Long-term amnioinfusion through a subcutaneously implanted amniotic fluid replacement port system for treatment of PPROM in humans.
OBJECTIVE
To introduce a novel method for the treatment of PPROM (preterm premature rupture of membranes) using continuous amnioinfusion via a subcutaneously implanted port system.


METHODS
After development and testing since 2001 in a fetal sheep model, the port system has been successfully implanted in two humans with PPROM. In the first case, the subcutaneous port system was implanted during the 23rd week of gestation in a 39-year-old 5th-gravida with PPROM since the 18th week of gestation; in the second case, the port system was implanted during the 24th week of gestation in a 27-year-old 3rd gravida with PPROM since the 21st week of gestation. After port implantation, 100ml/h saline solution was infused intermittently into the amniotic cavity. The whole course of treatment was supported by tocolysis.


RESULTS
In the cases presented, gestation was terminated by cesarean section, in one case in the 29th week of gestation, and in the other case in the 30th week. The newborns showed no signs of lung hypoplasia and were successfully extubated on the 1st or 2nd day after delivery. Six months later the children did not exhibit any deviation from the normal development.


CONCLUSIONS
Long-term amnioinfusion via a subcutaneously implanted port system could be used in humans with PPROM for prolongation of pregnancy and to avoid lung hypoplasia. Prospective randomized studies are ongoing.
Tchirikov
Michael
M
University Medical Center Mainz, Department of Obstetrics and Gynecology, International Teaching Center of Prenatal Diagnostic and Intrauterine Microinvasive Fetal Surgery, Mainz, Germany.tchirikov@uni-mainz.de
Steetskamp
Joscha
J
Hohmann
Manfred
M
Koelbl
Heinz
H
D000328:Adult; D000650:Amnion / Q000601:surgery; D000653:Amniotic Fluid; D036861:Delivery, Obstetric; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D007263:Infusions, Parenteral / Q000379:methods*; D008297:Male; D011247:Pregnancy; D016896:Treatment Outcome