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Carvalho NS, Moron AF, Witkin SS, Menon R, Cavalheiro S, Barbosa MM, Milani HJ, Sarmento SG, Ishigai MM. Histological response and expression of collagen, metalloproteinases MMP-1 and MMP-9 and tissue inhibitors of metalloproteinases TIMP-1 and TIMP-2 in fetal membranes following open intrauterine surgery: an experimental study. J Matern Fetal Neonatal Med 2020; 35:1301-1309. [PMID: 32295446 DOI: 10.1080/14767058.2020.1752654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To characterize aspects of the repair process by evaluating the tissue collagen density, metalloproteinases and tissue inhibitor of matrix metalloproteinases in the fetal membranes following open fetal surgery for myelomeningocele (MMC).Design: Experimental.Setting: Two Brazilian hospitals in 2013-2014.Population: 30 fetal membranes collected after elective cesarean deliveries, in patients who underwent open fetal surgery for MMC intrauterine repair.Methods: Regions within and surrounding the scar area and regions distant from the surgical site were evaluated for collagen concentration and expression of MMP-1, MMP-9, TIMP-1 and TIMP-2.Results: Collagen was increased in regions of scar formation (14.4 ± 2.7%) as compared to unaffected regions (8.0 ± 1.9%) (p < .001). The mean score of MMP-9 in the area of both the scar and suture was also increased above that observed in normal regions (p < .05). Conversely, MMP-1 was reduced in the scar when compared to the normal region and the area adjacent to the scar (suture region) (p < .05). TIMP-1 was increased in the suture region compared to the normal region (p < .05) while TIMP-2 was reduced in the scar region when compared to the other two regions (p < .05). The membrane repair process was also influenced by the number of previous pregnancies and gestational age at the time of surgery.Conclusion: Reparative activity of the fetal membrane after open fetal surgery involves up-regulation of collagen production and differential involvement of MMPs and TIMPs.
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Affiliation(s)
- Natalia S Carvalho
- Department of Obstetrics, Escola Paulista de Medicina - Federal University of São Paulo, São Paulo, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, Brazil
| | - Antonio F Moron
- Department of Obstetrics, Escola Paulista de Medicina - Federal University of São Paulo, São Paulo, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, Brazil.,Institute of Tropical Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Steven S Witkin
- Institute of Tropical Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Department of Obstetrics and Gynecology- Weil Cornell Medicine, New York, USA
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Texas, USA
| | - Sergio Cavalheiro
- Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, Brazil.,Department of Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Mauricio M Barbosa
- Department of Obstetrics, Escola Paulista de Medicina - Federal University of São Paulo, São Paulo, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, Brazil
| | - Herbene J Milani
- Department of Obstetrics, Escola Paulista de Medicina - Federal University of São Paulo, São Paulo, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, Brazil
| | - Stephanno G Sarmento
- Department of Obstetrics, Escola Paulista de Medicina - Federal University of São Paulo, São Paulo, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, Brazil
| | - Marcia M Ishigai
- Department of Pathology, Escola Paulista de Medicina - Federal University of São Paulo, São Paulo, Brazil
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Rives E, Denney JM, Brost BC. A transient finding of fetal head entrapment caught in a uterine synechium or amniotic band. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2018-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Uterine synechia are bands of fibrous tissue that when seen on prenatal ultrasound are not felt to pose significant risk to a fetus outside of early pregnancy loss. On the contrary, amniotic bands are diagnosed when bands of amniotic tissue are found to entrap and possible amputate involved fetal parts.
Case presentation
Ultrasound imaging demonstrated a twin pregnancy affected by entrapment of twin B’s head in a uterine synechium versus an amniotic band at 11 weeks + 0 days. The entrapment persisted until the second trimester. After a review of still images and video clips with a fetal surgeon, the patient was scheduled for possible fetal surgery. Upon arrival at 16 weeks + 0 days, the entrapment was observed to have spontaneously resolved. The patient experienced preterm premature rupture of membranes at 17 weeks + 6 days, and developed chorioamnionitis at 18 weeks + 5 days. Shortly after diagnosis with chorioamnionitis, she delivered spontaneously at 18 weeks + 5 days. Postnatal hysteroscopy demonstrated uterine synechium at the uterine fundus, which was resected.
Conclusions
This is the first case of fetal head entrapment by a uterine synechium.
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Affiliation(s)
- Edward Rives
- Wake Forest School of Medicine, Department of Obstetrics and Gynecology , Section on Maternal-Fetal Medicine , Winston-Salem, NC , USA
| | - Jeff M. Denney
- Wake Forest School of Medicine, Department of Obstetrics and Gynecology , Section on Maternal-Fetal Medicine , Winston-Salem, NC , USA
| | - Brian C. Brost
- Wake Forest School of Medicine, Department of Obstetrics and Gynecology , Section on Maternal-Fetal Medicine , Winston-Salem, NC , USA
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3
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Carvalho NS, Moron AF, Menon R, Cavalheiro S, Barbosa MM, Milani HJ, Ishigai MM. Histological evidence of reparative activity in chorioamniotic membrane following open fetal surgery for myelomeningocele. Exp Ther Med 2017; 14:3732-3736. [PMID: 29042971 PMCID: PMC5639275 DOI: 10.3892/etm.2017.4976] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/12/2017] [Indexed: 11/13/2022] Open
Abstract
An increased understanding of the reparative process in fetal membrane following surgical techniques may be helpful to decrease the risks to mother and fetus and avoid adverse pregnancy outcomes. The present study discusses histological evaluation of the fetal membrane following open fetal surgery. Chorioamniotic membranes (n=10) were obtained following birth from pregnancies that underwent open fetal surgery for myelomeningocele. The collagen distribution was quantified using picrosirius-polarization method comparing the suture site with non-suture site. The differences between the collagen fiber percentages at the two sites was evaluated by the paired t-test with P<0.05. The mean gestational age of fetal surgery was 26.09±0.3 and 33.81±0.82 weeks at birth. The picrosirius red sign was more intense at the suture site, primarily associated with collagen type 1. Collagen observed in the surgical area was significantly increased (13.22±2.84%) compared with the non-surgical area (6.16±1.09%; P<0.0001). It was observed that the reparative activity at the suture site of the fetal membrane was characterized by a significant increase in collagen fibers. The findings suggest nascent collagen synthesis, tissue remodeling and repair of suture site, a mechanism likely to prevent the amniotic fluid leakage and maintain pregnancy following open fetal surgery.
