Rare autologous amniotic patch infusion performed in complicated triplet pregnancy; Mangaluru doctors intervene after fluid leak

MANGALURU: The medical team at Father Muller Medical College successfully executed a rare autologous amniotic patch infusion using the advanced AmnioSeal procedure in a complicated triplet pregnancy in a 40-year-old woman.The patient was referred by the department of OBG for an anomaly scan. The scan revealed a dichorionic triamniotic triplet pregnancy, with one monochorionic pair sharing the same placenta. The following day, the patient presented with premature rupture of membranes (PV leak) from one of the monochorionic sacs. The patient was managed conservatively, but the slow leak continued, and the amniotic fluid level reached critically low levels.Recognising the high risk of pregnancy loss, a novel regenerative approach, an autologous amniotic patch infusion to seal the leak and minimise immunogenic response, was suggested. This cutting-edge intervention involved harvesting the patient's own platelets through apheresis (a medical procedure that separates blood into its components), followed by a precisely regulated intra-amniotic infusion of autologous platelets and cryoprecipitate into the affected sac.

The complex procedure was successfully carried out by the Fetal Medicine team led by Dr Muralidhar G.K, Dr Ram Shenoy, and Dr Prathima Prabhu, in close coordination with the obstetrics team of Dr Sujaya V Rao and Dr Joylene D’Almeida.The team overcame several critical challenges, including critically low amniotic fluid volume, complicating sac entry, avoiding injury to fetal parts and the umbilical cord during the procedure, risk of fetal bradycardia during prolonged intrauterine handling, co-twin movements, increasing procedural complexity, and risk.Despite these difficulties, the team completed the procedure with precision and care. Post-procedure monitoring has shown a favourable outcome, including the restoration of amniotic fluid, absence of infection, and continued fetal stability.“This case represents a major step forward in regenerative fetal therapy,” said Dr Ram Shenoy, Professor and Head of the Department of Radiology, adding, “Performing such a targeted intervention in a triplet pregnancy is exceedingly rare and no studies found to date.”This procedure holds promise in preventing preterm birth and its associated complications. Meanwhile, the patient continues to remain under close observation.