Intraamniotic sealing of fetoscopic membrane defects in ex vivo and in vivo sheep models using an integrated semirigid bioadhesive patch

Helfer, Talita Micheletti; Eixarch, Elisenda; Febas, G.; Berdún, Sergio; Parra, Johanna; Hernansanz, Albert; Borrós, Salvador; Gratacós, E.

doi:10.1016/j.ajogmf.2022.100593

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…We believe that the high rate of placental abruption may be related to oligohydramnios that persists after surgery and/or to the detachment of membranes since we do not suture the membranes prior to or after surgery. This is a limitation of our technique, which we believe can be improved on with the development of a method to fix the membranes before trocar insertion without opening the maternal abdomen, which has already been studied 27 .…”

Section: Discussionmentioning

confidence: 99%

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

Lapa

Acácio

Trigo

et al. 2023

Ultrasound in Obstet & Gyne

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ObjectiveTwin pregnancy is currently an exclusion criterion for the prenatal repair of open spina bifida. The objective of this study was to report our experience in the treatment of twin pregnancies using the SAFER technique for repair. We also discuss the rationale of currently exclusion criteria for fetal spina bifida repair.MethodsWe have successfully repaired eight affected fetuses in seven twin pregnancies. Six were dichorionic with only one twin affected, and one was monochorionic with both twins affected. Percutaneous fetoscopy was performed under CO2 insufflation in the sac of the affected twin. Neurosurgical repair was performed using a biocellulose patch to protect the placode and skin suture to hold the patch in place, with or without a myofascial flap. Neurodevelopment was assessed by the PEDI scale in babies older than 6 months and Alberta scale below 6 months of corrected age.ResultsFourteen fetuses were liveborn, of which eight presented open spina bifida. None required any additional repair. Gestational age at surgery varied from 27.3 to 31.1 weeks and gestational age at birth varied from 31.6 to 36.0 weeks. Sequalae of prematurity was not found in any of the unaffected twins and their short‐term neurodevelopment was normal, assessed at a median chronological age of 12.5 (interquartile range, 2.7‐18.1) months. In the affected group, only one baby had a ventricle‐peritoneal shunt placed.ConclusionsPrematurity is frequent after fetal surgery, and the risk is increased in twin pregnancies. Nevertheless, prenatal surgery using the SAFER technique is feasible with low risk to both twins and their mother, when performed by a highly experienced team. Long‐term cognitive assessment of the unaffected twin is needed.This article is protected by copyright. All rights reserved.

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Section: Discussionmentioning

confidence: 99%

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

Lapa

Acácio

Trigo

et al. 2023

Ultrasound in Obstet & Gyne

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“…Long-term studies, ideally lasting until the time of delivery, would be the next logical step and should be performed to assess if MG can maintain a tight fetal cavity until the end of pregnancy and is hence a strong candidate for the prevention of iPPROM. Furthermore, further optimization of the material is needed for treatments in a minimally invasive manner using recently developed devices [25,46]. For instance, the biomaterial's viscosity and gelation time should be optimized to allow the injection of the premixed components necessary for MG distribution and gelation.…”

Section: Discussionmentioning

confidence: 99%

In vivo Sealing of Fetoscopy-Induced Fetal Membrane Defects by Mussel Glue

et al. 2022

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Introduction: The benefits of fetal surgery are impaired by the high incidence of iatrogenic preterm prelabor rupture of the fetal membranes (iPPROM), for which chorioamniotic separation has been suggested as a potential initiator. Despite the urgent need to prevent iPPROM by sealing the fetoscopic puncture site after intervention, no approach has been clinically translated. Methods: A mussel-inspired biomimetic glue was tested in an ovine fetal membrane (FM) defect model. The gelation time of mussel glue (MG) was first optimized to make it technically compatible with fetal surgery. Then, the biomaterial was loaded in polytetrafluoroethylene-coated nitinol umbrella-shaped receptors and applied on ovine FM defects (N = 10) created with a 10 French trocar. Its sealing performance and tissue response were analyzed 10 days after implantation by amniotic fluid (AF) leakage and histological methods. Results: All ewes and fetuses recovered well after the surgery, and 100% ewe survival and 91% fetal survival were observed at explantation. All implants were tight at explantation, and no AF leakage was observed in any of them. Histological analysis revealed a mild tissue response to the implanted glue. Conclusion: MG showed promising properties for the sealing of FM defects and thereby the prevention of preterm birth. Studies to analyze the long-term tissue response to the sealant should be performed.

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“…Recently, such biomaterials were deployed with a minimally invasive surgical device ex vivo , proving their feasibility for minimally invasive applications. 90 Together, these novel materials are promising sealing strategies for the prevention of iPPROM.…”

Section: Translational Strategies For the Prevention Of Ipprommentioning

confidence: 99%

“…Recently, several cyanoacrylates with the support of a PTFE-coated nitinol receptor 81,111 (Fig. 9C) and integrated semirigid bioadhesive patches 90 (Fig. 9D) were evaluated in a sheep model.…”

Section: Translational Strategies For the Prevention Of Ipprommentioning

confidence: 99%

Biomaterial-based treatments for the prevention of preterm birth after iatrogenic rupture of the fetal membranes

et al. 2022

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Intraamniotic sealing of fetoscopic membrane defects in ex vivo and in vivo sheep models using an integrated semirigid bioadhesive patch

Cited by 6 publications

References 14 publications

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

Biocellulose patch technique for fetoscopic repair of open spina bifida in twin pregnancy

In vivo Sealing of Fetoscopy-Induced Fetal Membrane Defects by Mussel Glue

Biomaterial-based treatments for the prevention of preterm birth after iatrogenic rupture of the fetal membranes

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