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Nichols JH, Ali M, Anetor JI, Chen LS, Chen Y, Collins S, Das S, Devaraj S, Fu L, Karon BS, Kary H, Nerenz RD, Rai AJ, Shajani-Yi Z, Thakur V, Wang S, Yu HYE, Zamora LE. AACC Guidance Document on the Use of Point-of-Care Testing in Fertility and Reproduction. J Appl Lab Med 2022; 7:1202-1236. [DOI: 10.1093/jalm/jfac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/11/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The AACC Academy revised the reproductive testing section of the Laboratory Medicine Practice Guidelines: Evidence-Based Practice for Point-of-Care Testing (POCT) published in 2007.
Methods
A panel of Academy members with expertise in POCT and laboratory medicine was formed to develop guidance for the use of POCT in reproductive health, specifically ovulation, pregnancy, premature rupture of membranes (PROM), and high-risk deliveries. The committee was supplemented with clinicians having Emergency Medicine and Obstetrics/Gynecology training.
Results
Key recommendations include the following. First, urine luteinizing hormone (LH) tests are accurate and reliable predictors of ovulation. Studies have shown that the use of ovulation predicting kits may improve the likelihood of conception among healthy fertile women seeking pregnancy. Urinary LH point-of-care testing demonstrates a comparable performance among other ovulation monitoring methods for timing intrauterine insemination and confirming sufficient ovulation induction before oocyte retrieval during in vitro fertilization. Second, pregnancy POCT should be considered in clinical situations where rapid diagnosis of pregnancy is needed for treatment decisions, and laboratory analysis cannot meet the required turnaround time. Third, PROM testing using commercial kits alone is not recommended without clinical signs of rupture of membranes, such as leakage of amniotic fluid from the cervical opening. Finally, fetal scalp lactate is used more than fetal scalp pH for fetal acidosis due to higher success rate and low volume of sample required.
Conclusions
This revision of the AACC Academy POCT guidelines provides recommendations for best practice use of POCT in fertility and reproduction.
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Affiliation(s)
| | | | | | | | - Yu Chen
- Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Dalhousie University, and Memorial University , Fredericton, NB , Canada
| | - Sean Collins
- Vanderbilt University Medical Center , Nashville, TN , USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System , Nashville, TN , USA
| | - Saswati Das
- Dr. Ram Manohar Lohia Hospital, Atal Bihari Vajpayee Institute of Medical Sciences , New Delhi , India
| | - Sridevi Devaraj
- Texas Children’s Hospital and Baylor College of Medicine , Houston, TX , USA
| | - Lei Fu
- Sunnybrook Health Sciences Center , Toronto, ON , Canada
| | | | - Heba Kary
- King Fahd Armed Forces Hospital , Jeddah , Saudi Arabia
| | | | - Alex J Rai
- Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital , New York, NY , USA
| | - Zahra Shajani-Yi
- Laboratory Corporation of America (LabCorp) , San Diego, CA, USA
| | - Vinita Thakur
- Eastern Health Authority, Health Science Center and Memorial University , St. John’s, NL , Canada
| | - Sihe Wang
- Akron Children’s Hospital , Akron, OH , USA
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Jain S, Jaiswar SP, Singh N, Deo S, Agarwal M, Ali W. Beta-HCG Concentration in Vaginal Fluid: Used as a Diagnostic Biochemical Marker for Preterm Premature Rupture of Membrane in Suspected Cases and Its Correlation with Onset of Labour. J Obstet Gynaecol India 2020; 70:283-288. [PMID: 32764849 DOI: 10.1007/s13224-020-01327-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/20/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate β-hCG concentration in vaginal fluid as a biochemical marker for PPROM in suspected cases and its correlation with onset of labour. Materials and Methods This is a prospective case-control study carried out in tertiary care centre in 1 year. Total 150 pregnant women of gestational age 28-36 week + 6 days were included and were divided into two groups: control (Group 1) (n = 50) normal antenatal patients. Group 2 cases with history of leaking per vaginum subdivided into two groups-Group 2A-(n = 50) with no detectable leakage of amniotic fluid present on per speculum examination and Group 2B-(n = 50) with minimal leaking per vaginum present upon per speculum examination (frank leaking were excluded). β-hCG level was measured by chemiluminescent microparticle assay, and all women were followed till onset of labour. Results Mean β-hCG level in vaginal fluid was measured as 6.10 ± 8.52 mIU/mL, 57.10 ± 30.86 mIU/mL and 111.35 ± 36.01 mIU/mL in Group 1, Group 2A and Group 2B, respectively. By taking 21.5 mIU/ml as cut-off, receiver operating characteristic curve shows sensitivity 100%, specificity 92.0%, positive predictive value 92.6%, negative predictive value 100% and diagnostic accuracy 96%. Regarding the correlation of β-hCG level with onset of labour if the β-hCG level is < 21.5 mIU/ml, 100% pregnancy continued beyond 4 weeks and 56% women delivered within 4 weeks when β-hCG level is > 75 mIU/ml. Conclusion β-hCG in vaginal fluid is a reliable biochemical marker for diagnosing suspected cases of PPROM and is well correlated with onset of labour.
