Document Detail


An aggressive interventional protocol for early midtrimester premature rupture of the membranes using gelatin sponge for cervical plugging.
MedLine Citation:
PMID:  12439492     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This study was performed to evaluate a protocol for treatment of previable premature rupture of membranes (PROM) that includes the administration of gelatin sponge to retard the loss of fluid from the amniotic cavity. STUDY DESIGN: Women with PROM at <or=21 weeks' gestation with a structurally normal singleton; having no evidence of infection, active bleeding, or labor; and a maximum vertical fluid pocket of less than 1.5 cm were candidates. Interventions included hospital admission, amnioinfusion, cervical cerclage, administration of gelatin sponge (Gelfoam) into the amniotic cavity, antibiotic administration, and perioperative tocolysis. Weekly assessment of fluid status was performed and if oligohydramnios returned, patients were offered repeat amnioinfusion. RESULTS: Fifteen women with PROM at 17.9 +/- 2.2 weeks' gestation (range 13-21 weeks) underwent this protocol. Spontaneous PROM was diagnosed in 14 patients and one had iatrogenic PROM after fetoscopy. Eight fetuses reached a viable gestational age (>or=24 weeks, 53%), with six of these newborn infants surviving to hospital discharge (30%) and two suffering intrauterine death. The average gestational age of delivery for survivors was 31.8 +/- 4.3 weeks, range 25 to 36 weeks. Talipes equivarus was observed in three survivors (50%). Bilateral hip dysplasia and torticollis were also diagnosed in two infants. Respiratory distress syndrome was diagnosed in all cases delivered at less than 32 weeks but was not observed thereafter. No adverse sequelae have been attributed to gelatin sponge exposure. CONCLUSION: The observed survival rate with this interventional approach in a population at highest risk for pregnancy loss justifies further study of this treatment strategy. This protocol may not reduce the rate of musculoskeletal abnormalities.
Authors:
John M O'Brien; John R Barton; Douglas A Milligan
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  187     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-11-20     Completed Date:  2002-12-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1143-6     Citation Subset:  AIM; IM    
Affiliation:
Perinatal Diagnostic Center, Central Baptist Hospital, Lexington, KY 40503, USA. jobrien@bhsi.com
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MeSH Terms
Descriptor/Qualifier:
Cervix Uteri*
Female
Fetal Membranes, Premature Rupture / mortality,  therapy*
Gelatin*
Humans
Pilot Projects
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, Second
Surgical Sponges*
Survival Rate
Chemical
Reg. No./Substance:
9000-70-8/Gelatin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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