TRANSABDOMINAL INTRAAMNIOTIC ENDOSCOPIC ASSESSMENT OF PREVIABLE PREMATURE RUPTURE OF MEMBRANES

OBJECTIVE: Our purpose was to describe the endoscopic characteristics of the site of rupture in vivo in patients with spontaneous premature rupture of membranes. STUDY DESIGN: Patients with preterm premature ru pture of membranes between 16 and 26 weeks of gestation, without evide nce of intra-amniotic infection, and with a normal karyotype underwent transabdominal endoscopic examination of the amniotic cavity. Subsequ ently, an amniopatch of a combination of platelets and cryoprecipitate to seal the membrane defect was administered. The study was approved by the Institutional Review Board of St. Joseph's Hospital in Tampa, F lorida, and all patients gave written informed consent. RESULTS: Four patients underwent endoscopic examination and amniopatch administratio n; three had spontaneous preterm premature rupture of membranes, and i n the other the membranes ruptured after an early amniocentesis. The l ocation of the site of rupture was over the internal os in the 3 cases with spontaneous preterm premature rupture of membranes. This area wa s normal in the patient with iatrogenic preterm premature rupture of m embranes. The longer the time between preterm premature rupture of mem branes and fetoscopy, the larger and less defined was the site of rupt ure. The amniopatch restored amniotic integrity for a maximum of 72 ho urs. CONCLUSIONS: This is the first in vivo endoscopic visualization o f the site of spontaneous rupture of membranes from within the uterine cavity. The defect is located over the internal cervical os in patien ts with spontaneous preterm premature rupture of membranes. There appe ar to be time-related changes in the morphologic characteristics of th e site of rupture. Endoscopic visualization of the site of rupture has the potential for improving our understanding of spontaneous preterm premature rupture of membranes and in the development of possible ther apeutic alternatives.