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Experience with the use of "amniopatch" treatment for Premature Prelabour Rupture of Membrane (PROM)

Colleagues in Milan, Italy report that a Caucasian pregnant woman at 17 weeks of gestation developed a spontaneous rupture of amniotic membrane. This condition, known as PROM (Premature Prelabour Rupture of Membrane), leads to amniotic fluid leakeage and may cause fetal morbidity and/or mortality. In their review of the literature:

  • Lewi L. et al. Successful Patching of iatrogenic rupture of the fetal membranes; Placenta (2004), 25, 352-356.
  • Quintero RA et al. Treatment of iatrogenic previable premature rupture of membranes with intra-amniotic injection of platelets and cryoprecipitate (amniopatch): preliminary experiences. Am J Obstet Gyecol (1999), 181, 744-9.
  • Quintero RA. Treatment of previable premature rupture membranes Clin Perinatol 2003 sep; 30(3):573-89.

they have come across a "treatment" for this condition which is referred to as "amniopatch", which consists of the infusion of platelets and cryoprecipitate into the amniotic cavity.

They wonder if others have had experience with this 'treatment', and if so could the following questions be answered:

  1. What is the dose of platelets that is best to use?
  2. Do the platelets need to be CMV negative or, in case of absence of CMV negative donors would leukocyte-reduced platelet concentrates be sufficiently safe?

ADDENDA Sept. 13, 2005

1. A transfusion medicine physician in Chicago comments that based on his reading of the publications cited by the colleague in Milan, the articles cited address "iatrogenic" rupture of membranes such as might occur after amniocentesis, but not "spontaneous" rupture of membranes. He adds that his center has a researcher who is preparing a protocol in which maternal whole blood would be collected to make one unit of platelets and one unit of cryo into an amniopatch, and that their regional blood center will require two separate whole-blood donations for these products. The RBCs would be returned to the patient. This would take longer than in the 1999 article in which they said both products were available within 36 to 48 hours after collection, implying a single collection.
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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator
Posted: September 9, 2005

Addenda: Sept. 13, 2005

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