﺮـﻔﻧ
) 5 / 3 (%
و مرﺎﻬﭼ يرادرﺎﺑ 1
ﺮﻔﻧ ) 9 / 0 (%
ار ﻢﺠﻨـﭘ يرادرﺎﺑ
ﺖﺷاد . نارﺎﻤﻴﺑ رد يرادرﺎﺑ ﻦﻴﮕﻧﺎﻴﻣ 905
/
±0 76 / 1 دﻮﺑ .
ﻲــﺳرﺮﺑ نﺎــﻣز رد يرادرﺎــﺑ ﻦــﺳ ﻦﻴﮕﻧﺎــﻴﻣ 09
/
±2
75 / 31 ﺢﻄﺳ ﻦﻴﮕﻧﺎﻴﻣ و ﻪﺘﻔﻫ β-HCG
ﻚﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎﻣ رد
mIU/ml 89
/
±326 09 / 199 دﻮﺑ . ﺖﺴﺗ ﻪﺠﻴﺘﻧ Pooling
رد AF 41 ﺮﻔﻧ ) 3 / 33 (%
ﺒﺜﻣ ﻪﻌﻟﺎﻄﻣ درﻮﻣ داﺮﻓا زا دﻮﺑ ﺖ
.
رد ﺖـﺒﺜﻣ ﻦﻳزاﺮـﺘﻴﻧ ﺖﺴﺗ
39 ﺮـﻔﻧ ) 7 / 31 (%
نﺮـﻓ ﺖﺴـﺗ ،
رد ﺖﺒﺜﻣ 48
ﺮـﻔﻧ ) 39 (%
ﺖـﺒﺜﻣ ﺖﺴـﺗ و Baby check
رد
79 ﺮـــﻔﻧ ) 2 / 64 (%
ﺪـــﻳدﺮﮔ شراﺰـــﮔ رد .
44 رادرﺎـــﺑ نز
) 8 / 35 (%
ﻪــﺘﻓﺎﻳ ﺶﻫﺎــﻛ ﻲﻓاﺮﮔﻮﻧﻮــﺳ رد ﻚــﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎــﻣ
ﺪﻳدﺮﮔ شراﺰﮔ .
داﺪــﻌﺗ ،ﻦــﺳ ﺮــﻈﻧ زا ﻪــﻌﻟﺎﻄﻣ درﻮــﻣ هوﺮــﮔ ﻪــﺳ ﻦﻴــﺑ
ﺎﺣ ﻦﺳ ،يرادرﺎﺑ
ﻲـﻨﻌﻣ فﻼﺘـﺧا ﻂﻘـﺳ ﻪﻘﺑﺎـﺳ و ﻲﮕﻠﻣ
راد
ﺖﺷاﺪﻧ دﻮﺟو )
هرﺎﻤﺷ لوﺪﺟ 1
.(
ﻪﺴـﻴﻛ ﻲﮔرﺎـﭘ ﺺﻴﺨﺸـﺗ ياﺮﺑ ﺖﺒﺜﻣ نﺮﻓ ﺖﺴﺗ بآ
رد
ﺖﻴﺳﺎﺴـﺣ كﻮﻜﺸـﻣ هوﺮﮔ Sensitivity)
( 61
% ﻲـﮔﮋﻳو و
Specificity) 87 (
% داد نﺎﺸﻧ ار .
ﺖـﺒﺜﻣ ﻦﻳزاﺮـﺘﻴﻧ ﺖﺴـﺗ
،كﻮﻜﺸــﻣ هوﺮــﮔ رد بآ ﻪﺴــﻴﻛ ﻲﮔرﺎــﭘ ﺺﻴﺨﺸــﺗ ياﺮــﺑ ﺖﻴﺳﺎﺴﺣ 59
% ﻲﮔﮋﻳو و 82
% داد نﺎﺸﻧ ار .
هﺪــﺷ مﺎــﺠﻧا ﺰﻴﻟﺎــﻧآ رد Cut off
ياﺮــﺑ ﻢﻤﻴــﺘﭘا β-HCG
،
mIU/ml 5 / 79 ﺖﻴﺳﺎﺴــﺣ ﺎــﺑ 93
% ﻲــﮔﮋﻳو و 84
% هوﺮــﮔ رد
ﺪﻳدﺮﮔ ﻪﺒﺳﺎﺤﻣ ﺢﺿاو شﺰﻳﺮﺑآ هوﺮﮔ زا شﺰﻳﺮﺑآ ﻪﺑ كﻮﻜﺸﻣ .
