Letter - Why do the fetal membranes rupture after fetoscopy? – Comments on proposed mechanisms and adding the fetus as a potential culprit

It has never been taken into account that the fetus itself, by being trapped within the iatrogenic openings in the amniotic membrane from a previous intervention, can tear her home to pieces. As early rupture of membranes within hours or days after percutaneous fetoscopic surgery for spina bifida occurs in less than 10% of our cases, I would attribute most ruptures later in gestation to this effect. Fetal fingers and toes fit all too easily and – with advanced gestational age (the mean age of PROM after my approach to fetoscopic spina bifida surgery occurs around 30 weeks of gestation) – the fetus becomes certainly strong enough to achieve this mischievous feat. Supporting this notion of the (trapped) fetus as a potential culprit, many expectant mothers report a period of stronger fetal movements shortly prior to the occurrence of PROM.
Source: Fetal Diagnosis and Therapy - Category: Perinatology & Neonatology Source Type: research