Year: 2018
Type: article
Abstract: Premature preterm rupture of the membranes (PPROM) complicates fetal surgery in 32% of open neural tube defect repairs (Moldenhauer et al. Fetal Diagn Ther 2015;37:235-40). PPROM increases the risk of contractions and delivery as well as the risk of inflammation/infection for both mother and baby. Identification of those patients at risk of PPROM following fetal surgery would clearly be useful. The paper by Moron et al. is interesting and sheds light on this issue by suggesting an association between velevated levels of amniotic fluid lactic acid and matrix metalloproteinase-8 (MMP-8) and subsequent PPROM. This finding should prompt further investigation of the hypothesis, but much larger numbers with a different study design will be required to confirm this putative association. The authors recognise their sample size limitation, which clearly hampers regression analyses that may address confounders – of which there are many. It should also be noted that the duration of their surgery is much longer than that reported in the post MOMS era (121–127 versus 79 minutes) (Moldenhauer et al. 2015). It would be interesting to know whether amniotic fluid levels of lactic acid and/or MMP-8 was elevated at the time of genetic amniocentesis prior to surgery and whether there were complications (such as bleeding or membrane separation) prior to surgery. Further considerations for future study could be the contemporaneous sampling of these biomarkers in the maternal serum at the time of the amniotic fluid sampling. At this time, it is too early to change practice based on this study, but the findings are deserving of further more detailed investigation. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
Author: MA Belfort
Institution: Texas Medical Center
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2807053362