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Recording available 2/16-5/2
Recording available 2/16-5/2
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Abstract Award
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Poster Session 2

Category: Prematurity

Poster Session 2

(446) Comparing Standard Clinical Evaluation & Immunoassays in Diagnosing of Rupture of Membranes: A Systematic Review

Wednesday, February 11, 2026
3:30 PM - 5:00 PM  

    Submitting Author and Presenting Author(s)

  • Bhaskari Burra, BS, MD (she/her/hers)

    Maternal Fetal Medicine Fellow
    Mountain Area Health Education Center
    Mountain Area Health Education Center, North Carolina, United States

    • Coauthor(s)

  • BB

    Baillie Bronner, BS, MD

    Maternal Fetal Medicine Fellow
    Mountain Area Health Education Center
    Mountain Area Health Education Center, NC, North Carolina, United States

  • KA

    Katie Aman, BS, MPH

    Research Associate
    Mountain Area Health Education Center
    Mountain Area Health Education Center, NC, North Carolina, United States

  • KD

    Kathryn Davidson, BS, MD, MSc

    Maternal Fetal Medicine Faculty
    Mountain Area Health Education Center
    Mountain Area Health Education Center, NC, North Carolina, United States

Objective:
Preterm prelabor rupture of membranes and term prelabor rupture of membranes affect 3% and 8% of births in the United States. Accurate diagnosis prevents adverse outcomes or harmful interventions. Traditionally, rupture of membranes (ROM) is diagnosed by a speculum exam to visualize pooling, nitrazine testing, and/or ferning on microscopy. However, this can be insufficient as individual components are affected by blood, urine, semen, and lubricants. Rapid immunoassays were developed as a more accurate method of diagnosing ROM by detecting biochemical markers highly concentrated in amniotic fluid [placental alpha-microglobulin-1(PAMG-1), insulin like growth factor binding protein-1(ILGFBP-1), and alpha-fetoprotein(AFP)]. Our objective was to consolidate available data comparing standard clinical evaluation (SCE) and immunoassays in diagnosing ROM.

Study Design:
This systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Inclusion criteria were prospective/observational cohort studies comparing SCE and immunoassays against a standard reference measure with a gestational age of > 20 weeks.  Weighed means of the sensitivity, specificity, positive and negative predictive values of each method were calculated.

Results:
Of 31 abstracts screened, 15 met inclusion criteria. 11 studies compared SCE to PAMG-1, 2 compared SCE to ILGFBP-1, and 4 compared SCE with AFP/ILGFBP-1 duo-assay. AFP/ILGFBP-1 had the highest weighted sensitivity and PAMG-1 had the highest weighted specificity. SCE had the highest weighted PPV but the lowest weighted NPV. All immunoassays were more sensitive and more specific than SCE.

Conclusion:
Our systematic review demonstrates that immunoassays are highly sensitive, supporting their utility as effective screening tools. While SCE yielded excellent PPV, its NPV was limited, highlighting the need for a more reliable method to rule out ROM. These findings suggest a rationale for employing both SCE and immunoassays in tandem in diagnosing ROM. Future investigations should assess the diagnostic potential of this combined approach.