A NEW METHOD FOR SEALING THE IATROGENIC RUPTURES OF FETAL MEMBRANES IN THE PROCESS OF FETAL OPERATIONS

Abstract

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Background. The present study is aimed at developing a method for sealing iatrogenic ruptures of amniotic membranes in fetuscopic interventions. Aim. The applied technique is safe and effective for hermetic sealing of fetal membranes in fetoscopy and allows to reduce the frequency of iatrogenic complications, expand the indications for fetal surgical operations. Material and Methods. The research contributes to the transition of domestic fetal surgery to high-tech health care and technologies for preserving the health of newborns. In V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology developed a method and created the main components for sealing iatrogenic ruptures: a tissue sealant from the blood components of the mother, plasma enriched with platelets, which can be injected into the region defect of the fetal bladder in the form of a gel and a new type of amniotic catheter. PRP+activator is injected consecutively for 30 seconds through a specially designed amniotic catheter for this procedure, followed by activation of platelet degranulation and polymerization of fibrin directly in the defect area, which effectively seals the trocar hole from the inner and outer surfaces of the membranes and does not cause premature rupture of the membranes. Results and Discussion. A specially designed amniotic catheter is guided through the trocar into the amniotic fetal cavity and is retained in the latter by inflating the balloon of a round or semilunar shape at the proximal end of the device, thereby allowing it to closely adhere to the fetal membranes and the uterine wall, preventing detachment of the membranes and leakage into the uterine cavity of the inserted through a biological sealant catheter. Thus the sealant reliably closed the place of iatrogenic rupture of the fetal membrane. Thus, the developed technique for hermetic sealing of membranes with the algorithm for introducing sealant components (platelet degranulation activators) for regulating its transition from the liquid state to the solid state and the method of using the new amniotic catheter model make it possible to use this method in clinical practice.