title: Successful treatment of premature rupture of membranes after genetic amniocentesis by intra-amniotic injection of platelets and cryoprecipitate (amniopatch): a case report.
abstract: OBJECTIVE
  Iatrogenic premature rupture of membranes (PROM) occurs in approximately 1% of patients after genetic amniocentesis. If membranes do not seal spontaneously, fluid leakage through the vagina may cause infection and pregnancy loss. Intra-amniotic infusion of a platelet concentrate followed by a cryoprecipitate (amniopatch) is a possible therapeutic approach to restore the amnio-corial link and to facilitate the amniotic repair process.
  
  
  METHODS
  The autologeous platelet concentrate was produced by apheresis (MCS+, Haemonetics) and contained a total amount of 48 x 10(9) platelets in a volume of 30 ml. The concentration of fibrinogen in our cryoprecipitate (20 ml) was 680 mg/dl. An amniocentesis was performed to apply the amniopatch. The platelet concentrate was administered first followed by the cryoprecipitate.
  
  
  RESULTS
  We report the successful treatment of a 38-year-old woman with ruptured membranes after genetic amniocentesis in the 16th gestational week. Ten days after placement of the amniopatch we found a complete closure of the rupture, and in the 36th week of gestation the patient delivered a healthy infant by Caesarean section.
  
  
  CONCLUSIONS
  Intra-amniotic injection of platelets and cryoprecipitate was a successful and safe therapy for PROM in this patient. Knowledge of the site of rupture is not necessary for the amniopatch, as platelets seem to find their way to the defect and seal it. We consider that amniopatch therapy for iatrogenic PROM is a possible therapeutic alternative for prolonging and preserving pregnancy and improving the fetal outcome.
authors.affiliation: Department of Blood Group Serology and Transfusion Medicine, Medical University Graz, Austria. sabine.sipurzynski@klinikum-graz.at
authors.forename: S
authors.initials: S
authors.lastname: Sipurzynski-Budrass
authors.forename: S
authors.initials: S
authors.lastname: Macher
authors.forename: M
authors.initials: M
authors.lastname: Haeusler
authors.forename: G
authors.initials: G
authors.lastname: Lanzer
mesh_terms: D000328:Adult; D000649:Amniocentesis / Q000009:adverse effects*; D000650:Amnion / Q000293:injuries*; D001805:Blood Transfusion, Intrauterine; D005169:Factor VIII / Q000008:administration & dosage*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology / Q000628:therapy*; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D017713:Platelet Transfusion; D011247:Pregnancy; D011262:Pregnancy Trimester, Second
chemical_list: C026912:cryoprecipitate coagulum; D005169:Factor VIII; D005340:Fibrinogen