Repairing Fetal Membranes with a Self-adhesive Ultrathin Polymeric Film: Evaluation in Mid-gestational Rabbit Model
Preterm premature rupture of membranes causes 40% of all preterm births, affecting 150000 women each year in the United States. Prenatal diagnostic procedures and surgical interventions increase incidence of adverse events, leading to iatrogenic membrane rupture after a fetoscopic procedure in 45% of cases. We propose an ultrathin, self-adherent, poly-l-lactic acid patch (“nanofilm”) as a reparative wound closure after endoscopic/fetoscopic procedures. These nanofilms are compatible with application in wet conditions and with minimally invasive instrumentation. Ex vivo studies to evaluate the nanofilm were conducted using human chorion–amnion (CA) membranes. A custom-built inflation device was used for mechanical characterization of CA membranes and for assessment of nanofilm adhesion and sealing of membrane defects up to 3 mm in size. These ex vivo tests demonstrated the ability of the nanofilm to seal human CA defects ranging in size from 1 to 3 mm in diameter. In vivo survival studies were conducted in 25 mid-gestational rabbits, defects were created by perforating the uterus and the CA membranes and subsequently using the nanofilm to seal these wounds. These in vivo studies confirmed the successful sealing of defects smaller than 3 mm observed ex vivo. Histological analysis of whole harvested uteri 7 days after surgery showed intact uterine walls in 59% of the nanofilm repaired fetuses, along with increased uterine size and intrauterine development in 63% of the cases. In summary, we have developed an ultrathin, self-adhesive nanofilm for repair of uterine membrane defects.
KeywordsFetal surgery IPPROM Amnion Chorion Ultrathin polymeric film Poly l-lactic acid
The authors would like to acknowledge the staff at Division of Surgical Research, Vanderbilt University Medical Center for their support during animal surgery, Prof. Hernan Correa and Dr. Lacey Winchester from the Department of Pathology, Microbiology, and Immunology at Vanderbilt University Medical Center for their help for histological analysis. Special thanks are due to Dr. Kellie Boyle and the Translational Pathology Shared Resource at Vanderbilt University Medical Center. The authors are also grateful to Alicia K. Crum, Registered Diagnostic Medical Sonographer from the Department of fetal medicine for her support for ultrasound, Lynne Black and Prof. Kelly Bennett from the Division of Maternal Fetal Medicine for their help for human placenta collection and IRB approval, and Emily Guess and all the nurses at Labor&Delivery at Vanderbilt University Medical Center for tissues collections.
All authors disclosed no financial relationships relevant to this publication. This study was supported by an internal ViSE (Vanderbilt Initiative in Surgery and Engineering) grant and Vanderbilt Institute for Clinical and Translational Research (VICTR) within the project “Self-adhesive patch for fetal and obstetrical surgery and by CTSA award no. UL1TR000445 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.
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- 2.Adzick, N. S., E. A. Thom, C. Y. Spong, J. W. Brock, III, P. K. Burrows, M. P. Johnson, L. J. Howell, J. A. Farrell, M. E. Dabrowiak, L. N. Sutton, N. Gupta, N. B. Tulipan, M. E. D’Alton, and D. L. Farmer. A randomized trial of prenatal versus postnatal repair of myelomeningocele. N. Engl. J. Med. 364(11):993–1004, 2011.PubMedCentralPubMedCrossRefGoogle Scholar
- 7.Bilic, G., et al. Injectable candidate sealants for fetal membrane repair: bonding and toxicity in vitro. Am. J. Obstet. Gynecol. 02:85.e1–85.e9, 2001.Google Scholar
- 12.Fujino, K., M. Kinoshita, A. Saitoh, H. Yano, K. Nishikawa, T. Fujie, K. Iwaya, M. Kakihara, S. Takeoka, D. Saitoh, and Y. Tanaka. Novel technique of overlaying a poly-l-lactic acid nanosheet for adhesion prophylaxis and fixation of intraperitoneal onlay polypropylene mesh in a rabbit model. Surg. Endosc. 25(10):3428–3436, 2011.PubMedCrossRefGoogle Scholar
- 15.Haller, C. M., W. Buerzle, C. E. Brubaker, P. B. Messersmith, E. Mazza, N. Ochsenbein-Koelble, R. Zimmermann, and M. Ehrbar. Mussle-mimetic tissue adhesive for fetal membrane repair: a standardized ex vivo evaluation using elastomeric membranes. Prenat. Diagn. 31:654–660, 2011.PubMedCrossRefGoogle Scholar
- 26.Polishuk, W. Z., S. Kohane, and A. Hader. Fetal weight and membrane tensile strength. Am. J. Obstet. Gynecol. 20:204–250, 1964.Google Scholar
- 32.Wyatt-Ashmead, J., and A. Ashmead. Placental membrane bursting pressures. Mod. Pathol. 17:275, 2004.Google Scholar