A Novel Approach to Serial Amnioinfusion in a Case of Premature Rupture of Membranes Near the Limit of Viability

Abstract

Prelabor rupture of the membranes (PROM) near the limit of viability is associated with significant risks for both mother and fetus. Preterm labor, intra-amniotic infection, and placental abruption are the immediate risks to the pregnancy; however, the fetus incurs additional risks related to the sequela of persistent oligohydramnios. Transabdominal intra-amniotic infusions have been studied. Results, suggesting that this intervention may prolong the latency period, and potentially, decrease pulmonary hypoplasia in surviving neonates without evidence of increasing risk of intra-amniotic infection. To our knowledge, the use of antibiotic-infused fluid has not been reported in this clinical scenario. Therefore, we present a case of a patient with PROM before the limit of viability who underwent serial transabdominal amnioinfusions with oxacillin-containing normal saline, which resulted in membrane resealing and neonatal survival with no additional maternal morbidity.

Management and Interventions in Previable and Periviable Preterm Premature Rupture of Membranes: A Review

“…19 Because of the immediate effects of infection and placenta abruption and long-term effects of persistent oligohydramnios on the fetus, serial amnioinfusion with saline and an antibiotic have been reported to have been used successfully in a pregnancy starting at 21 6/7 weeks with eventual delivery at 34 weeks and in a pregnancy with pPPROM at 22 weeks with the saline antibiotic amnioinfusions started at 26 weeks and delivery at 33 weeks. 20,21 A continuous infusion of warm saline at the rate of 500-1000 mL/d by an indwelling catheter along with antibiotics and tocolytics was used in another study and was found to significantly increase the latency period (median: 13 vs 4 days, P < 0.001), and in the survival analysis, the women who remained undelivered were significantly higher in amnioinfusion group compared with the nonamnioinfusion group for each gestational age after PPROM (P < 0.001). 22 Amniopatches (fresh frozen plasma and platelets) have been uses successfully in cases of iatrogenic PPROM, which is 1 of the most common complications after invasive prenatal diagnosis and fetal surgery.…”