Amniopatch as an active treatment of spontaneous previable rupture of membranes

Ferianec, V.; Križko, M; Gábor, Martin; Papcun, P.; Alfoldi, Martin; Feriancová, Michaela

doi:10.1080/14767058.2022.2072723

Cited by 3 publications

(11 citation statements)

References 24 publications

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“…One previous systematic review on this topic was excluded [46] because the authors described the same cases as this review and included one article with iatrogenic PPROM and one article that raised concerns. Finally, 14 studies met the eligibility criteria and were included and analyzed in this systematic review [47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Four studies [47][48][49][50] on the spontaneous premature rupture of membranes analyzed the outcomes for 141 pregnancies and sealing and healing methods: 82 cases using an amniopatch with autologous or donor platelet concentrates and cryoprecipitate inserted by the ultrasound-guided amnioinfusion technique and 59 cases using an immunologic sealant or a mechanical cervical adapter for sealing (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…An amniopatch was used after serial amnioinfusion in case of continuous amniotic fluid leakage and anamnios/oligohydramnios [47,49,50]. In all studies, patients with regular uterine contractions or vaginal bleeding, signs or symptoms of clinical chorioamnionitis, or major fetal congenital anomalies were excluded.…”

Section: Resultsmentioning

confidence: 99%

“…Table 1 summarizes included studies on amniotic membrane sealing involving human models. Four studies [47][48][49][50] on the spontaneous premature rupture of membranes analyzed the outcomes for 141 pregnancies and sealing and healing methods: 82 cases using an amniopatch with autologous or donor platelet concentrates and cryoprecipitate inserted by the ultrasound-guided amnioinfusion technique and 59 cases using an immunologic sealant or a mechanical cervical adapter for sealing (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…No complete closure of the amniotic defect was obtained by Ferianec et al, but in most patients, they achieved an increase in AF volume production with a different duration of the interval without AF leakage. From 53 cases of amniopatch use, complete closure of the amniotic defect was observed in 6 women (12%), 35 babies were live-born (66%), and 33 babies survived (62%) and were discharged [50].…”

Section: Resultsmentioning

confidence: 99%

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Is Spontaneous Preterm Prelabor of Membrane Rupture Irreversible? A Review of Potentially Curative Approaches

et al. 2023

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There is still no curative treatment for the spontaneous preterm prelabor rupture of membranes (sPPROM), the main cause of premature birth. Here, we summarize the most recent methods and materials used for sealing membranes after sPPROM. A literature search was conducted between 2013 and 2023 on reported newborns after membranes were sealed or on animal or tissue culture models. Fourteen studies describing the outcomes after using an amniopatch, an immunologic sealant, or a mechanical cervical adapter were included. According to these studies, an increase in the volume of amniotic fluid and the lack of chorioamnionitis demonstrate a favorable neonatal outcome, with a lower incidence of respiratory distress syndrome and early neonatal sepsis, even if sealing is not complete and stable. In vivo and in vitro models demonstrated that amniotic stem cells, in combination with amniocytes, can spontaneously repair small defects; because of the heterogenicity of the data, it is too early to draw a thoughtful conclusion. Future therapies should focus on materials and methods for sealing fetal membranes that are biocompatible, absorbable, available, easy to apply, and easily adherent to the fetal membrane.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Is Spontaneous Preterm Prelabor of Membrane Rupture Irreversible? A Review of Potentially Curative Approaches

et al. 2023

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“…In addition, the placement of an amnio patch has been proposed by a few research groups. They propose the intraamniotic transfusion of maternal platelets and plasma to favor the temporary closure of the membrane defect [ 14 , 15 , 16 ]. Another alternative “experimental” solution is a serial amnioinfusion.…”

Section: Introductionmentioning

confidence: 99%

Maternal Outcomes Following Active vs. Expectant Management of Previable Preterm Pre-Labor Rupture of Membranes: A Meta-Analysis

