Transplantation of OMECS offers a reliable method not only to protect the woman's fertility from intrauterine re-adhesion after synechiotomy for IUA or uterine lumen adhesion but also to prevent adhesion after any intrauterine surgery in clinical cases.
Cell sheet transplantation can regenerate endometrial tissue with histological structure and physiological function supporting pregnancy similar to normal endometrial tissue. Translation of this endometrial cell sheet transplantation method to human patients with endometrial disorders could yield a novel therapy for uterine infertility.
Objective The study aimed to assess the feasibility of creating and transplanting human umbilical cord mesenchymal stem cell sheets applied to a rat model of hysterotomy, and additionally to determine benefits of human umbilical cord mesenchymal stem cell sheet transplantation in reducing uterine fibrosis and scarring.
Study Design Human umbilical cord mesenchymal stem cell sheets are generated by culturing human umbilical cord mesenchymal stem cells on thermo-responsive cell culture plates. The temperature-sensitive property of these culture dishes facilitates normal cell culture in a thin contiguous layer and allows for reliable recovery of intact stem cell sheets without use of destructive proteolytic enzymes.We developed a rat hysterotomy model using nude rats. The rat uterus has two distinct horns: one horn provided a control/untreated scarring site, while the second horn was the cell sheet transplantation site.On day 14 following surgery, complete uteri were harvested and subjected to histologic evaluations of all hysterotomy sites.
Results The stem cell sheet culture process yielded human umbilical cord mesenchymal stem cell sheets with surface area of approximately 1 cm2.Mean myometrial thickness in the cell sheet-transplanted group was 274 µm compared with 191 µm in the control group (p = 0.02). Mean fibrotic surface area in the human umbilical cord mesenchymal stem cell sheet-transplanted group was 95,861 µm2 compared with 129,185 µm2 in the control group. Compared with control horn sites, cell sheet-transplanted horns exhibited significantly smaller fibrotic-to-normal myometrium ratios (0.18 vs. 0.27, respectively, p = 0.029). Mean number of fibroblasts in cell sheet-transplanted horns was significantly smaller than the control horns (483 vs. 716/mm2, respectively, p = 0.001).
Conclusion Human umbilical cord mesenchymal stem cell sheet transplantation is feasible in a rat model of hysterotomy. Furthermore, use of stem cell sheets reduces fibroblast infiltration and uterine scar fibrotic tissue formation during hysterotomy healing, potentially mitigating risks of uterine scar formation.
Key Points
graduation in OB/GYN. Herein, we aimed to examine factors associated with the chosen route of operative delivery (abdominal vs. vaginal) in the second stage of labor for appropriate clinical indications, and to consider the potential impact of mid-cavity/rotational OVD skills on overall CD rates. STUDY DESIGN: Case-control study of patients delivered by OVD compared with second-stage CD over a 4-year period (2012-15) in a tertiary academic center. Multiple pregnancies, trial of labor after CD and intrauterine fetal deaths were excluded. Demographics and outcome data were collected retrospectively by interrogation of the OBNET database and individual chart review. Groups were compared using Student's t, Mann-Whitney U and chi-square tests as appropriate. IRB approval was granted (19-0017). RESULTS: In 2012-15, a total of 591 patients with unscarred uteri and singleton live fetuses required second stage operative intervention (5.7e7.1 % of births per annum). There were no differences between CD and OVD groups in age, gestation or labor onset. Women undergoing trial of OVD (68.4%) were more likely to be parous (21.6% vs. 12.0%, p¼0.022) with lower body mass index (24.9 AE 5.85 vs. 28.3 AE 1.56, p¼0.031). There were no differences in Apgars scores or umbilical arterial (UA) or venous pH, but UA base deficit was higher after OVD (5.5 AE 3.4 vs. 3.9 AE 0.3, p<0.001). Patients undergoing primary CD had a higher estimated fetal weight (3610 AE 37.2 vs. 3354 AE 25.8 g, p<0.001), station (+1 AE 0.1 vs. +3 AE 0.1, p<0.001) and actual birthweight (3507 AE 43.3 vs. 3352 AE 23.1 g, p¼0.002), however 88.8% were below the level of the ischial spines (0 to +2) and hence potentially eligible for mid-cavity OVD; only 12.5% were persistently OT and in need of manual rotation or rotational OVD. CONCLUSION: Factors associated with decision for primary CD in the second stage were largely predictable clinically. However, a substantial proportion may be preventable if providers adequately trained/experienced in mid-cavity/rotational OVD are available.
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