ناﺰﻴﻣ β-HCG ﺖﺒﺜﻣ ﻪﺠﻴﺘﻧ ﺎﺑ هوﺮﮔ رد ﻚﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎﻣ
Baby check ﻲﻨﻌﻣ رﻮﻃ ﻪﺑ
ﺘﻧ ﺎـﺑ هوﺮﮔ زا ﺮﺗﻻﺎﺑ يراد ﻪـﺠﻴ
ﻲﻔﻨﻣ Baby check دﻮﺑ
(p=0.000) ﻦﻴﮕﻧﺎﻴﻣ ﻪﻛ يرﻮﻃ ﻪﺑ ؛
ناﺰــﻴﻣ β-HCG ﻪــﺠﻴﺘﻧ ياراد هوﺮــﮔ رد ﻚــﻴﺗﻮﻴﻨﻣآ ﻊﻳﺎــﻣ
ﺖﺒﺜﻣ Baby check يوﺎﺴـﻣ
mIU/ml 94
/
±354 82 / 298
ﻲــــﻔﻨﻣ ﻪــــﺠﻴﺘﻧ هوﺮــــﮔ رد و Baby check
يوﺎﺴــــﻣ
mIU/ml 06
/
±6 95 / 3 ﺖﺳا هدﻮﺑ .
هرﺎﻤﺷ لوﺪﺟ 1
- هوﺮﮔ ﻪﺳ رد نارﺎﻤﻴﺑ تﺎﺼﺨﺸﻣ
ﺼﺨﺸﻣ تﺎ هوﺮﮔ PROM
N=41 كﻮﻜﺸﻣ هوﺮﮔ
PROM ﻪﺑ N= 42 نوﺪﺑ هوﺮﮔ
PROM N=40 p-value
ﻦﺳ ) لﺎﺳ mean ( 92 ±SD /
±5 78 / 24 42 /
±4 64 / 25 23 /
±6 27 n.s
ﻲﮕﻠﻣﺎﺣ ﻦﺳ mean ±SD 09
/
±2 41 / 31 04 /
±2 85 / 31 15 /
±2 32 n.s
يرادرﺎﺑداﺪﻌﺗ mean±SD 87
/
±0 70 / 1 82 /
±0 73 / 1 04 /
±1 87 / 1 n.s
ﺖﺒﺜﻣ نﺮﻓ ﺖﺴﺗ داﺪﻌﺗ (%) 48 n= ) 17 / 73 (%
30 ) 85 / 42 (%
18 ) 0 (%
0 000 / p=0
ﻦﻳزاﺮﺘﻴﻧ ﺖﺴﺗ داﺪﻌﺗ ﺖﺒﺜﻣ (%)
n=39 )
53 / 58 (%
24 ) 71 / 35 (%
15 ) 0 (%
0 000 / p=0
ﻚﻴﺗﻮﻨﻴﻣآ ﻊﻳﺎﻣ ﻪﺘﻓﺎﻳ ﺶﻫﺎﻛ
داﺪﻌﺗ (%) n=44 ) 73 / 70 (%
29 ) 71 / 35 (%
15 ) 0 (%
0 000 / p=0
β-HCG mIU/ml mean±SD 45
/
±359 75 / 37 391 /
±316 43 / 176 5 /
±1 71 / 7 000 / p=0
Baby check ﺖﺒﺜﻣ داﺪﻌﺗ (%)
n=79 )
100 (%
41 ) 47 / 90 (%
38 ) 0 (%
0 000 / p=0
ﻂﻘﺳ ﻪﻘﺑﺎﺳ داﺪﻌﺗ (%) n= 19 ) 19 / 12 (%
5 ) 28 / 14 (%
6 ) 20 (%
8 237 / p= 0
ﻪﺠﻴﺘﻧ و ﺚﺤﺑ يﺮﻴﮔ
هزاﺪﻧا ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد
يﺮـﻴﮔ β-HCG تﺎﺤـﺷﺮﺗ رد بآ ﻪﺴﻴﻛ سردوز ﻲﮔرﺎﭘ ﻪﺑ كﻮﻜﺸﻣ دراﻮﻣ رد لﺎﻨﻳژاو
ﺎﺑ
Cut off يوﺎﺴـــﻣ
mIU/ml 5
/ 79 ﺖﻴﺳﺎﺴـــﺣ زا 93
% و
ﻲﮔﮋﻳو 84 % دﻮﺑ رادﻮﺧﺮﺑ .
ﻪﺴـﻴﻛ سردوز ﻲﮔرﺎـﭘ ﺺﻴﺨﺸـﺗ ﺖـﻴﻤﻫا ﻪـﺑ ﻪﺟﻮﺗ ﺎﺑ
)بآ
3،2،21 و 22
(
ﻲﻣ ﺮﻈﻧ ﻪﺑ
ﻦﺘﻓﺎـﻳ ﺖـﻬﺟ شﻼـﺗ ﻪـﻧﻮﮔﺮﻫ ﺪﺳر
هار ﻪـﺑ ﻲـﻘﻄﻨﻣ كﻮﻜﺸﻣ دراﻮﻣ رد نآ ﺺﻴﺨﺸﺗ ياﺮﺑ ﻲﻠﺣ
ﻲــﻣ ﺮــﻈﻧ ﺪــﻨﻧﺎﻣ نﻮﮔﺎــﻧﻮﮔ داﻮــﻣ ﺖــﻠﻋ ﻦﻴــﻤﻫ ﻪــﺑ و ﺪــﺳر
ﻛﻮـــــﻟﺮﺘﻨﻳا ﻦﻴ
)6
8
،(
ﻦﻴﺌﺗوﺮـــــﭘ ﻮـــــﺘﻓ α
) 10 - 8
ﻦﻴﻣﺎـــــﻳد ،(
زاﺪﻴﺴـــﻛا
) 11 و 12
ﻦﻴﺘﻛﻻوﺮـــﭘ ،( )
13 و 14
ﻦﻴﻨﻴﺗاﺮـــﻛو هروا ،( )
15
،(
ﻲــﻨﻴﻨﺟ ﻦﻴﺘﻜﻧوﺮــﺒﻴﻓ
) 16
و(
Insulin like growth factor
binding Protein I
) 17
(
ﻪـﺘﻓﺮﮔ راﺮـﻗ ﻲﺳرﺮﺑ درﻮﻣ ﺪـﻧا
. ﻪـﺑ
ﺖﻴﻤﻫا ﻞﻴﻟد
PROM
ﺶﻴﭘ و رد ار يداﻮﻣﺰﻴﻧ نآ عﻮﻗو ﻲﻨﻴﺑ
هﺎﻣ ﺮﺗدوز يﺎﻫ
هزاﺪﻧا ﻲﮕﻠﻣﺎﺣ
ﻲﻣ يﺮﻴﮔ
ناﻮﺘﺑ ﺪﻳﺎﺷ ﺎﺗ ﺪﻨﻨﻛ
ﻲﺗﺎﻣاﺪﻗا ،ﻲﻳﻮﮕﺸﻴﭘ ﺎﺑ
)
ﻲﻧﺎـﻣرد ﻲـﺘﺣ (
هزاﺪـﻧا ﻞـﺜﻣ
يﺮـﻴﮔ
مود ﺮﺘﺴﻤﻳﺮﺗ رد ﻚﻴﺗﻮﻨﻴﻣآ ﻊﻳﺎﻣ رد ﻲﻨﻴﻨﺟ ﻦﻴﺑﻮﻠﮔﻮﻤﻫ
) 23 (
ﻦﻴﻠﺗوﺪﻧآ و مود ﺮﺘﺴﻤﻳﺮﺗ رد I
) 24
زا يﺮﻴﮕﺸـﻴﭘ ياﺮـﺑ ار (
PROM ﻪـﭼﺮﻫ ياﺮـﺑ شﻼـﺗ ﺮﮕﻧﺎـﻴﺑ ﻲﮕﻤﻫ ﻪﻛ ،داد مﺎﺠﻧا
ﻊﻳﺮﺳ نﺎﺸﻧ ﺮﺗ
ﺖـﺳا ﻲﮕﻠﻣﺎـﺣ ﻢـﻬﻣ ﻪﺿرﺎﻋ ﻦﻳا نداد .
ﻪـﺑ
ﺖﺴﺗ ﻪﻴﻠﻛ ﻪﻜﻨﻳا ﻞﻴﻟد
ﻲﻣ قﻮﻓ يﺎﻫ
ﺎـﺑ ﻲﮔدﻮﻟآ ﺖﻠﻋ ﻪﺑ ﺪﻧاﻮﺗ
هزاﺪـﻧا ،ﺪﻨﻫد نﺎﺸﻧ بذﺎﻛ ﺖﺒﺜﻣ نﻮﺧ
ﻞـﺜﻣ يداﻮـﻣ يﺮـﻴﮔ
ﺲﻜﻴﻣﻮﺌﺗوﺮﭘ Proteomics)
( ﻚـﻴﺗﻮﻨﻴﻣآ ﻊﻳﺎـﻣ رد ًﺎﻓﺮﺻ ﻪﻛ
ﻲــﻣ مﺎــﺠﻧا لﺎــﺣ رد ﺰــﻴﻧ دراﺪــﻧ دﻮــﺟو نﻮــﺧ رد و ﺪــﺷﺎﺑ
ﺖﺳا
).
