1/15. Treatment of iatrogenic previable premature rupture of membranes with intra-amniotic injection of platelets and cryoprecipitate (amniopatch): preliminary experience.OBJECTIVE: Our aim was to describe the treatment of iatrogenic previable premature rupture of membranes with the intra-amniotic injection of platelets and cryoprecipitate (amniopatch). STUDY DESIGN: patients with iatrogenic previable premature rupture of membranes and without evidence of intra-amniotic infection underwent transabdominal intra-amniotic injection of platelets and cryoprecipitate through a 22-gauge needle. The study was approved by the Institutional review Board of St Joseph's Hospital in Tampa, florida, and all patients gave written informed consent. RESULTS: Seven patients with iatrogenic preterm premature rupture of membranes underwent placement of an amniopatch. Membrane sealing was verifiable in 6 of 7 patients. Three patients had iatrogenic preterm premature rupture of membranes after operative fetoscopy, 3 cases were after genetic amniocentesis, and 1 was after diagnostic fetoscopy. Three pregnancies progressed well, with restoration of the amniotic fluid volume and no further leakage. Two patients had unexplained fetal death despite successful sealing. One case of bladder outlet obstruction had no further leakage, but oligohydramnios persisted and did not allow unequivocal documentation of sealing. One patient miscarried from twin-twin transfusion, but the amniotic cavity was sealed. CONCLUSIONS: Iatrogenic preterm premature rupture of membranes can be treated effectively with an amniopatch. The technique is simple and does not require knowledge of the exact location of the defect. Unexpected fetal death from the procedure may be attributable to vasoactive effects of platelets or indigo carmine. Although the appropriate dose of platelets and cryoprecipitate needs to be established, the amniopatch may mean that iatrogenic preterm premature rupture of membranes no longer needs to be considered a devastating complication of pregnancy.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/15. Intrauterine sling: a complication of the stuck twin syndrome.Stuck twin syndrome usually presents with polyhydramnios in the recipient sac and severe oligohydramnios in the donor sac. The donor is displaced against the uterine wall and remains adherent in that position. We present a case in which the diagnosis was more complicated, owing to the suspension of the stuck twin by a sling within the sac of the recipient. A monochorionic diamnionic twin gestation was complicated by twin-twin transfusion syndrome at 18 weeks of gestation. In our example, the stuck twin was suspended by a sling from the placenta. The sling band represented the intertwin membrane that was folded upon itself. amniotic fluid from the recipient twin was present in three dimensions around the stuck twin, except for the sling band. The suspension of the stuck twin by a sling within the amniotic fluid of the recipient is an unusual manifestation of the stuck twin syndrome.- - - - - - - - - - ranking = 0.1keywords = membrane (Clic here for more details about this article) |
3/15. Successful outcome after antibiotic treatment of postamniocentesis membrane rupture and chorioamnionitis in multiple pregnancy.Postamniocentesis chorioamnionitis is usually managed with induction of labor to prevent maternal sepsis and related morbidity and mortality. We report a case of chorioamnionitis in a triplet pregnancy after midtrimester genetic amniocentesis, in which multiple antibiotic treatment (ampicillin 2 g i.v. loading dose followed by 1 g i.v. every 6 hr; clindamycin 900 mg i.v. every 8 hr; gentamicin 120 mg i.v. loading dose followed by 100 mg i.v. every 8 hrs; and erythromycin 500 mg i.v. every 6 hr) for 7 days and delivery of the presumably infected triplet A successfully reversed the clinical symptomatology, allowing prolongation of pregnancy until 26 weeks and survival of the remaining fetuses. At age 2 years, both infants are doing well and are meeting their developmental milestones. The viable outcome of this management strategy suggests that antibiotic treatment and expectancy may be an option in selected cases of postamniocentesis chorioamnionitis in multiple pregnancies.- - - - - - - - - - ranking = 0.4keywords = membrane (Clic here for more details about this article) |
4/15. Prolapsed cord after external cephalic version in a patient with premature rupture of membranes and transverse lie.A 29-year-old G6 P3023 woman presented at 37 weeks' gestation with rupture of membranes and oligohydramnios. After informed consent was obtained, a successful external cephalic version (ECV) was performed. The patient went into spontaneous labor, but about 2h after the ECV, the umbilical cord prolapsed, necessitating cesarean section. umbilical cord prolapse is a possible complication of ECV in patients with rupture of membranes and oligohydramnios.- - - - - - - - - - ranking = 0.6keywords = membrane (Clic here for more details about this article) |
5/15. Inhaled nitric oxide for oligohydramnios-induced pulmonary hypoplasia: a report of two cases and review of the literature.We describe the clinical courses of two premature infants, a male born at 29(4/7) weeks' gestational age after an 8-week period of rupture of membranes (ROM) and severe oligohydramnios, and a female infant born at 31 weeks' gestational age after an 18-week period of ROM and severe oligohydramnios. Within hours after birth, despite intubation and aggressive ventilation, both infants developed fulminant hypoxic respiratory failure. Their clinical courses were consistent with pulmonary hypertension and both infants were transferred for trials of inhaled nitric oxide (iNO). Both infants had dramatic responses to iNO, suggesting that the pulmonary disease seen after prolonged oligohydramnios may have a component of nitric oxide-sensitive pulmonary hypertension. The goals of this article are to (1) review oligohydramnios-induced pulmonary hypoplasia, (2) discuss patients at highest mortality risk, and (3) describe the effects of iNO on pulmonary hypertension in infants with hypoxemia following prolonged ROM and severe oligohydramnios.- - - - - - - - - - ranking = 0.1keywords = membrane (Clic here for more details about this article) |
