title: Pre-emptive placement of a presealant for amniotic access.
abstract: OBJECTIVE
  Amniotic access for fetal diagnosis and therapy can lead to membrane leaks, separation, and preterm premature rupture of membranes. Morbidity limits the beneficial effects of fetal intervention. We propose to examine a novel preventive "presealant" membrane puncture technique and evaluate it in vitro.
  
  
  METHODS
  Fetal membranes from normal term deliveries were fastened to a pressure controlled pump and punctured after presealant placement. Distinct bioadhesives were then compared for sealing efficacy by the measurement of leak pressures. Membranes were also evaluated for changes in tensile rupture strength after treatment.
  
  
  RESULTS
  Preemptive sealing by 2 of the presealants achieved significantly higher leak pressures compared with control membranes (85 and 78, respectively, vs 27 cm of water; P < .05). One of the presealants worked effectively in a membrane-sealant-membrane interface (62 vs 30 cm of water; P < .05). All treated membranes, however, demonstrated diminished tensile rupture forces compared with control membranes (124 vs 170 g/cm2; P > .05).
  
  
  CONCLUSIONS
  The application of a presealant is effective for the prevention of iatrogenic rupture in an in vitro model and may be beneficial for clinical application. Further studies with different bioadhesives are needed, given the limitations of the glues that are described in this study.
authors.affiliation: Fetal Treatment Center, Department of Surgery, University of California, San Francisco, CA 94143-0570, USA.
authors.forename: Raul A
authors.initials: RA
authors.lastname: Cortes
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Wagner
authors.forename: Hanmin
authors.initials: H
authors.lastname: Lee
authors.forename: Matt S
authors.initials: MS
authors.lastname: Clifton
authors.forename: Erich
authors.initials: E
authors.lastname: Grethel
authors.forename: Soon Ha
authors.initials: SH
authors.lastname: Yang
authors.forename: Robert
authors.initials: R
authors.lastname: Ball
authors.forename: Michael R
authors.initials: MR
authors.lastname: Harrison
mesh_terms: D003487:Cyanoacrylates / Q000627:therapeutic use*; D005321:Extraembryonic Membranes; D005260:Female; D005333:Fetus / Q000601:surgery*; D006801:Humans; D011247:Pregnancy; D011677:Punctures; D013718:Tensile Strength
chemical_list: D003487:Cyanoacrylates