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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.
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