OC033: Treatment of previable iatrogenic rupture of membranes with the amniopatch: rationale for a randomized clinical trial
Year: 2004
Type: conference-abstract
Abstract: Iatrogenic premature rupture of membranes (iPROM) occurs in approximately 1% of 2nd-trimester genetic amniocenteses and in 5–8% of patients after diagnostic or operative fetoscopy. We have described a technique to seal iPROM with the intraamniotic injection of platelets and cryoprecipitate (amniopatch). This study describes our experience with the amniopatch for iPROM as the basis for conducting a randomized clinical trial (RCT). Patients with iPROM (< 24 weeks' gestation) with gross leakage of fluid (LOF) per vagina were offered an amniopatch. Amniotic fluid was analyzed for karyotype and evidence of intraamniotic infection. An amniopatch was performed in all cases. Sealing of fetal membranes was diagnosed if LOF per vagina stopped and reaccumulation of amniotic fluid was documented sonographically. Sealed and unsealed patients were compared in terms of gestational age at delivery (GAdel) and perinatal survival. A p < 0.05 was considered statistically significant. Twenty patients with iPROM (7 genetic amniocenteses, 7 laser therapy for twin–twin transfusion syndrome, 3 in-utero fetal lower urinary tract obstruction, 1 chorionic villus sampling and 2 cord ligations) underwent an amniopatch. Two patients interrupted their pregnancies and were excluded from further analysis: one patient had trisomy 18 and the other had intraamniotic infection. Sealed membranes occurred in 13/18 (72%) patients post-amniopatch. Perinatal survival was higher in sealed versus unsealed patients (77% versus 0%, P = 0.006, Fisher's exact test). The median GAdel was higher in sealed versus unsealed cases (35 weeks, range 18.9–41, vs. 20.8 weeks, range 19.6–21.7, P = 0.02, Mann-Whitney test). iPROM can be successfully treated in > 70% of patients with an amniopatch. Lack of membrane sealing is associated with poor perinatal outcome. A multicenter prospective RCT of expectant management versus amniopatch for iPROM is being organized by us.
DOI: 10.1002/uog.1153
Authors: R. Quintero, R. Chmait, C. Rossi, M. Allen, P. W. Bornick
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1998331941