1 3 Arch Gynecol Obstet DOI 10.1007/s00404-014-3225-5 MATERNAL-FETAL MEDICINE Fetal fibronectin (Quick Check fFN test) versus placental alpha microglobulin-1 (AmniSure test) for detection of premature rupture of fetal membranes Ibrahim A. Abdelazim · Khaled M. Abdelrazak · Mohamed Al-Kadi · Amr H. Yehia · Amr F. Abdulkareem Received: 5 November 2013 / Accepted: 17 March 2014 © Springer-Verlag Berlin Heidelberg 2014 insignificant compared with predictive values and accuracy of ferning, nitrazine and AmniSure tests. Conclusion fFN bedside test is better than nitrazine and ferning tests in detection of PROM, but is not suited for identification of clinically difficult cases with sus- pected PROM, because, it is influenceable and can give false-positive results in preterm labor, women >34 gesta- tional weeks and after any vaginal manipulation without PROM. Keywords Fetal fibronectin · fFN · Placental alpha microglobulin-1 · PAMG-1 · Premature rupture of fetal membranes Introduction Premature rupture of fetal membranes (PROM) is usually associated with significant perinatal and maternal infec- tious morbidities [1, 2]. Failure to identify patients with PROM can result in failure to implement standard meas- ures and conversely an incorrect diagnosis leads to inappro- priate interventions. Accurate diagnosis of PROM remains a frequent clinical problem in obstetrics [3, 4]. Diagnosis of PROM is usually based on the patient’s history, identifica- tion of gross pooling of amniotic fluids from the cervical canal during sterile speculum examination, ferning pattern, and nitrazine test [5–8]. Ferning has been associated with false-positive results in 5–30 %; due to contamination with fingerprints on a slide or contamination with semen or cervical mucus, and false-negative results in 5–12.9 %; due to dry swabs or contamination with blood [9, 10]. Nitrazine evaluation has been associated with false-positive results in 17.4 %; due to cervicitis, vaginitis, alkaline urine, blood, semen Abstract Objectives To compare accuracy of fetal fibronectin (fFN) versus placental alpha microglobulin-1 for detection of premature rupture of fetal membranes (PROM). Methods Two hundred and twenty pregnant women >34 and <37 weeks were included in this comparative prospec- tive study and divided into two groups according to pres- ence or absence of PROM. The diagnosis of PROM was based on patient’s history of sudden gush of water, pool- ing of amniotic fluid, positive ferning, positive nitrazine test, confirmed by visualization of fluid passing from the cervical canal and amniotic fluid index ≤5 cm measured by trans-abdominal ultrasound. Patients included in this study were examined by sterile speculum for visualization of membranes and for collection of samples (swabs) from posterior vaginal fornix. Results Sensitivity and specificity of AmniSure test to diagnose PROM were 97.3 and 98.2 %, respectively, com- pared with 94.5 and 89.1 %, respectively, for fFN test. Positive predictive value, negative predictive value, and accuracy of AmniSure test to diagnose PROM were 98.2, 97.3, and 97.7 %, respectively, compared with 89.7, 94.2, and 91.8 %, respectively, for fFN test. Predictive values and accuracy of fFN test to diagnose PROM were statistically I. A. Abdelazim · K. M. Abdelrazak · M. Al-Kadi · A. H. Yehia · A. F. Abdulkareem Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt I. A. Abdelazim (*) · A. F. Abdulkareem Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company (KOC), P.O. Box 9758, 61008 Ahmadi, Kuwait e-mail: dr.ibrahimanwar@gmail.com