25 و 26
(
β-HCG ﺤﺷﺮﺗ رد ﻲﮔرﺎﭘ ﻲﺳرﺮﺑ ياﺮﺑ ﺰﻴﻧ لﺎﻨﻳژاو تﺎ
ﺖـﺳا ﻪـﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ درﻮﻣ بآ ﻪﺴﻴﻛ .
ﻪـﻌﻟﺎﻄﻣ رد
يا
هزاﺪـﻧا ﻲـﺳرﺮﺑ ﺖـﻬﺟ ﻪﻛ
ﺢﻄـﺳ يﺮـﻴﮔ β-HCG
ﻊﻳﺎـﻣ رد
ﺖﻓﺮﮔ ترﻮﺻ لﺎﻨﻳژاو
) 20
HCG(
ﺪﻴﻔﻣ ﺮﻛرﺎﻣ ﻚﻳ ناﻮﻨﻋ ﻪﺑ
ياﺮﺑ PROM
ﺪـﻳدﺮﮔ شراﺰـﮔ مﻮـﺳ و مود ﺮﺘﺴﻤﻳﺮﺗ رد .
يورﺮﺑ يﺮﮕﻳد ﻪﻌﻟﺎﻄﻣ 52
ﺖـﻓﺮﮔ ترﻮـﺻ نز
) 27
(
ـﻛ ﻪ 20
،ﻢﻟﺎﺳ بآ ﻪﺴﻴﻛ ﺎﺑ نز 21
ﻲﻌﻄﻗ بآ ﻪﺴﻴﻛ ﻲﮔرﺎﭘ ﺎﺑ رﺎﻤﻴﺑ
و 11 ﺪـﻧدﻮﺑ بآ ﻪﺴـﻴﻛ ﻲﮔرﺎـﭘ ﻪﺑ كﻮﻜﺸﻣ درﻮﻣ .
ﻦـﻳا رد
ﺰﻴﻧ ﻪﻌﻟﺎﻄﻣ
ار نژاو يﻮﺸـﺘﺴﺷ زا هﺪـﻣآ ﺖـﺳد ﻪﺑ HCG
ﺺﻴﺨﺸــﺗ ياﺮــﺑ ﻲﻤﺟﺎــﻬﺗ ﺮــﻴﻏ و نازرا و ﺐــﺳﺎﻨﻣ شور PROM mIU/ml
Cut
off value دﺮﮔ حﺮﻄﻣ
ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ ﺎﺑ ﻪﺠﻴﺘﻧ ﺮﻈﻧ زا ﻪﻛ ﺪﻳ
دراد ﻲﻧاﻮﺨﻤﻫ .
ﺮﺘﺸـﻴﺑ نارﺎـﻤﻴﺑ داﺪـﻌﺗ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ رد
و ﺖـــﺳا هدﻮـــﺑ Cut off value
ﺮـــﺿﺎﺣ ﻪـــﻌﻟﺎﻄﻣ رد
mIU/mlدوﺪﺣ 5
/ 79 ﺖﺳا هﺪﻣآ ﺖﺳد ﻪﺑ .
يﺮـــﮕﻳد ﻪـــﻌﻟﺎﻄﻣ رد
) 6
β-HCG(
زا هﺪـــﻣآ ﺖـــﺳد ﻪـــﺑ
رد نژاو يﻮﺸﺘﺴﺷ 73
درﻮﻣ شﺰﻳﺮﺑآ ﺖﻳﺎﻜﺷ ﺎﺑ ﻪﻠﻣﺎﺣ نز
راﺮﻗ ﻲﺳرﺮﺑ و ﺖﻓﺮﮔ
Cut off value لﺎـﻤﻴﺘﭘا
mIU/ml 65
ﺪﻣآ ﺖﺳد ﻪﺑ .
ﻦـﻳا ﻪﻛ ﺪﻧدﺮﻛ شراﺰﮔ ﺰﻴﻧ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد نﺎﻧآ
ﺺﻴﺨﺸـﺗ ياﺮـﺑ يدﺎﻤﺘﻋا ﻞﺑﺎﻗ و ﺪﻴﻔﻣ شور ،شور PROM
دراد ﻲﻧاﻮﺨﻤﻫ ﺮﺿﺎﺣ ﻪﻌﻟﺎﻄﻣ ﺎﺑ ﻪﻛ ﺖﺳا .
يﺮـﮕﻳد ﻪـﻌﻟﺎﻄﻣ رد
) 8
،(
و HCG
-α ﻦﻴﺌﺗوﺮﭘﻮـﺘﻓ (Alpha
Feto Protein-AFP) ﻦﻴﻛﻮﻟﺮﺘﻨﻳا و
6 ﻲﮔرﺎﭘ ﺺﻴﺨﺸﺗ ياﺮﺑ
هوﺮـﮔ ود ﻦﻴﺑ بآ ﻪﺴﻴﻛ درﻮـﻣ ﻢﻟﺎـﺳ بآ ﻪﺴـﻴﻛ و PROM
ﺪﻨﺘﻓﺮﮔ راﺮﻗ ﻲﺳرﺮﺑ .