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Affiliation(s)
- Soumya Jain
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
| | - S P Jaiswar
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
| | - Nisha Singh
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
| | - Sujata Deo
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
| | - Monica Agarwal
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
| | - Wahid Ali
- Department of Pathology, Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
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Sisti G, Paccosi S, Parenti A, Seravalli V, Di Tommaso M, Witkin SS. Insulin-like growth factor binding protein-1 predicts preterm premature rupture of membranes in twin pregnancies. Arch Gynecol Obstet 2019; 300:583-587. [PMID: 31201536 DOI: 10.1007/s00404-019-05214-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Mechanisms leading to preterm premature rupture of membranes (PPROM) remain incompletely defined. Based on the elevated occurrence of PPROM in twin gestations and recent studies of the involvement of insulin-like growth factor binding protein-1 (IGFBP-1) in the inhibition of collagen production we hypothesized that serum IGFBP-1 levels might be predictive of susceptibility to PPROM in women with twins. METHODS In this prospective study peripheral blood was obtained from 58 women with twin gestations prior to 20 weeks gestation and sera analyzed by ELISA for concentrations of IGFBP-1. Demographic and clinical outcome data were subsequently obtained and associations between IGFBP-1 and PPROM were analyzed by the Mann-Whitney test and receiver operator curve (ROC) analysis. RESULTS Eight of our subjects developed PPROM. They did not differ from the other women in demographics, medical history or current pregnancy outcome parameters. However, median IGFBP-1 levels were higher in women who subsequently developed PPROM (59.3 ng/ml) than in the other women (46.6 ng/ml) (p = 0.042). Using a cutoff value of 53.9 ng/ml the circulating IGFBP-1 level predicted development of PPROM with a sensitivity of 74%, specificity of 75%, a negative predictive value of 97% and a positive predictive value of 20%. CONCLUSIONS Pending validation in larger studies the findings suggest that determination of serum IGFBP-1 levels in women with twin pregnancies may predict the later development of PPROM.
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Affiliation(s)
- Giovanni Sisti
- Department of Obstetrics and Gynecology, Lincoln Medical and Mental Health Center, 5th floor, 234 East 149th Street, Bronx, NY, 10451, USA. .,Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA.
| | - Sara Paccosi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Astrid Parenti
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Viola Seravalli
- Department of Health Sciences, Obstetrics and Gynecology Branch, University of Florence, Florence, Italy
| | - Mariarosaria Di Tommaso
- Department of Health Sciences, Obstetrics and Gynecology Branch, University of Florence, Florence, Italy
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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Majors CE, Smith CA, Natoli ME, Kundrod KA, Richards-Kortum R. Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings. LAB ON A CHIP 2017; 17:3351-3387. [PMID: 28832061 PMCID: PMC5636680 DOI: 10.1039/c7lc00374a] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Each day, approximately 830 women and 7400 newborns die from complications during pregnancy and childbirth. Improving maternal and neonatal health will require bringing rapid diagnosis and treatment to the point of care in low-resource settings. However, to date there are few diagnostic tools available that can be used at the point of care to detect the leading causes of maternal and neonatal mortality in low-resource settings. Here we review both commercially available diagnostics and technologies that are currently in development to detect the leading causes of maternal and neonatal mortality, highlighting key gaps in development where innovative design could increase access to technology and enable rapid diagnosis at the bedside.
