Treatment of previable premature ruptured membranes.

We have gained significant experience in the clinical understanding and treatment of PPROM in the last 5 years. From our work we can conclude that iatrogenic PPROM is not only a different entity etiologically, it is also different than spontaneous PPROM in its clinical behavior and response to therapeutic measures. Our current success rate with the amniopatch allows us to suggest that iatrogenic PPROM should no longer be viewed as a devastating complication of pregnancy. Instead, as other investigators corroborate our successful experience with the amniopatch, this procedure might become standard treatment for this unusual but frustrating complication of prenatal intervention. Regarding spontaneous PPROM, our work suggests that perhaps, in a select group of patients (in whom infection has not set in and in whom a smaller and better defined membrane defect might exist), there is the potential for developing a surgical technique that might graft the defect successfully and allow the integrity of the amniotic membrane to be restored. The actual surgical technique, the materials to be used, and the approach (transabdominal versus transcervical) are areas of research for the future. Meanwhile, continued efforts are warranted to decipher whether or not this obstetrical complication can one day be conquered.