Amnioinfusion vs. standard management for the second trimester PPROM: a systematic review and meta-analysis of observational studies and RCTs

Çelik, Ebru; Yıldız, Abdullah Burak; Cekic, Sebile Guler; Unal, Ceren; Ayhan, Işıl; Melekoğlu, Rauf; Gürsoy, Tuğba

doi:10.1080/14767058.2023.2230511

Cited by 2 publications

(5 citation statements)

References 36 publications

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“…45 From 10ml of AFSC conditioned medium, we extracted EVs with a typical double membrane morphology (Fig. 1B), a concentration of 7.47x10 10 and small size according to MISEV2023 (mean= 169±92.8nm; mode= 143nm; Fig. 1C) 39 , and expressing canonical EV markers (CD63, TSG101, FLOT1) without evidence of cellular debris (lack of CANX protein expression; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…13,38 This technique ensures high EV yield and is the most used isolation method to separate EVs for clinical applications in patients. 45 From 10ml of AFSC conditioned medium, we extracted EVs with a typical double membrane morphology ( Fig.1B ), a concentration of 7.47x10 10 and small size according to MISEV2023 (mean= 169±92.8nm; mode= 143nm; Fig.1C ) 39 , and expressing canonical EV markers (CD63, TSG101, FLOT1) without evidence of cellular debris (lack of CANX protein expression; Fig.1D ). It remains controversial whether AFSC-EV biological function varies according to vesicle size.…”

Section: Resultsmentioning

confidence: 99%

“…7 Attempts have been made to replenish the normal amniotic fluid volume by serial or continuous infusions with non-amniotic fluids during the mid-and third trimester. [8][9][10][11] However, randomized controlled trials have shown little or no benefit with amnioinfusion for perinatal survival, rather they have highlighted possible associated complications. 8,10,11 One could speculate that re-establishing just fluid volume is not enough, as the amniotic fluid is highly enriched with nutrients that are required for normal organogenesis.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] However, randomized controlled trials have shown little or no benefit with amnioinfusion for perinatal survival, rather they have highlighted possible associated complications. 8,10,11 One could speculate that re-establishing just fluid volume is not enough, as the amniotic fluid is highly enriched with nutrients that are required for normal organogenesis. 12 In particular, lung development is a complex process regulated by multiple signaling pathways involving several molecular species, such as miRNAs, proteins, and lipids.…”

Section: Introductionmentioning

confidence: 99%

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Amniotic fluid stem cell extracellular vesicles promote lung development via TGF-beta modulation in a fetal rat model of oligohydramnios

Doktor,

Figueira,

Fortuna

et al. 2024

Preprint

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Oligohydramnios (decreased amniotic fluid volume for gestational age) is a severe condition associated with high morbidity and mortality mainly due to fetal pulmonary hypoplasia. Currently, there are limited treatment options to promote fetal lung development. Administration of stem cells and their derivates have shown promising regenerative properties for several fetal and neonatal diseases related to arrested lung development. Herein, we first characterized pulmonary hypoplasia secondary to oligohydramnios in a surgical rat model. Experimental induction of oligohydramnios led to impaired lung growth, branching morphogenesis (fewer airspaces with decreasedFgf10,Nrp1,Ctnnb1expression), proximal/distal progenitor cell patterning (decreased Sox2 and Sox9 expression), and TGF-β signaling. We then tested antenatal administration of extracellular vesicles derived from amniotic fluid stem cells (AFSC- EVs). In oligohydramnios lungs, AFSC-EV administration improved lung branching morphogenesis and airway progenitor cell patterning at least in part through the release of miR-93-5p. Our experiments suggest that AFSC-EV miR-93-5p blocked SMAD 7, resulting in upregulation of pSMAD2/3 and restoration of TGF-β signaling. Conversely, oligohydramnios lungs treated with antagomir 93-5p transfected AFSC- EVs had decreased branching morphogenesis and TGF-β signaling. This is the first study reporting that antenatal administration of stem cell derivatives could be a potential therapy to rescue lung development in fetuses with oligohydramnios.HighlightsPulmonary hypoplasia secondary to oligohydramnios in fetal rats is characterized by impaired TGF-β signaling.AFSC-EV administration improves fetal lung branching morphogenesis and airway progenitor cell patterning.AFSC-EV effects are mediated at least in part via modulation of TGF-β signaling by the release of miR-93-5p from AFSC-EVs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Amniotic fluid stem cell extracellular vesicles promote lung development via TGF-beta modulation in a fetal rat model of oligohydramnios

Doktor,

Figueira,

Fortuna

et al. 2024

Preprint

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“…This treatment has been the subject of a meta-analysis from 2023. This meta-analysis reviewed the effect of serial transabdominal amnioinfusion on perinatal outcomes in preterm PROM occurring before 26 weeks of gestation [ 17 ]. They could not establish clear results because of the lack of studies covering this topic.…”

Section: Introductionmentioning

confidence: 99%

Maternal Outcomes Following Active vs. Expectant Management of Previable Preterm Pre-Labor Rupture of Membranes: A Meta-Analysis

2023

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The diagnosis of previable preterm pre-labor rupture of membranes (PROM) is known to be associated with poor outcomes for both the mother and the fetus. Following previable preterm PROM, patients are generally offered either active management through the termination of the pregnancy or expectant management to increase the chances of fetal survival. It is difficult to counsel patients because there is a lack of data directly comparing maternal outcomes following active vs. expectant management. Using the data in the current literature, the goal of the present meta-analysis was to determine if there were any differences in terms of maternal risks when active versus elective management was chosen. PubMed, Google Scholar, EMBASE, and Scopus were searched. We found four studies accounting for a total of 506 patients. The risk ratio (RR) of chorioamnionitis in active vs. expectant management was 0.30 (with a 95% confidence interval, CI, of 0.09–1.02). The heterogeneity of the study results was 81% (I2). A sub–analysis of two included studies revealed an RR of postpartum hemorrhage in active vs. expectant management of 0.75 (95% CI 0.27–2.07) and an RR of maternal sepsis of 0.23 (95% CI 0.04–1.28). The heterogeneity of the study results for this sub-analysis was 68% (I2) for postpartum hemorrhage and 0% (I2) for maternal sepsis. Overall, there was no statistically significant difference in the risk of chorioamnionitis, postpartum hemorrhage, or maternal sepsis when active management was chosen over expectant management in previable preterm PROM at <24 weeks. The scarcity and the high heterogeneity of the available data likely contributed to the lack of statistical significance and calls for further work directly comparing maternal outcomes following active vs. expectant management.

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Amnioinfusion vs. standard management for the second trimester PPROM: a systematic review and meta-analysis of observational studies and RCTs

Cited by 2 publications

References 36 publications

Amniotic fluid stem cell extracellular vesicles promote lung development via TGF-beta modulation in a fetal rat model of oligohydramnios

Amniotic fluid stem cell extracellular vesicles promote lung development via TGF-beta modulation in a fetal rat model of oligohydramnios

Maternal Outcomes Following Active vs. Expectant Management of Previable Preterm Pre-Labor Rupture of Membranes: A Meta-Analysis

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