Title

Amniopatch treatment of iatrogenic preterm premature rupture of membranes (iPPROM) after fetoscopic laser surgery for twin-twin transfusion syndrome.

Document Type

Article

Publication Date

6-1-2017

Identifier

DOI: 10.1080/14767058.2016.1214123

Abstract

OBJECTIVES: Amniopatch is a proposed treatment of iatrogenic preterm premature rupture of membranes (iPPROM). We studied characteristics associated with successful amniopatch treatment of iPPROM after fetoscopic laser surgery for twin-twin transfusion syndrome.

METHODS: Patients with iPPROM within 15 days of laser surgery treated with an amniopatch were studied. Factors associated with amniopatch success (i.e. cessation of leakage with normalization of amniotic fluid volume) were tested univariately and in multivariate logistic regression models. Continuous variables are expressed as median (range).

RESULTS: Of 1124 patients undergoing laser surgery, 19 (1.7%) had iPPROM and subsequent amniopatch. Twelve (63.2%) were successful. Latency in days from iPPROM to delivery was greater in the successful group (114.0 [87.0-141.0]) versus (44.0 [3.9-88.0], p = 0.0005), which translated into greater gestational age (GA) (weeks) at delivery (35.1 [30.9-39.4] versus 28.1 [22.0-31.0], p = 0.0005). The 30-day survival of the affected recipient twin was improved (100% versus 57.1%, p = 0.0361). After multivariate testing, GA < 20 weeks at the time of the amniopatch placement was the only variable that remained associated with successful sealing of the membranes.

CONCLUSIONS: Treatment of iPPROM via amniopatch was successful in almost two-thirds of cases and was associated with higher GA at delivery and improved perinatal survival.

Journal Title

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians

Volume

30

Issue

11

First Page

1349

Last Page

1354

MeSH Keywords

Female; Fetal Membranes, Premature Rupture; Fetofetal Transfusion; Fetoscopy; Gestational Age; Humans; Iatrogenic Disease; Infant, Newborn; Laser Therapy; Logistic Models; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Retrospective Studies; Risk Factors

Keywords

Fetal membrane patch; amniopatch; fetal membrane repair; fetal membrane sealant

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