The technique of fibrin adhesion for premature rupture of the membranes during pregnancy

Abstract

The description of a new technique for fibrin adhesion (in 28 patients) for premature rupture of the membranes in pregnancy is reported. Unless cerclage has been carried out earlier, it is necessary to suture the cervical canal immediately after rupture of the membranes in order to be able to insert a fibrin clot. The author's modified cerclage technique (reverse McDonald procedure) is described. The advantages are minimal trauma to the lower uterine segment and a somewhat physiologic fixation of the synthetic suture material. For application of the fibrin sealant, the Duploject syringe clip is used, as it allows exact dosage and blending of the two sealant components in the course of their application to the site of sealing. The problem of evaluation of the results of the procedure is discussed. The technique carries no risk to mother or child. No cases of amniotic infection syndrome have been observed. Through prolongation of the pregnancy, time is gained for maturation of the fetal lungs. Accordingly, the authors recommend the technique for treating premature rupture of the membranes, although there is as yet no definite answer as to the optimal timing of this adhesion treatment during pregnancy.