Doctors typically recommend a cesarean section for subsequent pregnancies if the first one was an emergency (something went wrong during natural childbirth). This subsequent operation for a woman is more complicated for many reasons: the risk of complications increases, healing takes longer, and the pain is more intense. There is also an increased risk of miscarriage in subsequent pregnancies.
Doctors from the Sechenov First Moscow State Medical University Maternity and Childhood Center of the Sechenov University of the Ministry of Health of Russia have proposed a unique technology for suturing the uterus during repeat cesarean sections. This technology can reduce the risk of complications, improve the regeneration of the myometrium (the muscular layer of the uterus), and increase a woman’s chances of carrying the next pregnancy to term.
How Does it Work?
Obstetrician-gynecologists at Sechenov University were the first in the world to use the amniotic membrane (a structure of the placenta) to heal the scar on the patient’s uterus. The amniotic membrane is a thin, semi-transparent membrane that lines the inner surface of the fetal sac. It contains stem cells that promote the regeneration of other tissues. During a cesarean section, doctors cut it to the size of the incision, place it on top, and fix it in place to prevent displacement.
Two main features:
1. Application of a special suture.
“During a cesarean section, scar forms on the uterus, and if a woman plans to give birth again, the scar must be robust, that is, good, but in some cases, it thins out,” explains Anatoly Ishchenko, director of the Department of Obstetrics and Gynecology named after V.F. Snegirev. – An inadequate scar poses a threat to a woman during subsequent pregnancies and childbirth and can lead to problems up to catastrophic ones. Therefore, we use special absorbable anchor threads with notches that “embed” into the tissues and apply the suture from the center to the sides to avoid excessive tension.
2. Own source of stem cells is used.
“We connect the amniotic membrane, which can promote tissue regeneration and the formation of a full-fledged scar,” continued Professor Leonid Alexandrov, head of the Department of Obstetrics and Gynecology No. 1 of the Sklifosovsky Research Institute. “This is a source of your own stem cells, collagen, and fibroblasts. It also has an antimicrobial effect and performs many functions, including the production of biologically active substances,” the Professor added.
Scientists say that this method allowed them to obtain an ideal, unchanged, natural collagen matrix with stem cells.
“In our previous studies, we took the basis, seeded it with cells, grew it, and then transplanted it to the patient. But it was artificially grown tissue. And here it is, our own natural implant, rich in stem cells, which will help a woman in terms of regeneration – restoring the uterine tissue to form a full-fledged scar. Moreover, this implant is sterile, so it does not need preparation: during the operation, take it, apply it, and that’s it,” noted Anatoly Ishchenko.
This technique was first applied a year ago, and about 70 people have been operated on since then. There were women with a third cesarean section and those who had already undergone cesarean section twice.
obstetrician-gynecologists from the Sechenov Center for Maternity and Childhood have been monitoring patients all this time. Using ultrasound and MRI, they track the healing of the scar. The first positive results are already there.
“We have one woman who came to us with her third cesarean section, and we applied the membrane to her. Now, she is already pregnant for the fourth time, at 21 weeks. We hope that our surgery will help her avoid complications and successfully carry the baby. We are all looking forward to this,” said Leonid Alexandrov.
In the future, scientists from Sechenov University plan to develop the technology further and use the amniotic membrane in other areas where regenerative medicine methods are in demand.
“The amniotic membrane has low immunogenicity (that is, it is extremely rarely rejected),” explained Nastasya Kosheleva, head of the Clinical Smart Technologies Laboratory and associate Professor at the Institute of Regenerative Medicine of the Sechenov University.
Clinics worldwide already actively use it in ophthalmology for surgical cornea treatment. The amniotic membrane can be cleaned of its cellular components and filled with patient cells. Various surgeries, including gynecology, can effectively use it after such treatments to reduce scarring risk and shorten patients’ rehabilitation time. Based on the amniotic membrane, we at Sechenov University plan to develop our own products in the future, she added.