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Affiliation(s)
- Natalia S Carvalho
- Department of Obstetrics, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04021-001, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, SP 04103-000, Brazil
| | - Antonio F Moron
- Department of Obstetrics, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04021-001, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, SP 04103-000, Brazil
| | - Ramkumar Menon
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Sergio Cavalheiro
- Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, SP 04103-000, Brazil.,Department of Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04021-001, Brazil
| | - Mauricio M Barbosa
- Department of Obstetrics, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04021-001, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, SP 04103-000, Brazil
| | - Herbene J Milani
- Department of Obstetrics, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04021-001, Brazil.,Fetal Medicine Division, Hospital e Maternidade Santa Joana, São Paulo, SP 04103-000, Brazil
| | - Marcia M Ishigai
- Department of Pathology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, SP 04021-001, Brazil
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Ananthan A, Athalye Jape G, Du Plessis J, Annear P, Page R, Rao S. Amniotic Band Syndrome With Pseudoarthrosis of Tibia and Fibula: A Case Report. J Foot Ankle Surg 2017. [PMID: 28623060 DOI: 10.1053/j.jfas.2017.04.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Constriction of the lower limb by a congenital amniotic band has been proposed to explain the development of pseudoarthrosis of the tibia and fibula. We report a case of amniotic band syndrome in a preterm female infant with pseudoarthrosis of the tibia and fibula. She was born at 29 weeks of gestation with congenital amniotic bands and was noted to have a severely edematous left foot distal to the constricting band with rudimentary digits. The skin was pink and well perfused with palpable pulses. Radiography demonstrated pseudoarthrosis of the tibia and fibula. The limb deformities were managed with splints, positioning, and physiotherapy. She underwent Z-plasty with soft tissue release on the left lower leg on day 7 of life. At 36 weeks of postmenstrual age, a repeat radiograph showed markedly improved growth of the tibia and fibula with mature new bone formation, which avoided the need for further surgical intervention. During the follow-up period, she underwent left Syme's amputation at 18 months. At 29 months of age, the child was able to walk and run without support. The findings from our case confirm the potential for bone growth in patients with amniotic band syndrome, once the constricting band has been released. Simple release of the constriction band with Z-plasty resulted in growth of mature bone, replacing the pseudoarthrosis and, hence, the patient did not require surgical amputation. Thus, one should be cautious when deciding on surgical amputation, even in the presence of pseudoarthrosis, especially in preterm infants. Early limb-preserving surgery with release of the constricting band with an intention to salvage the limb appears appropriate.
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Affiliation(s)
- Anitha Ananthan
- Senior Resident, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
| | - Gayatri Athalye Jape
- Assistant Professor, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Jean Du Plessis
- Assistant Professor, Department of Neonatal Paediatrics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Peter Annear
- Orthopaedic Surgeon, Department of Orthopaedics, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Rohan Page
- Plastic Surgeon, Department of Plastic Surgery, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Shripada Rao
- Associate Professor, Centre for Neonatal Research and Education, University of Western Australia, Crawley, Western Australia, Australia
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Romero-Valdovinos M, Galván-Montaño A, Olivo-Díaz A, Maravilla P, Bobadilla NA, Vadillo-Ortega F, Flisser A. The Amniotic Band Syndrome in the Rat Is Associated with the Activation of Transforming Growth Factor-β. THE AMERICAN JOURNAL OF PATHOLOGY 2015; 185:2076-82. [DOI: 10.1016/j.ajpath.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 12/11/2022]
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6
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Rodríguez González ZI, Soriano Padilla F. [Complex of amniotic deformities, adhesions, mutilations: Endless debate]. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2015; 72:159-168. [PMID: 29421497 DOI: 10.1016/j.bmhimx.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 06/23/2015] [Accepted: 06/23/2015] [Indexed: 11/28/2022] Open
Abstract
Amniotic deformities, adhesions, mutilations (ADAM) complex is a broad heterogeneous spectrum of congenital anomalies. ADAM complex is characterized by constriction rings, amputation of fingers or limbs and the presence of the amniotic band. However, it may also involve craniofacial disruptions, body wall defects and internal organ abnormalities. The aim of this review is to present the results found in regard to ADAM complex from its historical background, clinical manifestations, epidemiology, etc. In particular, our attention was focused on demonstrating the varying etiopathogenesis theories of ADAM complex and their contradictions. The study was conducted using the databases of PubMed, EBSCO host, Ovid, SpringerLink, Scopus, nature.com, JAMA and ScienceDirect with the following keywords for the search: "amniotic band syndrome", "amniotic band sequence", "Streeter dysplasia", "ADAM complex". In this study we used 22 full-text articles. Patients with ADAM complex require a complete pre- and postnatal evaluation to integrate the diagnosis and to decide on timely treatment. It is important for clinicians and surgeons to possess knowledge of this entity. Further research is necessary to establish a nosological basis.
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Affiliation(s)
| | - Fernando Soriano Padilla
- Cirugía Maxilofacial Pediátrica, Unidad de Medicina de Alta Especial, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F., México
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