Amniopatch Treatment for Spontaneous Previable, Preterm Premature Rupture of Membranes Associated or Not with Incompetent Cervix

Abstract

Objective: We reviewed women with previable spontaneous premature rupture of membranes (sPPROM) in whom an amniopatch was performed and compared their pregnancy outcomes with a conservative management group. Methods: Amniopatch, an amnioinfusion of autologous platelet concentrate followed by cryoprecipitate, was performed in 7 women with sPPROM diagnosed at 17–23 weeks’ gestation, including one twin pregnancy. Three patients had incompetent cervices and the other 4 patients had sPPROM without incompetent cervices. Pregnancy outcomes of the cases were compared with the controls who were managed conservatively (n = 22). Results: Amniopatch treatment was successful in 1 of 7 cases (14.3%), in which the ruptured membranes were completely sealed and the patient delivered a healthy baby at 39 weeks’ gestation. No procedure-related complications were observed. Overall, neonatal outcome was similar in the amniopatch and conservatively managed groups, although the incidences of early neonatal sepsis and respiratory distress syndrome were lower in the amniopatch group. Conclusion: The overall success rate of amniopatch among our small number of cases was low. However, if successful, amniopatch may prolong a pregnancy with previable sPPROM to term.

Amniopatch Treatment in Spontaneous Previable Preterm Rupture of Membranes with Neonatal Outcomes

“…For these reasons, previous studies have found that the amniopatch procedure in sPPROM is far less effective . We reviewed the available literature to find cases of sPPROM treated with amniopatch but the treatment was only successful in a few cases [11,15,19]. Kwak et al reported in his study that amniopatch treatment in spontaneous ruptures was successful in 1 out of 7 cases (14.3%).…”

“…All except one were born prematurely and one had a mild disability. Other studies reported lower rates of complet healing of membranes with spontaneous rupture (11-14.3 %) [19][20][21]. Contino et al and Ferianec both reported two successful cases delivered at 27 weeks [12] and 33 weeks of gestation [15], respectively.…”

Management of severe oligohydramnios with antepartum transabdominal amnioinfusion

“…Another 100 ml of normal saline is then instilled to achieve the optimal (> 5 cm) deepest pocket of the AF bag. Theoretically, the platelet/cryoprecipitate plug may seal the amniotic membranous defect by artificial platelet activation and fibrin adhesion at the site of the rupture, forming a 'white' coagulum as a plug 123,124,126,133 . In our analysis, the overall perinatal survival rate was highest (61.4%) after treatment with AP.…”

“…This technique is basically performed in the case of iPPROM. In sPPROM cases, the AP predominantly fails, usually because of infection 133 . The membrane defects after needle-based procedures or fetoscopy are usually well demarcated and relatively small, and the needles or trocars are usually inserted into the uterine cavity under sterile circumstances.…”

“…The procedure was successful in only 3 cases (11.5%) [124][125][126]132,133 . This low success rate limits the use of AP for the treatment of iatrogenic amniotic leakage, and PPROM is rather a therapeutic target for APTA 124,133,151,161 .…”