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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Chmait RH, Kontopoulos EV, Chon AH, Korst LM, Llanes A, Quintero RA. Amniopatch treatment of iatrogenic preterm premature rupture of membranes (iPPROM) after fetoscopic laser surgery for twin-twin transfusion syndrome. J Matern Fetal Neonatal Med 2016; 30:1349-1354. [PMID: 27686840 DOI: 10.1080/14767058.2016.1214123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Amniopatch is a proposed treatment of iatrogenic preterm premature rupture of membranes (iPPROM). We studied characteristics associated with successful amniopatch treatment of iPPROM after fetoscopic laser surgery for twin-twin transfusion syndrome. METHODS Patients with iPPROM within 15 days of laser surgery treated with an amniopatch were studied. Factors associated with amniopatch success (i.e. cessation of leakage with normalization of amniotic fluid volume) were tested univariately and in multivariate logistic regression models. Continuous variables are expressed as median (range). RESULTS Of 1124 patients undergoing laser surgery, 19 (1.7%) had iPPROM and subsequent amniopatch. Twelve (63.2%) were successful. Latency in days from iPPROM to delivery was greater in the successful group (114.0 [87.0-141.0]) versus (44.0 [3.9-88.0], p = 0.0005), which translated into greater gestational age (GA) (weeks) at delivery (35.1 [30.9-39.4] versus 28.1 [22.0-31.0], p = 0.0005). The 30-day survival of the affected recipient twin was improved (100% versus 57.1%, p = 0.0361). After multivariate testing, GA < 20 weeks at the time of the amniopatch placement was the only variable that remained associated with successful sealing of the membranes. CONCLUSIONS Treatment of iPPROM via amniopatch was successful in almost two-thirds of cases and was associated with higher GA at delivery and improved perinatal survival.
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Affiliation(s)
- Ramen H Chmait
- a Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
| | - Eftichia V Kontopoulos
- b Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, University of Missouri-Kansas City School of Medicine, Children's Mercy Hospital , Kansas City , MO , USA , and
| | - Andrew H Chon
- a Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
| | - Lisa M Korst
- c Childbirth Research Associates , North Hollywood , CA , USA
| | - Arlyn Llanes
- a Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California , Los Angeles , CA , USA
| | - Rubén A Quintero
- b Department of Obstetrics and Gynecology , Division of Maternal-Fetal Medicine, University of Missouri-Kansas City School of Medicine, Children's Mercy Hospital , Kansas City , MO , USA , and
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