رد قﻮـﻓ دراﻮـﻣ ﻪﺳ ﺮﻫ ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد
هوﺮــﮔ
ﻢﻟﺎــﺳ ﻲﻧﻮــﻴﻨﻣآ ﻪﺴــﻴﻛ ﺎــﺑ هوﺮــﮔ زا ﺮﺘﺸــﻴﺑ PROM
ﺪﻳدﺮﮔ شراﺰﮔ .
ﻲﺼﻴﺨﺸﺗ شزرا ﻪﻌﻟﺎﻄﻣ ﻦﻳا رد ﺮﺘﺸﻴﺑ AFP
HCG زا و ﻦﻴﻛﻮﻟﺮﺘﻨﻳا زا ﺮﺘﺸﻴﺑ HCG
6 ﺪـﻳدﺮﮔ شراﺰـﮔ و
ﺰﻴﻧ يﺮﮕﻳد ﻪﻌﻟﺎﻄﻣ
) 13
،ﻦﻴﺘﻛﻻوﺮـﭘ هدﺎﻣ ﻪﺳ (
و AFP β-HCG
ﺺﻴﺨﺸـﺗ ياﺮـﺑ نژاو زا هﺪـﻣآ ﺖـﺳد ﻪـﺑ ﻊﻳﺎﻣ رد PROM
ﺪﻨﺘﻓﺮﮔ ﻪﺴﻳﺎﻘﻣ درﻮﻣ .
يور ﺮﺑ ﻪﻌﻟﺎﻄﻣ 100
ﻦﻴـﺑ ﻪـﻠﻣﺎﺣ نز
37 - 28
ﺖﻓﺮﮔ ترﻮﺻ ﻲﮕﻠﻣﺎﺣ ﻪﺘﻔﻫ .
هوﺮـﮔ رد هدﺎـﻣ ﻪﺳ ﺮﻫ
PROM ﺎﺑ ﺰـﻴﻧ ﻪـﻌﻟﺎﻄﻣ ﻦﻳا رد و دﻮﺑ لﺮﺘﻨﻛ هوﺮﮔ زا ﺮﺗﻻﺎﺑ ،
داد نﺎﺸﻧ ار يﺮﺗﻻﺎﺑ ﻲﺼﻴﺨﺸﺗ شزرا AFP .
ترﻮــﺻ ﺮــﮕﻳد داﻮــﻣ ﺎــﺑ ﻪﺴــﻳﺎﻘﻣ ﺮــﺿﺎﺣ ﻪــﻌﻟﺎﻄﻣ رد ﺖﺳا ﻪﺘﻓﺮﮕﻧ .
ﻲﻣ ﺮﻈﻧ ﻪﺑ
داﺪـﻌﺗ ﺎـﺑ ﺮﺘﺸـﻴﺑ تﺎـﻌﻟﺎﻄﻣ ﺪـﺳر
ﺖـﺳا مزﻻ ﻪﺴـﻳﺎﻘﻣ ﻦﻳا ياﺮﺑ ﺮﺘﺸﻴﺑ رﺎﻤﻴﺑ .
لﺎـﺣ ﻦﻴـﻋ رد
هزاﺪﻧا يﺮﻴﮔ β-HCG ﺖـﺳا رادرﻮﺧﺮﺑ يﺮﺘﺸﻴﺑ ﺖﻟﻮﻬﺳ زا رد و
Setting ﺘﺸﻴﺑرد ﺖﺳا ﻦﻜﻤﻣ ﺲﻧاژروا ﻞـﺑﺎﻗ ﺰـﻛاﺮﻣ ﺮ
هزاﺪﻧا
هزاﺪـﻧا ﻪـﻛ ﻲﻟﺎﺣ رد ؛ﺪﺷﺎﺑ يﺮﻴﮔ
ﺮـﮕﻳد داﻮـﻣ يﺮـﻴﮔ
ﺖﺳا ﻦﻜﻤﻣ تﺎﻋﺎﺳ مﺎﻤﺗ ردو ﺰﻛاﺮﻣ ﻪﻤﻫ رد و ﺖﺳا ناﺮﮔ هزاﺪﻧا ﻞﺑﺎﻗ ﺪﺷﺎﺒﻧ يﺮﻴﮔ
.
