Amniopatch procedure after previable iatrogenic rupture of the membranes: A two-center review

OBJECTIVE: This study aimed to analyze success rates and pregnancy outcomes of amniopatch procedures for previable iatrogenic preterm prelabour rupture of the membranes (PPROM) with associated oligohydramnios.

METHODS: Retrospective analysis of amniopatch procedures performed at the University Hospitals Leuven, Belgium, and the Mount Sinai Hospital Toronto, Canada. Cases were analyzed overall and in two sub-groups: PPROM after a needle-based procedure (NP group, n = 13) or after fetoscopic intervention (FI group, n = 11). Complete technical success was defined as cessation of leakage and normalization of amniotic fluid volume, partial success as cessation of leakage, or re-establishment of volume. Further outcomes were pregnancy duration and outcome, fetal/neonatal morbidity and mortality, and maternal morbidity.

RESULTS: Gestational age at amniopatch was comparable in both groups (NP: 20.1, FI: 21.0 weeks). Amniopatch was completely and partially successful in 29% (NP: 31%; FI: 27%) and 29% (NP: 15%; FI: 45%), respectively. Mean gestational age at delivery was 27.5 weeks (NP: 25.5; FI: 29.4 weeks). Overall neonatal survival was 17/31 (55%) (NP: 4/13 (31%), FI: 13/18 (72%); p = .02). Chorioamnionitis occurred in three cases, two associated with maternal sepsis. Severe neonatal morbidity occurred in two survivors.

CONCLUSION: Amniopatch for iPPROM was successful in 58%, with an overall live birth rate of 68% and survival to discharge of 55%.