In vitro sealing of punctured fetal membranes: potential treatment for midtrimester premature rupture of membranes.
OBJECTIVE
Midtrimester premature rupture of membranes causes significant perinatal morbidity and death. No effective treatment exists. We investigated (1) whether a needle puncture in the fetal membranes could be sealed in vitro and (2) the optimal composition of the sealant to be used.


METHODS
Membranes from second trimester pregnancies (16-24 weeks of gestation) were stretched over a modified syringe with a 2.5-cm open diameter. The syringe was filled with 20 mL of second trimester amniotic fluid, and the membrane was punctured with a 20-gauge needle. Sealants were injected into the amniotic fluid. The primary outcome variable was time for leakage of amniotic fluid. Median times for leakage for the formulations were compared by Wilcoxon exact rank sum test.


RESULTS
Platelets alone failed to seal the puncture site. All other formulations stopped leakage temporarily. Tisseel (Baxter Corp, Glendale, Calif) and cryoprecipitate/thrombin preparations led to more prolonged sealing of punctured amniotic membranes than platelets (P <.01) and were not significantly different from each other.


CONCLUSIONS
Of the sealants tested in vitro, amniotic membranes are best sealed by a fibrin/thrombin-based sealant.
Reddy
U M
UM
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, USA.
Shah
S S
SS
Nemiroff
R L
RL
Ballas
S K
SK
Hyslop
T
T
Chen
J
J
Wapner
R J
RJ
Sciscione
A C
AC
D000650:Amnion / Q000187:drug effects* / Q000378:metabolism; D000653:Amniotic Fluid / Q000378:metabolism; D001792:Blood Platelets / Q000502:physiology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D066298:In Vitro Techniques; D007267:Injections; D010539:Permeability; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011677:Punctures; D013917:Thrombin / Q000627:therapeutic use*; D013997:Time Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D013917:Thrombin