Sipurzynski-Budrass S, Macher S, Haeusler M, Lanzer G
Department of Blood Group Serology and Transfusion Medicine, Medical University Graz, Austria.
Vox Sang. 2006 Jul;91(1):88-90. doi: 10.1111/j.1423-0410.2006.00784.x.
Iatrogenic premature rupture of membranes (PROM) occurs in approximately 1% of patients after genetic amniocentesis. If membranes do not seal spontaneously, fluid leakage through the vagina may cause infection and pregnancy loss. Intra-amniotic infusion of a platelet concentrate followed by a cryoprecipitate (amniopatch) is a possible therapeutic approach to restore the amnio-corial link and to facilitate the amniotic repair process.
The autologeous platelet concentrate was produced by apheresis (MCS+, Haemonetics) and contained a total amount of 48 x 10(9) platelets in a volume of 30 ml. The concentration of fibrinogen in our cryoprecipitate (20 ml) was 680 mg/dl. An amniocentesis was performed to apply the amniopatch. The platelet concentrate was administered first followed by the cryoprecipitate.
We report the successful treatment of a 38-year-old woman with ruptured membranes after genetic amniocentesis in the 16th gestational week. Ten days after placement of the amniopatch we found a complete closure of the rupture, and in the 36th week of gestation the patient delivered a healthy infant by Caesarean section.
Intra-amniotic injection of platelets and cryoprecipitate was a successful and safe therapy for PROM in this patient. Knowledge of the site of rupture is not necessary for the amniopatch, as platelets seem to find their way to the defect and seal it. We consider that amniopatch therapy for iatrogenic PROM is a possible therapeutic alternative for prolonging and preserving pregnancy and improving the fetal outcome.
医源性胎膜早破（PROM）在基因羊膜腔穿刺术后约1%的患者中发生。如果胎膜不能自行封闭，经阴道的液体渗漏可能导致感染和流产。羊膜腔内注入浓缩血小板后再注入冷沉淀（羊膜贴片）是恢复羊膜-绒毛连接并促进羊膜修复过程的一种可能的治疗方法。
自体浓缩血小板通过血细胞分离术（MCS+，Haemonetics）制备，30ml体积中含有总量为48×10⁹个血小板。我们的冷沉淀（20ml）中纤维蛋白原浓度为680mg/dl。进行羊膜腔穿刺以应用羊膜贴片。先注入浓缩血小板，随后注入冷沉淀。
我们报告了一名38岁女性在妊娠第16周基因羊膜腔穿刺术后胎膜破裂的成功治疗案例。放置羊膜贴片10天后，我们发现破裂处完全闭合，在妊娠第36周时患者通过剖宫产分娩出一名健康婴儿。
羊膜腔内注射血小板和冷沉淀对该患者的胎膜早破是一种成功且安全的治疗方法。进行羊膜贴片治疗无需知道破裂部位，因为血小板似乎能自行找到缺损处并将其封闭。我们认为，医源性胎膜早破的羊膜贴片治疗是延长和维持妊娠以及改善胎儿结局的一种可能的治疗选择。
