Objective: The purpose of this project was to study an in vitro model for plugging membrane defects with gelatin sponge and to develop a method with which to use this material to treat premature rupture of the membranes.
Study design: Fetal membranes were fixed over the opening of a flask that was filled with saline solution and gelatin sponge. Defects of various sizes were created, and the usefulness of differing sizes of gelatin sponge to obstruct the defects was observed. This technique was then applied to a case of previable, spontaneous premature rupture of the membranes.
Results: Fifteen amniotomies were performed in the in vitro model. The gelatin sponge obstructed all defects less than 7 mm in length, when pieces up to 1 x 1 cm in dimension (n = 8 amniotomies) were used. For larger defects or those defects with a complex shape (such as cruciate), gelatin sponge was not effective at arresting fluid loss (n = 4 amniotomies). An inspection of larger gelatin sponge pieces, after instillation through a 12-gauge angiocatheter, revealed 36% (15 of 42 pieces) of 1 x 1 - cm pieces remained intact. A case of spontaneous, previable premature rupture of the membranes was treated with this material. A favorable outcome was observed.
Conclusion: Gelatin sponge is successful at arresting the egress of fluid through membrane defects when smaller defects are present. Complex or larger linear defects may not be treated by this method alone and necessitate adjuvant therapies. This therapeutic strategy can be applied to cases of previable, spontaneous premature rupture of the membranes.