Fibrin Sealing by Tissucol in Premature Rupture of the Fetal Membranes

Abstract

The fetal membranes are a protective barrier against infection: however, premature rupture occurs in about 10% of cases. The premature — and especially the very early — rupture of the fetal membranes exposes the fetus to three major problems: (1) prematurity with respiratory distress (hyaline membrane disease) and deficiency of maturity for many fetal organs, e.g., kidneys; (2) problems related to anoxia and its management, e.g., ROP, enterocolitis; (3) infections due to amnionitis caused by the lack of the protective barrier. In addition, the fetus might swallow the infectious amniotic fluid and, thus, be at risk for septicemia.

For the mother, the greatest problem consists in local infection, with amnionitis, or general infection, with maternal septicemia.

Fibrin sealing with Tissucol, under very strict conditions (without any vaginal infection), offers an interesting solution, increasing not only the chances of the fetus but also the mother’s comfort and the economic costs of this condition. This procedure permits prolongation of gestation and thereby obtain better maturity of the fetus.

In addition fetal pulmonary maturity is only achieved if the fetus is able to “breathe” during its intrauterine life. This breathing permits opening of the fetal alveoli and their maturation.

The loss of amniotic fluid may induce fetal deformations by fetal compressions which are not normally absorbed by amniotic fluid. Without sealing of the amniotic membranes, the only solution is hospitalization, with strict observation to detect maternal or fetal infection and, in case of infection, artificial induction of labor resulting in a vaginal delivery or, often, in a caesarean section due to prematurity.

The use of Tissucol provides very interesting benefits for mothers both psychologically and economically.