Amniopatch as a treatment for rupture of membranes following laser surgery for twin-twin transfusion syndrome.
OBJECTIVE
The risk of iatrogenic rupture of membranes (IROM) is 5-30% after operative fetoscopy. The aim of this study was to describe outcomes of patients with IROM following selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS) who were subsequently treated with amniopatch therapy.


METHODS
A review of patients who underwent treatment for mid-trimester TTTS between March 2006 and February 2008 with IROM within 7 days of SLPCV was performed. IROM patients without evidence of preterm labor or chorioamnionitis were offered expectant management, pregnancy termination, or amniopatch therapy.


RESULTS
Ninety-three patients were treated with SLPCV, of which three (3.2%) had IROM within 7 days. All three opted for amniopatch therapy which was performed at 18 2/7, 23 1/7, and 22 6/7 weeks' gestation in patients 1, 2 and 3, respectively. In patients 1 and 2, amniopatch therapy sealed membranes within 7 days. A second amniopatch was required for patient 3 before IROM resolved. Gestational ages at delivery were 38 2/7, 37 5/7 and 30 2/7 weeks, respectively.


CONCLUSIONS
Amniopatch is a viable treatment option for iatrogenic ROM following SLPCV.
Pathak
Bhuvan
B
University of Southern California, Keck School of Medicine, Maternal Fetal Medicine, Los Angeles, Calif., USA.
Khan
Amer
A
Assaf
Samer A
SA
Miller
David A
DA
Chmait
Ramen H
RH
D000293:Adolescent; D000328:Adult; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000209:etiology / Q000628:therapy*; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects; D006801:Humans; D007049:Iatrogenic Disease; D017075:Laser Coagulation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016896:Treatment Outcome