Preterm Prelabor Rupture of Membranes and Fetal Survival after Minimally Invasive Fetal Surgery: A Systematic Review of the Literature

Abstract

Objective: Iatrogenic preterm prelabor rupture of membranes (iPPROM; <37 weeks of gestation) is a major complication of fetal surgery. Little information is available about risk factors and incidence. Methods: We systematically reviewed reported iPPROM rates, gestational age at delivery and fetal survival after representative minimally invasive antenatal procedures. Results: A total of 1,146, 36 and 194 cases with mean iPPROM rates of 27, 31 and 26% were included for placental laser in twin-twin transfusion syndrome, shunting in lower urinary tract obstruction and interventions for twin-reversed arterial perfusion, respectively. In the statistical analysis, the maximum diameter of the instrument predicted iPPROM rate and was significantly related to gestational age at birth as well as fetal survival. Information on duration of the respective procedures was scarce and did not allow for meaningful analysis. Conclusions: iPPROM occurs in about 30% of cases treated by minimally invasive fetal surgery. The maximum diameter of the instrument explains iPPROM rate, gestational age at birth and fetal survival. Great variations in the reporting of iPPROM make data analysis difficult.

Absorbable gelatin plug does not prevent iatrogenic preterm premature rupture of membranes after fetoscopic laser surgery for twin–twin transfusion syndrome

“…In addition, on review of the medical records, we were unable to differentiate delivery following spontaneous preterm labor from iatrogenic premature delivery. The mean gestational age at delivery in our study, in both groups, was at the lower range of the previously reported case series of 27-35 weeks 16 . The cause of variation in the gestational age at delivery between the centers remains unknown.…”

“…There was one case of PPROM within 3 weeks of the procedure. However, the overall gestational age at delivery in their series was 28.4 weeks with a procedure-to-delivery interval of 6.5 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] weeks. This gestational age at delivery was 3-4 weeks lower than in other published series.…”

A model for the compressible, viscoelastic behavior of human amnion addressing tissue variability through a single parameter

“…Such a model represents the first step towards the development of numerical simulation tools to address clinical questions, as for example potential structural weakening caused by prenatal surgery [Devlieger et al, 2006;Beck et al, 2012] or increased rupture risk associated with cervical opening or pelvic floor laxity [Menon et al, 2015].…”

Repairing Fetal Membranes with a Self-adhesive Ultrathin Polymeric Film: Evaluation in Mid-gestational Rabbit Model

“…A recent review reported the diameter of the surgical instruments and the number of entries into the uterine cavity as the two main factors leading to IPPROM (6). Physical access and time constraints are critical to successful suturing of fetal tissues.…”