1. In vitro sealing of punctured fetal membranes: potential treatment for midtrimester premature rupture of membranes
- Author
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Anthony Sciscione, Terry Hyslop, Samir K. Ballas, Ronald J. Wapner, Jodi Chen, Richard L. Nemiroff, Uma M. Reddy, and S. Shah
- Subjects
Blood Platelets ,medicine.medical_specialty ,Fetal Membranes, Premature Rupture ,Amniotic fluid ,Time Factors ,Fibrin Tissue Adhesive ,Punctures ,In Vitro Techniques ,Fibrin ,Permeability ,Injections ,Pregnancy ,medicine ,Humans ,Amnion ,Fibrin glue ,Syringe ,biology ,business.industry ,Sealant ,Thrombin ,Obstetrics and Gynecology ,medicine.disease ,Amniotic Fluid ,Surgery ,Membrane ,Cryoprecipitate ,Pregnancy Trimester, Second ,biology.protein ,Female ,Tissue Adhesives ,business ,Premature rupture of membranes - Abstract
Objective: Midtrimester premature rupture of membranes causes significant perinatal morbidity and death. No effective treatment exists. We investigated (1) whether a needle puncture in the fetal membranes could be sealed in vitro and (2) the optimal composition of the sealant to be used. Study Design: Membranes from second trimester pregnancies (16-24 weeks of gestation) were stretched over a modified syringe with a 2.5-cm open diameter. The syringe was filled with 20 mL of second trimester amniotic fluid, and the membrane was punctured with a 20-gauge needle. Sealants were injected into the amniotic fluid. The primary outcome variable was time for leakage of amniotic fluid. Median times for leakage for the formulations were compared by Wilcoxon exact rank sum test. Results: Platelets alone failed to seal the puncture site. All other formulations stopped leakage temporarily. Tisseel (Baxter Corp, Glendale, Calif) and cryoprecipitate/thrombin preparations led to more prolonged sealing of punctured amniotic membranes than platelets ( P Conclusion: Of the sealants tested in vitro, amniotic membranes are best sealed by a fibrin/thrombin–based sealant. (Am J Obstet Gynecol 2001;185:1090-3.)
- Published
- 2001