title: An in vitro model and case report that used gelatin sponge to restore amniotic fluid volume after spontaneous premature rupture of the membranes.
abstract: OBJECTIVE
  The purpose of this project was to study an in vitro model for plugging membrane defects with gelatin sponge and to develop a method with which to use this material to treat premature rupture of the membranes.
  
  
  METHODS
  Fetal membranes were fixed over the opening of a flask that was filled with saline solution and gelatin sponge. Defects of various sizes were created, and the usefulness of differing sizes of gelatin sponge to obstruct the defects was observed. This technique was then applied to a case of previable, spontaneous premature rupture of the membranes.
  
  
  RESULTS
  Fifteen amniotomies were performed in the in vitro model. The gelatin sponge obstructed all defects less than 7 mm in length, when pieces up to 1 x 1 cm in dimension (n = 8 amniotomies) were used. For larger defects or those defects with a complex shape (such as cruciate), gelatin sponge was not effective at arresting fluid loss (n = 4 amniotomies). An inspection of larger gelatin sponge pieces, after instillation through a 12-gauge angiocatheter, revealed 36% (15 of 42 pieces) of 1 x 1 - cm pieces remained intact. A case of spontaneous, previable premature rupture of the membranes was treated with this material. A favorable outcome was observed.
  
  
  CONCLUSIONS
  Gelatin sponge is successful at arresting the egress of fluid through membrane defects when smaller defects are present. Complex or larger linear defects may not be treated by this method alone and necessitate adjuvant therapies. This therapeutic strategy can be applied to cases of previable, spontaneous premature rupture of the membranes.
authors.affiliation: Department of Maternal-Fetal Medicine, Perinatal Diagnostic Center, Central Baptist Hospital, Lexington, Ky 40503, USA. jobrien@bhsi.com
authors.forename: J M
authors.initials: JM
authors.lastname: O'Brien
authors.forename: B M
authors.initials: BM
authors.lastname: Mercer
authors.forename: J R
authors.initials: JR
authors.lastname: Barton
authors.forename: D A
authors.initials: DA
authors.lastname: Milligan
mesh_terms: D000328:Adult; D000650:Amnion / Q000378:metabolism* / Q000473:pathology; D000653:Amniotic Fluid / Q000378:metabolism*; D002823:Chorion / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000473:pathology / Q000628:therapy*; D005780:Gelatin; D006801:Humans; D010539:Permeability; D011247:Pregnancy; D011677:Punctures; D015503:Surgical Sponges; D016896:Treatment Outcome
chemical_list: D005780:Gelatin