Endoscopic surgical treatment of premature rupture of membranes in an animal model

R. A. Quintero, P. W. Bornick, W. J. Morales, M. Allen, J. Arroyo, N. Garabelis, R. Engleman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective: To test the feasibility of repairing ruptured fetal membranes in an animal model by fixing a collagen-based graft through minimally invasive techniques. Materials and methods: Ten pregnant ewes underwent laparotomy and minimal hysterotomy at 100 days' gestation. A 1-cm defect was created endoscopically in the amnion over the internal os. A collagen graft (Biosis, Cook Ob/Gyn, Spencer, IN) was welded to the edges of the defect with Nd: YAG energy in the experimental group (n = 7). The graft was sealed with fibrin glue (TISSEEL, Baxter Healthcare Corporation, Glendale, CA) under CO2 medium. The defect was not repaired in the control group (n = 3). A second-look fetoscopy was scheduled 3 weeks later, and the membranes were examined histologically after delivery. Results: Successful placement of the graft was achieved in all seven experimental animals, but six of them miscarried before second-look fetoscopy. In the remaining animal, sealing of the membrane occurred, but the graft could not be found histologically. Complete sealing of the amniotic cavity was evaluated endoscopically under water in the last two experimental animals. Of the three controls, second-look fetoscopy was possible in two. Necrosis of the amnion with growth of Staphylococcus aureus (n = 1), spontaneous membrane resealing (n = 1) and miscarriage before second-look fetoscopy (n = 1) occurred in this group. Conclusions: Endoscopic grafting of amniotic membranes can be accomplished with laser welding and supplemental fibrin-glue sealing of a collagen graft. The repair allows restoration of the amniotic fluid volume without leakage. These experiments may be an important step in devising a surgical technique to treat spontaneous rupture of membranes in humans.

Original languageEnglish (US)
Pages (from-to)65-69
Number of pages5
JournalPrenatal and Neonatal Medicine
Volume6
Issue number1
StatePublished - Jan 1 2001

Keywords

  • Fetal surgery
  • Fetoscopy
  • Fibrin glue
  • Premature rupture of membranes
  • Tissue welding

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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