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Affiliation(s)
- Catherine E Majors
- Department of Bioengineering, Rice University, 6100 Main Street, MS-142, Houston, TX 77005, USA.
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Eleje GU, Ezugwu EC, Eke AC, Ikechebelu JI, Ezeama CO, Ezebialu IU, Ojiegbe NO, Obiora CC, Okafor CI, Udigwe GO, Nwosu BO, Ezugwu FO. Accuracy and response time of dual biomarker model of insulin-like growth factor binding protein-1/ alpha fetoprotein (Amnioquick duo+) in comparison to placental alpha-microglobulin-1 test in diagnosis of premature rupture of membranes. J Obstet Gynaecol Res 2017; 43:825-833. [DOI: 10.1111/jog.13296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/04/2016] [Accepted: 12/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- George Uchenna Eleje
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Euzebus Chinonye Ezugwu
- Department of Obstetrics and Gynecology; University of Nigeria Teaching Hospital; Ituku-Ozalla Enugu Nigeria
| | - Ahizechukwu Chigoziem Eke
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Joseph Ifeanyichukwu Ikechebelu
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Chukwuemeka Okwudili Ezeama
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | | | | | | | | | - Gerald Okanandu Udigwe
- Effective Care Research Unit, Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Campus Nnewi Nigeria
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Betrand Obi Nwosu
- Department of Obstetrics and Gynecology; Nnamdi Azikiwe University; Nnewi Nigeria
| | - Frank O. Ezugwu
- Department of Obstetrics and Gynecology; ESUT Teaching Hospital; Parklane Enugu Nigeria
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Eleje GU, Ezugwu EC, Eke AC, Ikechebelu JI, Obiora CC, Ojiegbe NO, Ezebialu IU, Ezeama CO, Nwosu BO, Udigwe GO, Okafor CI, Ezugwu FO. Comparison of the duo of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) and traditional clinical assessment for diagnosing premature rupture of fetal membranes. J Perinat Med 2017; 45:105-112. [PMID: 27855117 DOI: 10.1515/jpm-2016-0204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the diagnostic accuracy of insulin-like growth factor binding protein-1/alpha fetoprotein (Amnioquick duo+®) compared with traditional clinical assessment (TCA) of nitrazine, ferning and pooling for the diagnosis of prelabor rupture of membranes (PROM). METHODS A double-blinded, multicenter clinical study was conducted between February 2015 and August 2015 among pregnant women presenting with symptoms or features suggestive of PROM between 24 and 42 weeks gestation. Confirmation of PROM was done after delivery based on the presence of any two of these criteria: delivery within 48 h to 7 days, evidence of chorioamnionitis, membranes explicitly ruptured at delivery and adverse perinatal outcomes strongly correlated with prolonged PROM. Sensitivity, specificity and accuracy were outcome measures assessed. RESULTS Two hundred and thirty-six women were recruited. Three women were excluded from the final analysis due to lack of follow-up data and failure to meet inclusion criteria. Two hundred and thirty-three women had complete data for analysis. The specificity and sensitivity values for TCA were 76.2% and 85.2%, which were lower than those of Amnioquick duo+, which were 97.6% and 97.9%, respectively. The accuracy of Amnioquick duo+ was statistically higher (97.9% vs. 83.7%; RR=1.17; 95%CI=1.10-1.24; P<0.001). In equivocal cases (pooling=negative), the accuracy of Amnioquick duo+ vs. TCA was 98.4% vs. 69.4% (RR=1.42; 95%CI=1.20-1.68; P<0.001) at ≥34 weeks gestation and 100.0% vs. 71.4% (RR=1.40; 95%CI=1.07-1.83; P=0.021) at <34 weeks gestation. CONCLUSION The performance matrix of Amnioquick duo+® was superior to that of TCA for diagnosing PROM even in equivocal cases.
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