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Amniopatch - possibility of successful treatment of spontaneous previable rupture of membranes in the second trimester of pregnancy by transabdominal intraamiotic application of platelets and cryoprecipitate.

OBJECTIVE
To outline possibility of successful treatment of spontaneous previable rupture of membranes in the second trimester of pregnancy.


INTRODUCTION
Spontaneous previable rupture of membranes (SPROM) in the second trimester of pregnancy is one of the most alarming problems in current obstetrics. Perinatal mortality is about 60 %, one third of which represents intrauterine fetal demise. Surviving neonates suffer from various complications. There are different clinical approaches regarding treatment of SPROM.


MATERIAL AND METHODS
We present a case of a 30 year old secundigravida with a history of SPROM at 19+1 weeks gestation. Ultrasonographic examination revealed anhydramnios. Genital cultures and laboratory studies ruled out infectious etiology of SPROM. Due to expected poor neonatal outcome, decision to attempt amniopatch as an experimental therapeutic alternative was made at 21+1 weeks gestation (two weeks after SPROM had occurred). Autologous concentrated platelets followed by autologous cryoprecipitate were administered into the amniotic cavity transabdominally under ultrasound guidance. After 3 days sonographic examination showed normal volume of amniotic fluid. On 22 postoperative day, patient notice some leaking of fluid vaginally. Fetal growth was appropriate, amniotic fluid volume was decreased, however, oligohydramnios never progressed to anhydramnios. Pregnancy ended with primary cesarean delivery at 33+1 weeks gestation. Live born male infant with 1750 g birth weight was delivered. Postnatal development was within normal limits.


CONCLUSION
Intraamniotic application of "amniopatch" may represent a possibly successful treatment of spontaneous previable rupture of membranes. This case reports the longest stop of the leaking of amniotic fluid and total prolongation of pregnancy with favorable perinatal outcome after "amniopatch" treatment of spontaneous previable rupture of membranes in the second trimester so far published in available literature.