Preterm Prelabor Rupture of Membranes and Fetal Survival after Minimally Invasive Fetal Surgery: A Systematic Review of the Literature

Veronika Beck, Paul Lewi, Leonardo Gucciardo, Roland Devlieger
2012 Fetal Diagnosis and Therapy  
in about 30% of cases treated by minimally invasive fetal surgery. The maximum diameter of the instrument explains iPPROM rate, gestational age at birth and fetal survival. Great variations in the reporting of iPPROM make data analysis difficult. Background Minimally invasive fetal surgery nowadays is performed for a selected number of fetal conditions. The procedures are mostly carried out under ultrasound guidance and can be divided into two categories. First, the relatively well-established
more » ... needle techniques' as for instance intrauterine blood sampling and transfusion in the case of fetal anemia or fetal shunting for lower urinary tract obstructions (LUTO) and pleural effusions, in which a sharp needle of various diameters is introduced into the uterine cavity under ultrasound guidance. Secondly, the fetoscopic procedures that are of- Key Words Acardiac twin ؒ Fetal therapy ؒ Laser coagulation ؒ Obstructive uropathy ؒ Premature rupture of membrane ؒ Twin-twin transfusion syndrome ؒ Lower urinary tract obstruction ؒ Twin-reversed arterial perfusion ؒ Laser ablation ؒ Fetal shunt ؒ Cord occlusion Abstract Objective: Iatrogenic preterm prelabor rupture of membranes (iPPROM; ! 37 weeks of gestation) is a major complication of fetal surgery. Little information is available about risk factors and incidence. Methods: We systematically reviewed reported iPPROM rates, gestational age at delivery and fetal survival after representative minimally invasive antenatal procedures. Results: A total of 1,146, 36 and 194 cases with mean iPPROM rates of 27, 31 and 26% were included for placental laser in twin-twin transfusion syndrome, shunting in lower urinary tract obstruction and interventions for twin-reversed arterial perfusion, respectively. In the statistical analysis, the maximum diameter of the instrument predicted iPPROM rate and was significantly related to gestational age at birth as well as fetal survival. Information on duration of the respective procedures was scarce and did not allow for meaningful analysis. Conclusions: iPPROM occurs
doi:10.1159/000331165 pmid:22104520 fatcat:p4cy3xjavnegxc4z3ckquv3zfe