Ramesha Papanna1, Lovepreet K Mann2, Kenneth J Moise2, Themis Kyriakides3, Anthony Johnson2, Elisa Garcia2, Catalin S Buhimschi4, Irina A Buhimschi5. 1. 1] Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut [2] The Fetal Center at Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology & Reproductive Sciences, The University of Texas Health Medical School, Houston, Texas. 2. The Fetal Center at Children's Memorial Hermann Hospital, Department of Obstetrics, Gynecology & Reproductive Sciences, The University of Texas Health Medical School, Houston, Texas. 3. Department of Pathology, Yale University School of Medicine, New Haven, Connecticut. 4. Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio. 5. 1] Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio [2] Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio [3] Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
Abstract
BACKGROUND: Preterm premature rupture of membranes remains a major complication after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS). We studied the histologic changes of fetal membranes post-FLS and investigated a possible impact of amniotic fluid (AF) dilution. METHODS: Fetal membranes of 31 pregnancies that underwent FLS for TTTS were investigated histologically at delivery at different sites: trocar site of recipient sac and at distance, donor sac, and inter-twin membrane. RESULTS: The trocar insertion site on the recipient sac showed no signs of histologic hallmarks of healing. Wide-spread alteration in collagen organization and higher apoptotic index in the amnion of the recipient sac which were absent in donor's and reference membranes. To explain the mechanisms, we analyzed the AF composition of recipient sacs from TTTS pregnancies vs. GA-matched healthy singleton controls and found glucose, protein and lactate dehydrogenase activity were all significantly lower in TTTS sacs consistent with over-dilution of recipient's AF (~2-fold). In-vitro exposure of healthy amniochorion to analogous dilutional stress conditions recapitulated the histologic changes and induced apoptosis and autophagy. CONCLUSION: Alteration in structural integrity of the recipient's amniochorion, possibly in response to dilution stress, along with ineffective repair mechanisms may explain the increased incidence of preterm birth post-FLS.
BACKGROUND:Preterm premature rupture of membranes remains a major complication after fetoscopic laser surgery (FLS) for twin-twin transfusion syndrome (TTTS). We studied the histologic changes of fetal membranes post-FLS and investigated a possible impact of amniotic fluid (AF) dilution. METHODS: Fetal membranes of 31 pregnancies that underwent FLS for TTTS were investigated histologically at delivery at different sites: trocar site of recipient sac and at distance, donor sac, and inter-twin membrane. RESULTS: The trocar insertion site on the recipient sac showed no signs of histologic hallmarks of healing. Wide-spread alteration in collagen organization and higher apoptotic index in the amnion of the recipient sac which were absent in donor's and reference membranes. To explain the mechanisms, we analyzed the AF composition of recipient sacs from TTTS pregnancies vs. GA-matched healthy singleton controls and found glucose, protein and lactate dehydrogenase activity were all significantly lower in TTTS sacs consistent with over-dilution of recipient's AF (~2-fold). In-vitro exposure of healthy amniochorion to analogous dilutional stress conditions recapitulated the histologic changes and induced apoptosis and autophagy. CONCLUSION: Alteration in structural integrity of the recipient's amniochorion, possibly in response to dilution stress, along with ineffective repair mechanisms may explain the increased incidence of preterm birth post-FLS.
Authors: Femke Slaghekke; Liesbeth Lewi; Johanna M Middeldorp; Anne Sophie Weingertner; Frans J Klumper; Philip Dekoninck; Roland Devlieger; Mariano M Lanna; Jan Deprest; Romain Favre; Dick Oepkes; Enrico Lopriore Journal: Am J Obstet Gynecol Date: 2014-05-09 Impact factor: 8.661
Authors: N Scott Adzick; Elizabeth A Thom; Catherine Y Spong; John W Brock; Pamela K Burrows; Mark P Johnson; Lori J Howell; Jody A Farrell; Mary E Dabrowiak; Leslie N Sutton; Nalin Gupta; Noel B Tulipan; Mary E D'Alton; Diana L Farmer Journal: N Engl J Med Date: 2011-02-09 Impact factor: 91.245
Authors: Alexander C Engels; Luc Joyeux; Johannes Van der Merwe; Julio Jimenez; Savitree Pranpanus; David W Barrett; Che Connon; Tina T Chowdhury; Anna L David; Jan Deprest Journal: Prenat Diagn Date: 2017-12-11 Impact factor: 3.242
Authors: Natalia S Carvalho; Antonio F Moron; Ramkumar Menon; Sergio Cavalheiro; Mauricio M Barbosa; Herbene J Milani; Marcia M Ishigai Journal: Exp Ther Med Date: 2017-08-21 Impact factor: 2.447
Authors: B J Amberg; R J Hodges; A J Kashyap; S M Skinner; K A Rodgers; E V McGillick; J A Deprest; S B Hooper; K J Crossley; P L J DeKoninck Journal: Ultrasound Obstet Gynecol Date: 2019-03 Impact factor: 7.299
Authors: David W Barrett; Anna L David; Christopher Thrasivoulou; Alvaro Mata; David L Becker; Alex C Engels; Jan A Deprest; Tina T Chowdhury Journal: Prenat Diagn Date: 2016-09-25 Impact factor: 3.050