title: The closure of iatrogenic membrane defects after amniocentesis and endoscopic intrauterine procedures.
abstract: OBJECTIVE
  To describe a new technique for wound closure after endoscopic intrauterine procedures which prevents amniotic fluid leakage after the procedure.
  
  
  METHODS
  This is an observational study which reviews a new technique under an IRB-approved protocol. The rationale for this study was the increasing frequency of intrauterine endoscopic procedures. The most common complication of these procedures is persistent leakage of amniotic fluid from puncture sites, which can result in preterm labor and preterm delivery. Thus, these procedures carry a high morbidity rate that may overcome the benefit of the intervention. We have employed a new technique, which has successfully prevented amniotic fluid leakage following the procedure. The instruments used for the endoscopic procedures were no larger than 3.5 mm for all cases. A sealant of platelets was rapidly injected followed by injection of fibrin glue and powdered collagen slurry at each puncture site. Sonography for modified AFI, clinical examination for nitrazine and ferning, and pad count were performed after each procedure at three intervals: immediately after the procedure, 24 h and 48 h.
  
  
  RESULTS
  Eight patients undergoing an endoscopic intrauterine procedure (either cord ligation for twin-twin transfusion syndrome or sealing of ruptured membranes after amniocentesis) were included. All patients were treated between 18 and 24 weeks of gestation. Sonography, clinical examination and pad count revealed no evidence of amniotic fluid leakage either intra-abdominally or vaginally in any of the patients. There was 1 patient who ruptured membranes 12 h after the procedure due to severe vomiting. Another patient elected to terminate the pregnancy 48 h after the procedure without evidence of leakage. The remaining patients continued for 8 weeks or more without fluid leakage.
  
  
  CONCLUSIONS
  The technique described, immediate sealing of puncture wounds following endoscopic intrauterine procedures, is effective in preventing amniotic fluid loss after the procedure.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, NYU School of Medicine, New York, NY 10016, USA. byoung530@cs.com
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Young
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Roman
authors.forename: Andrew P
authors.initials: AP
authors.lastname: MacKenzie
authors.forename: Courtney D
authors.initials: CD
authors.lastname: Stephenson
authors.forename: Victoria
authors.initials: V
authors.lastname: Minior
authors.forename: Andrei
authors.initials: A
authors.lastname: Rebarber
authors.forename: Ilan
authors.initials: I
authors.lastname: Timor-Tritsch
mesh_terms: D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects; D005321:Extraembryonic Membranes / Q000601:surgery*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology* / Q000601:surgery*; D005332:Fetoscopy; D006801:Humans; D007049:Iatrogenic Disease; D013513:Obstetric Surgical Procedures / Q000009:adverse effects*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011677:Punctures / Q000009:adverse effects