يﺮﮕﻳد ﻪﻌﻟﺎﻄﻣ
) 28
ﺰـﻴﻧ (
β-HCG ﺖـﺳد ﻪـﺑ ﻊﻳﺎـﻣ رد ار
ﺺﻴﺨﺸـــﺗ ياﺮـــﺑ نژاو يﻮﺸـــﺘﺴﺷ زا هﺪـــﻣآ PROM
هزاﺪﻧا
ﻳزرا ﺪﻴﻔﻣ ار نآ و ﺖﺳا هدﺮﻛ يﺮﻴﮔ هدﺮﻛ ﻲﺑﺎ
ﺪـﻧا . رد
ﻪﻌﻟﺎﻄﻣ ﻦﻳا mIU/ml Cut off value
8 / 39 ياﺮﺑ β-HCG
ﺖﺳا هﺪﻣآ ﺖﺳد ﻪﺑ .
ﻲﻣ ﺮﻈﻧ ﻪﺑ تﺎﻌﻟﺎﻄﻣ ﻢﻛ داﺪﻌﺗ ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ تﺎﻌﻟﺎﻄﻣ ﺪﺳر
يور ﺮـﺑ ﺪـﻳﺎﺑ نارﺎـﻤﻴﺑ ﺮﺘﺸـﻴﺑ داﺪﻌﺗ ﺎﺑ يﺮﺘﺸﻴﺑ β-HCG
ﺖــﺳا مزﻻ ﺰــﻴﻧ و دﺮــﻴﮔ ترﻮــﺻ Cut off value
ياﺮــﺑ
PROM
ﻴﻴﻌﺗ ﻲﮕﻠﻣﺎﺣ ﻒﻠﺘﺨﻣ ﻦﻴﻨﺳ رد ددﺮﮔ ﻦ
. ﻪﺑ ﻪﺟﻮﺗ ﺎﺑ
هزاﺪﻧا ﺖﻟﻮﻬﺳ
يﺮﻴﮔ β-HCG ﻪـﻛ نآ ندﻮـﺑ سﺮﺘﺳد رد و
ﻲﻣ
ﺖﻴﻛ ﺎﺑ ﺪﻧاﻮـﺗ
يﺎﻫ β-HCG ﺰﻴﻧ و دﻮﺷ مﺎﺠﻧا ﺰﻴﻧ هدﺎﻣآ
ﻪﻴﺟﻮﺗ ﺮﺘﺸﻴﺑ تﺎﻘﻴﻘﺤﺗ مﺎﺠﻧا ،نآ ندﻮﺑ نازرا ﺖﺳا ﺮﻳﺬﭘ
.
ﻦﻳاﺮﺑﺎﻨﺑ HCG يﻮﺸـﺘﺴﺷ زا هﺪـﻣآ ﺖـﺳد ﻪـﺑ ﻊﻳﺎـﻣ
ﻪـﺑ كﻮﻜﺸﻣ دراﻮﻣ رد لﺎﻨﻳژاو و PROM
ﻲـﻌﻄﻗ PROM
ز
ﻲﻣ و ﺖﺳا ﻢﻟﺎﺳ بآ ﻪﺴﻴﻛ دراﻮﻣ زا ﺮﺗدﺎﻳ ناﻮﻨﻋ ﻪﺑ ﺪﻧاﻮﺗ
ﺺﻴﺨﺸــﺗ رد ﻊﻳﺮــﺳ و ﺐــﺳﺎﻨﻣ دﺎــﻤﺘﻋا ﻞــﺑﺎﻗ ﺖﺴــﺗ ﻚــﻳ PROM دﺮﻴﮕﺑ راﺮﻗ هدﺎﻔﺘﺳا درﻮﻣ
.
ﺮﻜﺸﺗ و ﺮﻳﺪﻘﺗ ﻲﺗﺎـﻘﻴﻘﺤﺗ حﺮﻃ ﺐﻟﺎﻗ رد ﻪﻟﺎﻘﻣ ﻦﻳا )
ﺪـﻛ هژوﺮـﭘ 571
( ﺎـﺑ و
مﻮـﻠﻋ هﺎﮕﺸﻧاد يروآ ﻦﻓ و تﺎﻘﻴﻘﺤﺗ ﺖﻧوﺎﻌﻣ ﻲﻟﺎﻣ ﺖﻳﺎﻤﺣ ﮔ ﻪﻴﻬﺗ ناﺮﻳا ﻲﻜﺷﺰﭘ ﺖﺳا هﺪﻳدﺮ
.
ﻊﺑﺎﻨﻣ ﺖﺳﺮﻬﻓ
1- Mercer BM. Preterm rupture of the membranes.
Obstet Gynecol; 2003. 101: 178-93.
