Sealing of ruptured amniotic membranes with intra-amniotic platelet-cryoprecipitate plug

Quintero, RubénA.; Romero, Roberto; Dzieczkowski, Jeff; Mammen, Eberhard F.; Evans, M. I.

doi:10.1016/s0140-6736(96)90316-5

Cited by 64 publications

(23 citation statements)

References 3 publications

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“…The resultant oligohydramnios was associated with the development of severe variable decelerations of the fetal heart rate and eventually required preterm delivery. Use of an intra-amniotic platelet-cryoprecipitate plug to seal a high membrane leak has been described [15], but was not attempted in this case.…”

Section: Discussionmentioning

confidence: 97%

In utero Decompression of a Cystic Grade IV Sacrococcygeal Teratoma

Garcia

Morgan²,

Bruner³

1998

Fetal Diagn Ther

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Sacrococcygeal teratomas (SCT) are the most common congenital tumors in the newborn. The prevalence rate is approximately 1 per 40,000 births, with 80% occurring in females. The majority of these tumors are external, protruding from the perineal region. Intrapelvic SCTs, by contrast, are extremely rare and difficult to diagnose in utero. Only 15% of the SCTs are entirely cystic, the majority being mixed or solid tumors. We describe a case of a fetal cystic presacral (grade IV) SCT, discovered at 22 weeks of gestation, which resulted in bilateral ureteral obstruction and hydronephrosis. This is the first known reported case of prenatally decompressing a cystic SCT via an amniotic catheter to alleviate a mass effect in the fetus.

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Section: Discussionmentioning

confidence: 97%

In utero Decompression of a Cystic Grade IV Sacrococcygeal Teratoma

Garcia

Morgan²,

Bruner³

1998

Fetal Diagn Ther

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“…Numerous attempts to seal the rupture of the membrane including the use of collagen or gelatin plugs, slurry of platelets/fibrinogens and also endoscopic closure of fetal membrane defects have been investigated [19,33,[126][127][128][129][130].…”

Section: Fetal Membrane Repairmentioning

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

188

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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“…In the last few years, several possible strategies to prevent or treat PROM have been described, including collagen plugs (Gratacos et al, 2000), native amniotic scaffolds (Mallik et al, 2007, Ochsenbein-Kolble et al, 2007, collagen plugs enriched with platelets and amniotic fluid cells (Liekens et al, 2008) in a rabbit model or gelatin sponge plugs in a ovine and primate model (Luks et al, 1999), fibrin glue (Sciscione et al, 2001, Harmanli et al, 1998, amniopatches (Quintero, 2001, Quintero et al, 1999, Quintero et al, 1996, amniografts (Quintero et al, 2002), maternal blood clot plugs (Sener et al, 1997), combinations of platelets, fibrin glue and powdered collagen slurry (Young et al, 2004), and gelatine sponges (Papanna et al, 2010) in humans. The relatively poor outcome using collagen-based matrices in conjunction with fibrin glue might be attributed to their high susceptibility to proteolytic remodelling and might be a result of instable plugging and leakage shortly after application (Quintero et al, 2002).…”

Section: Distension Of the Mussel Gluementioning

confidence: 99%

Mussel‐mimetic tissue adhesive for fetal membrane repair: a standardized ex vivo evaluation using elastomeric membranes

et al. 2011

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ObjectiveIatrogenic preterm premature rupture of membranes (iPPROM), the main complication of invasive interventions in the prenatal period, seriously limits the benefit of diagnostic or surgical prenatal procedures. This study aimed to evaluate preventive plugging of punctured fetal membranes in an ex vivo situation using a new mussel‐mimetic tissue adhesive (mussel glue) to inhibit leakage.MethodsA novel biomechanical test device that tests the closure of injured membranes under near‐physiological conditions was used. Mussel glue, a poly(ethylene glycol)‐based hydrogel, was used to seal membrane defects of up to 3 mm in mechanically well‐defined elastomeric membranes with three different degrees of stiffness.ResultsElastomeric test membranes were successfully employed for testing mussel glue under well‐defined conditions. Mussel glue plugs were distended by up to 94%, which translated to an improved sealing efficiency on elastomeric membranes with high stiffness. For the stiffest membrane tested, a critical burst pressure of 48 mbar (36 mmHg) was accomplished in this ex vivo setting.ConclusionsMussel glue appears to efficiently seal membrane defects under well‐standardized ex vivo conditions. As repaired membranes resist pressures measured in amniotic cavities, mussel glue might represent a novel sealing method for iatrogenic membrane defects. Copyright © 2011 John Wiley & Sons, Ltd.

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Sealing of ruptured amniotic membranes with intra-amniotic platelet-cryoprecipitate plug

Cited by 64 publications

References 3 publications

In utero Decompression of a Cystic Grade IV Sacrococcygeal Teratoma

In utero Decompression of a Cystic Grade IV Sacrococcygeal Teratoma

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

Mussel‐mimetic tissue adhesive for fetal membrane repair: a standardized ex vivo evaluation using elastomeric membranes

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