Treatment of PPROM with anhydramnion in humans: first experience with different amniotic fluid substitutes for continuous amnioinfusion through a subcutaneously implanted port system

Abstract

Objective: This study aims to treat patients with preterm premature rupture of the membranes (PPROM) and anhydramnion using continuous amnioinfusion through a subcutaneously implanted port system. Methods: An amniotic fluid replacement port system was implanted in seven patients with PPROM and anhydramnion starting at the 20 th week of gestation (range, 14-26 weeks) for long-term amnioinfusion. Saline solutions (2 L/day; Jonosteril ® , Sterofundin ® , isotonic NaCl 0.9% solution, lactated Ringer's solution) and a hypotonic aqueous composition with reduced chloride content similar to the electrolyte concentration of human amniotic fluid were used for the continuous amnioinfusion. Results:The mean duration of the PPROM delivery interval continued for 49 days (range, 9-69 days), with 3 weeks of amnioinfusion via the port system (range, 4-49). The newborns showed no signs of lung hypoplasia. Conclusion: Long-term lavage of the amniotic cavity via a subcutaneously implanted port system in patients with PPROM and anhydramnion may help prolong the pregnancy and avoid fetal lung hypoplasia. A hypotonic aqueous composition with reduced chloride content similar to human amniotic fluid can be safely used for amnioinfusion. Prospective randomized studies are ongoing.

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

“…The continuous long-time amnio-infusion through a subcutaneously implanted port system is a method to establish a chronic lavage of the amniotic cavity (Figure 4) [66][67][68]. A subcutaneous pouch for the port capsule is prepared under local anesthesia.…”

“…Gratacos et al did not find any evidence of spontaneous membrane healing after fetoscopy in humans suggesting that the membrane defect persists until delivery [33]. Recent studies found that there is a relationship between the access hole size and the rate of PPROM as a complication of fetoscopic surgery [68,72]. We demonstrated a four-fold reduction in the rate of the access trauma of chorio-amniotic membranes by application of smaller fetoscopic devices with a 1 mm flexible optic [66], however, the risk of PPROM before 32/0 weeks could not be reduced to less than 10% of our cohort [67].…”

“…The risk of fluid leak (PPROM) after amniocentesis is relative low (1%-2%). Risk of PPROM after the fetoscopy correlates with the degree of FM damage: the smaller the fetoscopic sheath, the lower the risk of the PPROM [66][67][68][69][70]. The ability of chorio-amniotic membranes to repair themselves following injury is limited in humans and animals [67,71].…”

“…The amnioinfision does not appear to increase the risk of FIRS and associated adverse neurodevelopmental outcomes (Figure 4) [66][67][68][69][70]133]. Porat et al suggested that serial transabdominal amnioinfusions for early PPROM may improve early PPROM-associated morbidity and mortality rates.…”

“…Porat et al suggested that serial transabdominal amnioinfusions for early PPROM may improve early PPROM-associated morbidity and mortality rates. Continuous amnioinfusion via a subcutaneously implanted port-system with an amniotic fluid-like hypotonic solution may work to "flush out" bacterial contaminates ( Figure 4) ( Tables 4 and 5) [67,68,70].…”