2- Simhan HN, Canavan TP. Preterm premature rupture of membranes: diagnosis, evaluation and management strategies. BJOG; 2005. 112(Suppl 1): 32-37.
3- Canavan TP, Simhan HN, Caritis S. An evidence-
based approach to the evaluation and treatment of premature rupture of membranes: part I. Obstet Gynecol Surv; 2004. 59(9): 669-77.
4- Friedman ML, McElin TW. Diagnosis of ruptured fetal membranes. Clinical study and review of the literature. Am J Obstet Gynecol; 1969. 104: 544-50.
5- Bennett SL, Cullen JB, Sherer DM, Woods Jr JR.
The ferning and nitrazine tests of amniotic fluid between 12 and 41 weeks gestation. Am J Perinatol;
1993. 10: 101-104.
6- Lewis DF, Major CA, Towers CV, Asrat T, Harding JA, Garoite TJ. Effects of digital vaginal examinations on latency period in preterm premature rupture of membranes. Obstet Gynecol; 1992. 80: 630- 34.
7- Esim E, Turan C, Unal O, Dansuk R, Cengizglu B.
Diagnosis of premature rupture of membranes by identification of beta- HCG in vaginal washing fluid. Eur J Obstet Gynecol Reprod Biol; 2003. 107(1): 37-40.
8- NI CY, Jia WX, Yi WM, Feng LH, YU LZ.
Practicability of using vaginal fluid, markers in detecting premature rupture of membranes. Ann Clin Biochem;
2003. 40(Pt5): 542-45
9- Kishida T, Yamada H, Furuta I, Kobayashi N, Hirayama EK, Ebina Y, et al. Persistent ditection of alfa- fetoprotein in the vagina without overt preterm rupture of the membranes. Clinical and chemical characterizations. Fetal Diagn Ther; 2001. 16(5): 259-64.
10- Kishida T, Yamada H, Furuta I, Kobayashi N, Hirayama EK, Ebina Y, et al. Increased levels of interlukin-6 in cervical secretions and assessment of the uterine cervix by transvaginal ultrasonography predict preterm premature rupture of the membranes. Fetal Diagn Ther; 2003. 18(2): 98-104.
11- De Meeus JB, Sima Ole B, Bascou V, Magnin G, Biological diagnosis of premature rupture of membranes:
respective values of diamine oxidase activity compared to vaginal fluid PH. Amnicator J Gynecol obstet Biol Reprod; 1997. 26(7): 730-33.
12- Filet JP, More N, Librati C, Ruffie A, Delouis P, Cluzeau MH, et al. Evaluation of 3 diagnostic methods in premature rupture of membranes: diamine- oxidase assay, alpha- fetoprotein assay, colorimetric method evaluating the pH. Rev Fr Gynecol Obstet; 1994. 89(3):
123-28.
13- Shahin M, Raslan H. Comparative study of three amniotic fluid markers in premature rupture of membranes: prolactin, bata subunit of human chorionic gonadotropin, and alpha- fetoprotein. Gynecol Obstet Invest; 2007. 63(4): 195-99
14- Buyukbayrak EE, Turan C, Unal O, Dansuk R, Cengizouglu B. Diagnostic power of the vaginal washing – fluid prolactin assay as an alternative method for the diagnosis of premature rupture of membranes. J Matern Fetal Neonatal Med; 2004. 15(2): 120-25.
15- Kafali H, Oksuzler C. Vaginal fluid urea and creatinine in diagnosis of premature rupture of membranes. Arch Gynecol Obstet; 2007. 275(3): 157-60.
16- Erksen NL, Parisi VM. Fetal fibronectin: a method for detecting the presence of amniotic fluid.
Obstet Gyecol; 1992. 80(3): 451-54.
17- Jeurgens- Borst AJ, Bekkers RL, Sporken JM, van den Berg PP. Use of insulin like growth factor binding protein -1 in the diagnosis of ruptured fetal membranes. Eur J Obstet Gynecol Reprod Biol; 2002.
102(1): 11-14.
18- Akercan F, Cripan T, Kazandi M, Terek MC, Mgoyi L, Ozkinay E. The value of the insulin- like growth factor binding protein-1 in the cervical- vaginal secretion detected by immunochromatographic dipstick test in the prediction of delivery in women with clinically unconfirmed preterm premature rupture of membranes. Eur J Obstet Gynecol Reprod Biol; 2005.
121(2): 159- 63.
19- Erdemoglu E, Mungan T. Significance of detecting insulin- like growth factor binding protein-1 in cervicovaginal secretions: comparison with nitrazine test and amniotic fluid volume assessment. Acta Obstet Gynecol Scand; 2004. 83(7): 622-26.
20- Anai T, Tanaka Y, Hirota Y, Miyakawa I.
