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Why Do the Fetal Membranes Rupture after Fetoscopy?: Comments on Proposed Mechanisms and Adding the Fetus as a Potential Culprit

It has never been taken into account that the fetus itself, by being trapped within the iatrogenic openings in the amniotic membrane from a previous intervention, can tear her home to pieces. As early rupture of membranes within hours or days after percutaneous fetoscopic surgery for spina bifida occurs in less than 10% of our cases, I would attribute most ruptures later in gestation to this effect. Fetal fingers and toes fit all too easily and - with advanced gestational age (the mean age of PROM after my approach to fetoscopic spina bifida surgery occurs around 30 weeks of gestation) - the fetus becomes certainly strong enough to achieve this mischievous feat. Supporting this notion of the (trapped) fetus as a potential culprit, many expectant mothers report a period of stronger fetal movements shortly prior to the occurrence of PROM.