Diagnosis of premature rupture of membranes: inspiration from the past and insights for the future

Abstract

Objective: To review the diagnostic methods described to confirm premature rupture of membranes during pregnancy, and to assess their effectiveness in establishing the diagnosis.

Data sources and extraction: The medical literature was searched to identify all relevant studies and reviews on methods for diagnosis of membrane rupture published in English up to January 31, 2009. Medline and the Cochrane databases were searched, and reference lists in identified articles were also examined. Articles not available through journals' online editions were retrieved by manual search.

Study selection: We identified 71 original studies and reviews on diagnostic methods of chorioamniotic membrane rupture published in English. These articles were reviewed and results were summarized based on the diagnostic test assessed.

Conclusion: Recognition of the importance of and difficulties in confirmation of rupture of the chorioamniotic membranes pervades past and present obstetric publications. The subjectivity and poor sensitivity of early diagnostic techniques for confirmation of ruptured membranes sparked technical advancements using biochemical markers. None of these biochemical tests have gained popularity, although novel techniques involving placental markers such as placental alpha microglobulin-1 may provide a future solution to the problem of diagnosing chorioamniotic membrane rupture.