6/15. Vertebral hypersegmentation in a case of the VATER association.Associations are statistical clusterings of malformations not known to be polytopic field defects, sequences, or syndromes. The VATER association is a nonrandom association of malformations including vertebral, anal, cardiovascular, tracheoesophageal, genitourinary, and limb defects. The caudal "dysplasia" sequence of lumbosacral vertebral defects, genitourinary abnormalities, and imperforate anus overlaps the VATER association. The cloacal membrane agenesis sequence is a pattern of malformations resulting in the absence of anal, genital, and urinary orifices with associated malformations in surrounding structures. We report on a 37-week gestation liveborn male with oligohydramnios deformations, tetralogy of fallot, "H-type" tracheoesophageal fistula, duodenal atresia, imperforate anus, urethral atresia, undescended testes, absent right kidney with a small dysplastic left kidney, a "cloacal-like" abnormality of the bladder and distal bowel, and thoracic and lumbar vertebral hypersegmentation. This patient has manifestations of the VATER association, the caudal dysplasia sequence, and the cloacal membrane agenesis sequence. We propose that some of his defects may represent a malformation sequence secondary to excessive embryonic flexion resulting from vertebral hypersegmentation.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
7/15. Successful external cephalic version after amnioinfusion in a patient with preterm premature rupture of membranes.After hospitalization subsequent to preterm premature rupture of membranes at 29 weeks, our patient was scheduled for induction of labor at 34 weeks. When the fetus was found to be breech with oligohydramnios, amnioinfusion was performed to facilitate external cephalic version, and this successful procedure enabled the patient to deliver vaginally.- - - - - - - - - - ranking = 0.5keywords = membrane (Clic here for more details about this article) |
8/15. Sporadic Larsen syndrome in a preterm female originally diagnosed as positional deformities due to oligohydramnios.Few reports describe incidental prenatal diagnosis of sporadic Larsen syndrome by ultrasound, but none of these discuss coincidental oligohydramnios or an association with fetal growth restriction. A 28-year-old woman had prolonged rupture of membranes causing marked oligohydramnios at 32 weeks gestation in her first pregnancy. Labor was induced by vaginal prostaglandins and oxytocin infusion after dexamethasone administration because of concern about placental abruption. She delivered vaginally a live female infant weighing 1960 g (< 10th percentile) with multiple skeletal malformations and characteristic facies originally suspected as positional. Newborn x-rays, however, established the diagnosis of Larsen syndrome with bilateral dislocations of the hips, knees (genu recurvatum), and ankles (club foot). The neonatal karyotype was 46,XX. Parental examination and family history were unremarkable. The newborn did well with bilateral lower extremities cast. Postnatal diagnosis of Larsen syndrome should be suspected in neonates with multiple skeletal abnormalities following oligohydramnios.- - - - - - - - - - ranking = 0.1keywords = membrane (Clic here for more details about this article) |
9/15. Pierson syndrome: a novel cause of congenital nephrotic syndrome.In this report, we describe a newborn infant who presented with congenital nephrotic syndrome and renal insufficiency, as well as bilateral microcoria. This constellation of findings is a hallmark of Pierson syndrome, a newly recognized genetic disorder that is caused by a deficiency of beta2 laminin in the basement membrane. Our patient demonstrated classic histopathologic findings of Pierson syndrome on renal biopsy, including absence of beta2 laminin on immunofluorescent staining, and genetic testing confirmed the diagnosis. We conclude that Pierson syndrome should be included in the differential diagnosis for congenital nephrotic syndrome, especially in patients with ocular abnormalities.- - - - - - - - - - ranking = 0.1keywords = membrane (Clic here for more details about this article) |
10/15. Premature rupture of membranes at 20 weeks: report of a successful outcome after transcervical application of fibrin glue.A 30-year-old primigravida was admitted to hospital at 20 weeks of gestation because of premature rupture of membranes and oligohydramnios. The patient was maintained in bed rest and given intravenous ampicillin. Forty-eight hours later, after documenting the absence of infection and maintenance of the oligohydramnios, fibrin glue was applied transcervically under ultrasound control. There was subjective improvement in amniotic fluid volume after treatment, but always within the criteria of oligohydramnios. fibrin glue application was repeated twice due to reported increase in fluid loss and diminished amniotic fluid volume on ultrasound. amoxicillin per os was started at 23 weeks, and clavulanic acid was added at 26 weeks due to the isolation of an escherichia coli on cervical-vaginal cultures. No signs of infection ensued until 34 weeks, when an axillary temperature of 39.5 degrees C was detected together with a non-reassuring cardiotocographic pattern, the latter leading to the performance of an urgent cesarean section. The newborn had an apgar score of 9/10/10, umbilical artery pH of 7.32, and no external deformities. He showed no signs of lung hypoplasia and required no oxygen supplementation. Oropharyngeal and blood cultures revealed an E. coli infection and antibiotic treatment was started. No further complications occurred and he was discharged home on the 8th day of life. At 12 months, the child reveals a normal development. The mother had a mild and short-lasting wound infection and was discharged on the 8th postoperative day.- - - - - - - - - - ranking = 0.5keywords = membrane (Clic here for more details about this article) |
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