Vaginal fluid HCG levels for detecting premature rupture of membranes. Obstet Gynecol; 1997. 89(2):
261-64.
21- Newton ER. Preterm labor, Preterm premature rupture of membranes and chorioamnionitis. Clin Prenatal; 2005. 32(3): 571-600.
22- Ramsey PS, Liman JM, Brumfield CG, Carlo W.
Chorioamnionitis increases neonatal morbidity in pregnancies complicated by preterm premature rupture of membranes. Am J Obstet Guneocol; 2005. 19(4): 1162-66.
23- Vaisbuch E, Kusanovic JP, Erez O, Mazaki- Tovi S, Gotsch F, Kim CJ, et al. Amniotic fluid fetal hemoglobin in normal pregnancies and pregnancies complicated with preterm labor or pre-labor rupture of membranes. J Matern Fetal Neonatal Med; 2009. 22(5):
388-97.
24- Margarit L, Griffiths AN, Tsapanos V, Tsakas S, Decavalas G. Amniotic fluid endothelin levels and the incidence of premature rupture of membranes. Int J Gynaecol Obstet; 2006. 93(1): 18-21.
25- Vuadens F, Benay C, Crettaz D, Gallot D, Sepin V, Schneider P, et al. Identification of biologic markers of the premature rupture of fetal membranes: proteomic approach. Proteomics; 2003. 3(8): 1521-25.
26- Thadikkaran L, Crettaz D, Sigenthaler MA, Gallot D, Sapin V, Lozzo RV, et al. The role of proteomic in the assessment of premature rupture of fetal membranes. Clin Chim Acta; 2005. 360(1-2): 27-36.
27- Mangano B, Diani F, Faccini G, Zatti N, Zardini E.
Proposal of new test for the diagnosis of PROM based on the
determination of hCG in the washing fluid of the posterior vaginal fornix. Minerva Ginecol; 2000. 52(5): 185-88.
28- Kim YH, Park YW, Kwon HS, Kim JY, Kim BJ.
Vaginal fluid beta- human chorionic gonadotropin level in the diagnosis of premature rupture of membranes.
Acta Obstet Gynecol Scand; 2005. 84(8): 802-05.
Evaluation of Vaginal Fluid β-HCG for Diagnosis of Premature Rupture of Membranes
Sh. Baha Sadri, MDI *M. Kashanian, MDII Sh. Khalili, MDIII
Abstract
Background: Premature Rupture Of Membranes (PROM) is one of the most important problems of pregnancy and accurate diagnosis of suspicious cases is under special concern. In this regard, researches are being conducted in order to find a reliable, fast and simple method for accurate diagnosis. The purpose of the present study is to evaluate vaginal fluid β-HCG for diagnosis of PROM.
Methods: An observational cross sectional study was performed on 123 pregnant women who were in the third trimester of gestation (gestational age more than 28 weeks of pregnancy). The patients were considered in 3 groups including: PROM group (41 cases), suspicious for PROM (42 cases) and intact membranes (40 cases). Five ml sterile normal saline was introduced in to the posterior fornix of vagina, then vaginal fluid was aspirated and sent to the laboratory for β-HCG measurement. Finally, the amount of β-HCG was compared in the 3 groups. For data analysis student t-test, One way Anova and Kruskal Walis tests were used. SPSS V.11.5 was also used.
Results: β-HCG concentration was 7.71±15.7 mIU/ml in the intact membrane group, 468.06±366.34 mIU/ml in the PROM group and 176.43± 316.37 mIU/ml in the suspicious group which showed a significant difference between the 3 groups (p=0.000). In order to find an optimal Cut off value for β- HCG, Receiver Operating Characteristics Curve (ROC) was used and a Cut off value of 79.5 mIU/ml with a sensitivity of 95% and specificity of 84% was determined to be optional.
Conclusion: β-HCG is higher in PROM and suspicious for PROM patients, and thus may be used as a suitable, fast and reliable test for detecting PROM.
Keywords: 1) Premature rupture of membranes (PROM) 2) Beta- HCG(β-HCG) 3) Amniotic membranes 4) Vaginal fluid 5) Pregnancy
This study has been conducted under the financial support of Iran University of Medical Sciences and Health Services.This article is a summary of the thesis by Sh. Khalili, MD for the degree of speciality in Obstetrics and Gynecology under supervision of Sh.
Baha Sadri, MD (2008).
I) Assistant Professor of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Akbarabadi Teaching Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran
II) Associate Professor Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Molavi Str, Molavi Sq, Akbarabadi Teaching Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran (*Corresponding Author)
III) Resident of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Akbarabadi Teaching Hospital, Iran University of Medical Sciences and Health Services, Tehran, Iran