2023

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The diagnosis of previable preterm pre-labor rupture of membranes (PROM) is known to be associated with poor outcomes for both the mother and the fetus. Following previable preterm PROM, patients are generally offered either active management through the termination of the pregnancy or expectant management to increase the chances of fetal survival. It is difficult to counsel patients because there is a lack of data directly comparing maternal outcomes following active vs. expectant management. Using the data in the current literature, the goal of the present meta-analysis was to determine if there were any differences in terms of maternal risks when active versus elective management was chosen. PubMed, Google Scholar, EMBASE, and Scopus were searched. We found four studies accounting for a total of 506 patients. The risk ratio (RR) of chorioamnionitis in active vs. expectant management was 0.30 (with a 95% confidence interval, CI, of 0.09–1.02). The heterogeneity of the study results was 81% (I2). A sub–analysis of two included studies revealed an RR of postpartum hemorrhage in active vs. expectant management of 0.75 (95% CI 0.27–2.07) and an RR of maternal sepsis of 0.23 (95% CI 0.04–1.28). The heterogeneity of the study results for this sub-analysis was 68% (I2) for postpartum hemorrhage and 0% (I2) for maternal sepsis. Overall, there was no statistically significant difference in the risk of chorioamnionitis, postpartum hemorrhage, or maternal sepsis when active management was chosen over expectant management in previable preterm PROM at <24 weeks. The scarcity and the high heterogeneity of the available data likely contributed to the lack of statistical significance and calls for further work directly comparing maternal outcomes following active vs. expectant management.

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Anti-infectious and anti-inflammatory effect of amniopatch in the treatment of spontaneous previable rupture of membranes

Alföldi,

Ferianec

2024

Arch Gynecol Obstet

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Spontaneous previable rupture of membranes complicates approximately 0.4–0.7% of pregnancies and is associated with severe maternal and neonatal morbidity and mortality. Intra-amniotic inflammation is present in up to 94.4% of cases, most often caused by a bacterial infection. In comparison, the effectiveness of antibiotic therapy in its eradication reaches less than 17%. Inflammatory activity in the amniotic cavity disrupts the physiological development of the fetus with an increase in maternal, fetal, and neonatal inflammatory morbidity through the development of fetal inflammatory response syndrome, maternal chorioamnionitis, and neonatal sepsis. Amniopatch is an invasive therapeutic technique based on intra-amniotic administration of maternal hemoderivates in the form of thromboconcentrate and plasma cryoprecipitate to provide the temporary closure of the fetal membranes defect and secondary restitution of normohydramnios with correction of pressure–volume ratios. The supposed basis of this physical–mechanical action is the aggregation of coagulant components of amniopatch in the area of the defect with the formation of a valve cap. The background for the formulation of the hypothesis on the potential anti-infectious and anti-inflammatory action of non-coagulant components of amniopatch involved: i) clinical–academic and publishing outputs of the authors based on their many years’ experience with amniopatch application in the treatment of spontaneous previable rupture of membranes (2008–2019), ii) the documented absence of clinically manifested chorioamnionitis in patients treated this way with a simultaneously reduced incidence of neonatal respiratory distress syndrome compared to expectant management (tocolysis, corticotherapy, antibiotic therapy). The non-coagulant components of plasma cryoprecipitate include mainly naturally occurring isohemagglutinins, albumin, and soluble plasma fibrinogen. Although these components of the amniopatch have not been attributed a significant therapeutic role, the authors assume that due to their opsonizing and aggregative properties, they can significantly participate in optimizing the intrauterine environment through the reduction in bacterial and cytokine charge in the amniotic fluid. The authors think these facts constitute a vital stimulus to future research–academic activity and, at the same time, an idea for reconsidering the therapeutic role of amniopatch as a tool for improving perinatal results of spontaneous previable ruptures of membranes.

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Amniopatch as an active treatment of spontaneous previable rupture of membranes

Cited by 3 publications

References 24 publications

Is Spontaneous Preterm Prelabor of Membrane Rupture Irreversible? A Review of Potentially Curative Approaches

Is Spontaneous Preterm Prelabor of Membrane Rupture Irreversible? A Review of Potentially Curative Approaches

Maternal Outcomes Following Active vs. Expectant Management of Previable Preterm Pre-Labor Rupture of Membranes: A Meta-Analysis

Anti-infectious and anti-inflammatory effect of amniopatch in the treatment of spontaneous previable rupture of membranes

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