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  • Print publication year: 2019
  • Online publication date: October 2019

Chapter 50 - Strategies to Repair Defects in the Fetal Membrane

from Fetal Stem Cell Transplantation

Summary

The fetal membranes (FM) are comprised of the amniotic membrane (AM), chorionic membrane (CM), and underlying maternal decidua. Together they provide a barrier towards ascending infection and enable amniotic fluid (AF) homeostasis. Preterm premature rupture of the membranes (PPROM) can occur spontaneously and complicates around 2% of all pregnancies, leading to preterm birth, chorioamnionitis, neonatal sepsis, limb position defects, respiratory distress syndrome, pulmonary hypoplasia, and chronic lung disease. Membrane separation is a common finding after open fetal surgery that leads to iatrogenic PPROM (iPPROM) and intrauterine infection, complicating over 30% of fetal surgeries. The subsequent associated preterm birth compromises the outcome of treatment, reducing the clinical effectiveness of fetal surgery [1]. Spontaneous healing of the membranes does not occur after fetoscopic surgery, leaving a visible defect in the FM (Figure 50.1) that is prone to AF leakage and subsequent iPPROM [2]. To date, there are no clinical solutions to improve healing of the FM after they rupture.