Amnioinfusion in preterm PROM: effects on amnion and cord histology

Locatelli, Anna; Andreani, Marianna; Ghidini, Alessandro; Verderio, Maria; Pizzardi, Agnese; Vergani, Patrizia; Salafia, Carolyn M.

doi:10.1038/sj.jp.7211876

Cited by 9 publications

(8 citation statements)

References 11 publications

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“…The amniotic fluid is often replaced with warmed Ringer's lactate either during fetoscopy or following amniotic insufflation [27,78]. As Ringer's lactate has lower osmolarity than normal amniotic fluid, surgeons rely on fetal secretions (urine, lung, nasal, and salivary) and intramembranous reabsorption to normalize the amniotic fluid osmolarity after surgery [38,78,79,86,87]. The complete replacement of the amniotic fluid, after fetoscopy, is expected to take up to 48 hours [38].…”

Section: Diluting the Amniotic Fluidmentioning

confidence: 99%

Why Do the Fetal Membranes Rupture Early after Fetoscopy? A Review

et al. 2021

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Iatrogenic preterm premature rupture of the fetal membranes (iPPROM) remains the Achilles’ heel of keyhole fetal surgery (fetoscopy) despite significant efforts in preclinical models to develop new therapies. This limited success is partially due to incomplete understanding why the fetal membranes rupture early after fetoscopy and notable differences in membrane physiology between humans and domestic species. In this review, we summarize aspects of fetoscopy that may contribute to iPPROM, the previous efforts to develop new therapies, and limitations of preclinical models commonly used in fetal membrane research.

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Section: Diluting the Amniotic Fluidmentioning

confidence: 99%

Why Do the Fetal Membranes Rupture Early after Fetoscopy? A Review

et al. 2021

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“…De Santis et al reported that the patients with PPROM did not appear to demonstrate any benefit from this repetitive AF replacement (250 mL per intervention) as measured by post procedure AFI because fluid loss occurred within 6 h of instillation [136,149]. Locatelli et al found that the serial AI could improve the neonatal outcome primarily by prolonging latency [145,151]. The patients with PPROM and oligohydramnios had a significantly shorter interval to delivery, lower neonatal survival of 20%, 62% of pulmonary hypoplasia and 60% rate of neurological handicap.…”

Section: Amnio-infusion Techniquesmentioning

confidence: 99%

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

Tchirikov

Schlabritz‐Loutsevitch

Mäher

et al. 2017

Journal of Perinatal Medicine

187

153

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Mid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%-0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long-and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The "classic PPROM" with oligo/anhydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The "high PPROM" syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for "high PPROM" syndrome. In some cases, the rupture of only one membrane -either the chorionic or amniotic membrane, resulting in "pre-PPROM" could precede "classic PPROM" or "high PPROM". The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed during in specula investigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intraamniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR) = 0.66), neonatal infections (RR = 0.67) and abnormal ultrasound scan of neonatal brain (RR = 0.67)]. The positive effect of continuo...

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“…2. Conductor in the amniotic cavity [26] мощью коллагена, смеси тромбоцитов и фибриногена достаточно противоречивы, что требует дальнейших исследований в данном направлении и сравнения разных методик и технологий [9, [31][32][33].…”

Section: обсуждение и выводыunclassified

Minimally invasive intrauterine interventions: a review of their use in the prevention of pregnancy complications in case of premature discharge of amniotic fluid and rupture of the amniotic membrane during fetoscopic interventions

Kosovtsova¹,

Putilova²,

Pavlichenko³

et al. 2019

Z.akus.zen.bolezn

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This review article highlights the results of using the variety of methods to prevent premature discharge of amniotic fluid as a complication of minimally invasive intrauterine interventions: the imposition of tissue sealant and amniopatch; amnioinfusion with normal saline, Ringer’s solution or artificial amniotic fluid using a port system. A historical background is given on the application of these correction methods.

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Amnioinfusion in preterm PROM: effects on amnion and cord histology

Cited by 9 publications

References 11 publications

Why Do the Fetal Membranes Rupture Early after Fetoscopy? A Review

Why Do the Fetal Membranes Rupture Early after Fetoscopy? A Review

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

Minimally invasive intrauterine interventions: a review of their use in the prevention of pregnancy complications in case of premature discharge of amniotic fluid and rupture of the amniotic membrane during fetoscopic interventions

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