Ruptura prematura de membranas ovulares / Premature rupture of ovular membranes

La ruptura prematura de las membranas ovulares se define como la pérdida de la integridad del amnios y corion antes del inicio del trabajo de parto, afecta el 3 % de los embarazos, causa un tercio de los partos pretérminos, los cuales ocupan el 10,49 % de los nacimientos y es el origen de altos índices de morbimortalidad perinatal. En la actualidad, el manejo de esta patología se orienta principalmente en evitar los factores de riesgo, hacer un diagnóstico adecuado, determinar la edad gestacional en que ocurre, realizar el monitoreo exhaustivo del bienestar materno-fetal y en decidir el momento idóneo de finalización de la gestación para minimizar sus complicaciones. Debido a la compleja y lábil estructura histológica de las membranas ovulares, se ha dejado a un lado el tratamiento directo de la entidad el cual sería sellar o reparar el defecto en sí. En los últimos años, numerosos estudios y protocolos clínicos de prestigiosos centros asistenciales han servido como guía para el manejo de esta entidad, pero en muy pocos se observa una terapia destinada a la reparación de dichas membranas o en sellar tal defecto. Las evidencias científicas demuestran que la regeneración y reparación de las membranas es lenta y compleja y los tratamientos propuestos para reparar o sellar su defecto no han gozado de la aceptación científica para su aprobación, sin embargo, el uso del parche hemático transvaginal endocervical autólogo luce como una alternativa terapéutica prometedora(AU)

The premature rupture of the ovular membranes is defined as the loss of the integrity of the amnion and chorion before the on set of labor, affects 3% of pregnancies, causes athird of preterm births which occupy 10,49% of births and is the origin of high rates of perinatal morbidity and mortality. At present, the management of this pathology is mainly oriented towards avoiding risk factors, making an adequate diagnosis, determining the gestational age in which it occurs, carrying out exhaustive monitoring of maternal-fetal well-being and deciding the ideal moment to end the treatment. Pregnancy to minimizeits complications. Due to the complex and labile histological structure of the ovular membranes, the direct treatment of the entity has been set a side, which would be to seal or repairthe defect it self. In recent years, numerous studies and clinicalprotocols from prestigious health care centers have served as aguide for the management of this entity, but very few have observed a therapy aimed at repairing said membranes or sealing such a defect. Scientific evidence shows that the regeneration and repair of the membranes is slow and complex and the treatment sproposed to repair or seal their defect have not enjoyed scientific acceptance for their approval, how ever, the use of the autologous endocervical transvaginal blood patch looks like a promising therapeutic alternative(AU)

A systematic review of amniopatch

The objective of this review is to evaluate the safety and effectiveness of the amniopatch procedure for the treatment ofpreterm premature rupture of the membranes. The searches were conducted via electronic databases including Ovid-MEDLINE, Ovid-Embase, the Cochrane Library, and eight Korean databases. In the study design, in addition to randomized controlled trials, case report studies in which patients underwent the amniopatch procedure were included. Two reviewers independently selected data in standardized form and assessed the methodological quality. Quality evaluation was performed by the SIGN (Scottish Intercollegiate Guideline Network) method. A total of 11 studies (2 cohort studies, 1 case series, and 8 case reports) were included. There were no serious maternal or fetal complications. It was reported that there were lower rates of maternal chorioamnionitis after the amniopatch relative to conservative treatment (control). The mean gestational age at delivery was 27.7 weeks (a total of 70 cases in 10 studies; spontaneous group, 27.6 weeks; iatrogenic group, 27.8 weeks). The amniopatch was successful in 46.6% of cases (33/71 cases in 11 studies). The overall neonatal survival rate was 55.3% (52/94 cases in 11 studies). Neonatal morbidity was 23.4% (11/47 cases in 7 studies). Although this systematic review, did not find clear evidence of the safety and effectiveness, the amniopatch procedure is a viable treatment option to prolong a pregnancy with previable premature rupture of membranes.