Preterm premature rupture of membrane assessment via transperineal ultrasonography: a diagnostic accuracy study

Yuce, Tuncay
Tanju, Ozge
Koc, Acar
Objective: The objective of this study is to evaluate diagnostic accuracy of transperineal ultrasound assessment compared to speculum examination by using placental alfa-microglobulin (PAMG)-1 tests as reference.Methods: This was a prospective observational study conducted in Ankara University Hospital. Women with early and late preterm pregnancies with suspected rupture of membranes, i.e. women with a complaint of fluid leakage (105 in total) were enrolled. Prior to speculum examination, sagittal and transverse plane views of the fornices and cervix were obtained via transperineal ultrasonography and images were stored. Then the speculum examination for amniotic fluid pooling was performed. Definite diagnoses were made with PAGM-1 assays. After collection of the data, ultrasound images were analyzed by an observer blind to physical examination findings. Hypoechogenic fluid appearance around the cervix and in the fornices was considered positive for preterm premature rupture of membranes (PPROM). Results of physical and ultrasound examination were compared with PAMG-1 test as a reference method. The diagnostic performance of transperineal ultrasound was tested with accuracy parameters and receiver-operating characteristics (ROC) curves. Inter-rater reliability was analyzed with Cohen's kappa.Results: In total, 103 pregnant women were evaluated. The prevalence of PPROM in our study population was 43.14%. At a 5mm diagnostic threshold, the sensitivity and specificity values of transperineal assessment were 95.45% (95% CI: 84.50-99.31%) and 96.55% (95% CI: 88.07-99.48%), respectively, and they were comparable with speculum examination in a population of preterm pregnant women with suspected PPROM (p>0.05). Interobserver reliability analysis with Cohen's kappa has shown good very good agreement with the kappa value of 0.93 (95% CI 0.87-1.00).Conclusions: Transperineal ultrasonography is a novel method that can be used to assess vaginal pooling of amniotic fluid. Ultrasonography offers similar sensitivity and specificity compared with speculum examination and it is non-invasive.


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Objective: Small for gestational age (SGA) fetuses are at increased risk of admission to the neonatal unit, even at term. We aimed to develop and validate a predictive model for the risk of prolonged neonatal unit admission in suspected SGA fetuses at term. Methods: A single-center cohort study of singleton pregnancies with SGA fetus, defined as estimated fetal weight (EFW) less than the 10th centile, at term. The variables included known risk factors for neonatal unit admissions: maternal characteristics, ...
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Kalafat, Erkan; Kalaylioglu, Zeynep; Thilaganathan, Basky; Khalil, Asma (Elsevier BV, 2020-09-01)
Objective A secondary analysis of the trial of randomized umbilical and fetal flow in Europe suggested that the umbilicocerebral ratio (UCR) provides better differentiation of neurodevelopmental outcome in the abnormal range compared with that of the cerebroplacental ratio (CPR).1 However, the reported superiority of UCR is controversial.2 This study aimed to compare the CPR and the UCR for predicting operative delivery for presumed fetal compromise and prolonged neonatal unit (NNU) admission in term fetus...
Genetic aspects of human male infertility: the frequency of chromosomal abnormalities and Y chromosome microdeletions in severe male factor infertility
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Objective: The main purpose of this, study is to detect the frequency and type of both chromosomal abnormalities and Y chromosome microdeletions in patients with severe male factor infertility and fertile control subjects. The association between the genetic abnormality and clinical parameters was also evaluated. Methods: This study was carried out in 208 infertile and 20 fertile men. Results of 208 patients, 1 19 had non-obstructive azoospermia and 89 had severe oligoasthenoteratozoospermia (OAT). Seventee...
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Giorgione, V; Ridder, A.; Kalafat, E.; Khalil, A.; Thilaganathan, B. (Wiley, 2020-10-01)
Background Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth. Objectives This review aims to estimate the incidence of hypertension in the first 2 years after HDP. Search strategy MEDLINE, Embase and Cochrane databases were systematically searched in October 2019. Selection criteria Observational studies comparing hypertension rate following H...
Citation Formats
E. KALAFAT, T. Yuce, O. Tanju, and A. Koc, “Preterm premature rupture of membrane assessment via transperineal ultrasonography: a diagnostic accuracy study,” JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, pp. 3690–3694, 2016, Accessed: 00, 2020. [Online]. Available: