University of Southern California, Keck School of Medicine, Maternal Fetal Medicine, Los Angeles, Calif., USA.
Fetal Diagn Ther. 2010;27(3):134-7. doi: 10.1159/000275685. Epub 2010 Jan 13.
The risk of iatrogenic rupture of membranes (IROM) is 5-30% after operative fetoscopy. The aim of this study was to describe outcomes of patients with IROM following selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS) who were subsequently treated with amniopatch therapy.
A review of patients who underwent treatment for mid-trimester TTTS between March 2006 and February 2008 with IROM within 7 days of SLPCV was performed. IROM patients without evidence of preterm labor or chorioamnionitis were offered expectant management, pregnancy termination, or amniopatch therapy.
Ninety-three patients were treated with SLPCV, of which three (3.2%) had IROM within 7 days. All three opted for amniopatch therapy which was performed at 18 2/7, 23 1/7, and 22 6/7 weeks' gestation in patients 1, 2 and 3, respectively. In patients 1 and 2, amniopatch therapy sealed membranes within 7 days. A second amniopatch was required for patient 3 before IROM resolved. Gestational ages at delivery were 38 2/7, 37 5/7 and 30 2/7 weeks, respectively.
Amniopatch is a viable treatment option for iatrogenic ROM following SLPCV.
在手术性胎儿镜检查后，医源性胎膜破裂（IROM）的风险为 5-30%。本研究旨在描述接受选择性激光血管吻合术（SLPCV）治疗双胎输血综合征（TTTS）后发生 IROM 并随后接受羊膜贴片治疗的患者的结局。
回顾 2006 年 3 月至 2008 年 2 月期间接受中期 TTTS 治疗且在 SLPCV 后 7 天内发生 IROM 的患者。没有早产或绒毛膜羊膜炎证据的 IROM 患者可选择期待治疗、终止妊娠或羊膜贴片治疗。
93 例患者接受了 SLPCV 治疗，其中 3 例（3.2%）在 7 天内发生了 IROM。所有 3 例患者均选择了羊膜贴片治疗，分别在患者 1、2 和 3 的 18 2/7、23 1/7 和 22 6/7 孕周进行。在患者 1 和 2 中，羊膜贴片治疗在 7 天内封闭了胎膜。患者 3 则需要第二次羊膜贴片治疗，然后 IROM 才得到解决。分娩时的胎龄分别为 38 2/7、37 5/7 和 30 2/7 周。
羊膜贴片是 SLPCV 后医源性 ROM 的一种可行的治疗选择。
