Ferianec Vladimír, Krizko Marian, Papcun Peter, Svitekova Klara, Cizmar Branislav, Holly Ivan, Holoman Karol
2nd Department of Obstetrics and Gynecology, Comenius University, Bratislava, Slovakia.
Neuro Endocrinol Lett. 2011;32(4):449-52.
To outline possibility of successful treatment of spontaneous previable rupture of membranes in the second trimester of pregnancy.
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.
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.
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.
概述妊娠中期胎膜早破成功治疗的可能性。
妊娠中期胎膜早破（SPROM）是当前产科最令人担忧的问题之一。围产期死亡率约为60%，其中三分之一为宫内胎儿死亡。存活的新生儿会出现各种并发症。关于SPROM的治疗有不同的临床方法。
我们报告一例30岁经产妇，孕19+1周时发生SPROM。超声检查显示羊水过少。生殖道培养和实验室检查排除了SPROM的感染病因。由于预期新生儿预后不良，在孕21+1周（SPROM发生两周后）决定尝试羊膜贴片作为一种实验性治疗选择。在超声引导下经腹将自体浓缩血小板随后是自体冷沉淀注入羊膜腔。3天后超声检查显示羊水量正常。术后第22天，患者注意到阴道有液体渗漏。胎儿生长正常，羊水量减少，但羊水过少从未进展为羊水过少。妊娠于孕33+1周时行首次剖宫产结束。分娩出一名出生体重1750g的活产男婴。产后发育正常。
羊膜腔内应用“羊膜贴片”可能是胎膜早破成功治疗的一种方法。本病例报告了在现有文献中迄今为止发表的经“羊膜贴片”治疗妊娠中期胎膜早破后羊水渗漏停止时间最长、妊娠总延长且围产期结局良好的情况。
