A novel therapy for spontaneous previable amniotic fluid leak by using intra‐amniotic platelet rich fibrin and plasma: A case report

Abstract

Abstract Introduction Previable premature rupture of membrane (PV‐PROM) is a complex clinical situation posing considerable risks to the foetus. There is an extreme paucity of management options and clear guidelines in the literature for this dismal situation. This is the first report on usage of a novel combination of cellular therapeutic agents in a case of PROM. This study reports the earliest gestational age at which a case of spontaneous PV‐PROM (sPV‐PROM) has been successfully dealt by active management and, the longest period of continuation of pregnancy in a singleton sPV‐PROM for a total of 149 days. Objective To study the benefit of Intraamniotic Injection of PRF and PRP (IFPRP) in an index case of PV‐PROM. Design This is a case report of a 26‐year‐old woman with a recurrent, sPV‐PROM at 14 weeks 2 days with a previous pregnancy loss due to PV‐PROM at 18 weeks managed in a private reproductive health hospital in Mysore, India. Methods Our subject underwent an elective cervical stitch at 14 weeks. She had confirmed, repeated episodes of leak after 30 h of the procedure. Apart from aggressive management to control infection with vaginal asepsis, an Intraamniotic injection of 9 mL of autologous PRF and 4.5 mL of PRP was done under ultrasound guidance. The pregnancy was monitored closely for signs of infection and foetal wellbeing. Results The amniotic fluid leak stopped immediately after IFPRP for 36 h. After two more bouts of small leak, it stopped completely. She delivered a healthy baby of 3.4 kg at 35 weeks 4 days. The mother and baby did well postnatally. Conclusion Our protocol for fixing the leak is simple, easy to use, and can be done in resource‐poor settings which we consider is a big advantage. Further studies are needed to explore its potential in treating PROM.

Keywords

• amniotic fluid leak
• case report
• PRF
• PROM
• PRP