Delivery of patients with a uterine scar who have undergone cell technology in a previous caesarean section

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Abstract

Objective: To determine the likelihood of successful spontaneous delivery in women with myometrial scars who had undergone cell technology, that is, mesenchymal stromal cell derived exosomes (MSCE), during a previous caesarean section.

Materials and methods: Group 1 (study group) included 60 pregnant and parturient women who underwent cell technologies. Group 2 (control group) consisted of 100 pregnant and parturient women without exosomal support. In addition, an intra-natal assessment of the scar condition was performed in 71 parturient women, including 19 and 22 women from groups 1 and 2, respectively. In addition, the condition of the lower uterine segment was evaluated by ultrasound in 30 women without a post-caesarean uterine scar in the control group. A suprapubic arrangement of a RAB6-D volumetric convex transducer with a frequency of 2–8 MHz and an intracavitary IC5-9-D transducer with a frequency of 4–9 MHz from the GE Voluson E8 device (USA) was used. The primary endpoints were the course of pregnancy and childbirth in patients in the study and control groups. Secondary endpoints included the results of repeated deliveries of patients with uterine scars with and without the use of cell technologies, i.e., exosomal support.

Results: No infectious or inflammatory complications were observed in postpartum women who underwent cell technologies, while 6/100 (6 %) patients in group 2 had symptoms of metroendometritis, which required hospitalization and inpatient treatment. Two patients in group 2 (2%) developed lochiometra, as confirmed by ultrasound and office hysteroscopy. The rate of successful vaginal deliveries was 63.6% (14/22) in the group with prior exosomal support, compared to 20.7% (6/29) in the control group.

Conclusion: This study demonstrated the feasibility of using cell technologies, specifically exosomes derived from mesenchymal stromal cells of placental origin, to improve the repair of postoperative myometrial scars and increase the likelihood of safe spontaneous delivery in women with a history of abdominal delivery. This finding suggests the potential of reducing the cesarean section rate in patients with a post-cesarean uterine scar.

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About the authors

Oleg G. Pekarev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: o_pekarev@oparina4.ru
ORCID iD: 0000-0001-7122-6830

Dr. Med. Sci., Professor, Deputy Director of the Institute of Obstetrics

Russian Federation, Moscow

Igor I. Baranov

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: i_baranov@oparina4.ru
ORCID iD: 0000-0002-9813-2823

Dr. Med. Sci., Professor, Head of the Department of Scientific and Educational Programs

Russian Federation, Moscow

Evgenia O. Pekareva

Novosibirsk City Clinical Perinatal Center

Author for correspondence.
Email: o_pekarev@oparina4.ru
ORCID iD: 0000-0002-6335-2121

Dr. Med. Sci., Obstetrician-Gynecologist

Russian Federation, Novosibirsk

Denis N. Silachev

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of the Russian Federation

Email: o_pekarev@oparina4.ru
ORCID iD: 0000-0003-0581-9755

Dr. Bio. Sci., Head of the Cell Technologies Laboratory

Russian Federation, Moscow

Ivan M. Pozdnyakov

Novosibirsk City Clinical Perinatal Center

Email: o_pekarev@oparina4.ru
ORCID iD: 0000-0003-0600-3053

Dr. Med. Sci., Professor, Chief Physician

Russian Federation, Novosibirsk

References

  1. Майбородин И.В., Якимова Н.В., Матвеева В.А., Пекарев О.Г., Майбородина Е.И., Пекарева Е.О. Ангиогенез в рубце матки крыс после введения аутологичных мезенхимальных стволовых клеток костномозгового происхождения. Бюллетень экспериментальной биологии и медицины. 2010; 150(12): 705-11. [Mayborodin I.V., Yakimova N.V., Matveeva V.A., Pekarev OG, Mayborodina E.I., Pekareva E.O. Angiogenesis in the uterine rumen of rats after administration of autologous mesenchymal stem cells of bone marrow origin. Bulletin of Experimental Biology and Medicine. 2010; 150(12): 705-11. (in Russian)].
  2. Майбородин И.В., Якимова Н.В., Матвеева В.А., Пекарев О.Г., Майбородина Е.И., Пекарева Е.О., Ткачук О.К. Морфологический анализ результатов введения аутологичных стволовых стромальных клеток костномозгового происхождения в рубец матки крыс. Морфология. 2010; 138(6): 47-55. [Mayborodin I.V., Yakimova N.V., Matveeva V.A., Pekarev O.G., Maiborodina E.I., Pekareva E.O., Tkachuk O.K. Morphological analysis of the results of the introduction of autologous stromal stem cells of bone marrow origin into the rat uterine scar. Morphology. 2010; 138(6): 47-55. (in Russian)].
  3. Майбородин И.В., Оноприенко Н.В., Частикин Г.А. Морфологические изменения тканей матки крыс и возможность самопроизвольных родов в результате введения мультипотентных мезенхимных стромальных клеток на фоне гидрометры. Бюллетень экспериментальной биологии и медицины. 2015; 159(4): 511-6. [Mayborodin I.V., Onoprienko N.V., Chastikin G.A. Morphological changes in the tissues of the uterus of rats and the possibility of spontaneous delivery as a result of the introduction of multipotent mesenchymal stromal cells against the background of a hydrometer. Bulletin of Experimental Biology and Medicine. 2015; 159(4): 511-6. (in Russian)].
  4. Rodrigues M., Yates C.C., Nuschke A., Griffith L., Wells A. The matrikine tenascin-C protects multipotential stromal cells/mesenchymal stem cells from death cytokines such as FasL. Tissue Eng. Part A. 2013; 19(17-18): 1972-83. https://dx.doi.org/10.1089/ten.TEA.2012.0568.
  5. Майбородин И.В., Матвеева В.А., Маслов Р.В., Оноприенко Н.В., Кузнецова И.В., Частикин Г.А., Аникеев А.А. Некоторые реакции регионарных лимфатических узлов крыс после имплантации в дефект костной ткани мультипотентных стромальных клеток, адсорбированных на полигидроксиалканоате. Морфология. 2016; 149(2): 21-6. [Mayborodin I.V., Matveeva V.A., Maslov R.V., Onoprienko N.V., Kuznetsova I.V., Chastikin G.A., Anikeev A.A. Some reactions of rat regional lymph nodes after implantation of multipotent stromal cells adsorbed on a polyhydroxyalkanoate into a bone defect. Morphology. 2016; 149(2): 21-6. (in Russian)].
  6. Майбородин И.В., Морозов В.В., Аникеев А.А., Фигуренко Н.Ф., Маслов Р.В., Частикин Г.А., Матвеева В.А., Майбородина В.И. Макрофагальный ответ у крыс на введение мультипотентных мезенхимальных стромальных клеток в регион хирургической травмы. Новости хирургии. 2017; 25(3): 233-41. [Mayborodin I.V., Morozov V.V., Anikeev A.A., Figurenko N.F., Maslov R.V., Chastikin G.A., Matveeva V.A., Mayborodina V.I. Macrophage response in rats to the introduction of multipotent mesenchymal stromal cells into the region of surgical injury. Surgery News. 2017; 25(3): 233-41. (in Russian)].
  7. Yates C.C., Nuschke A., Rodrigues M., Whaley D., Dechant J.J., Taylor D.P., Wells A. Improved transplanted stem cell survival in a polymer gel supplemented with Tenascin C accelerates healing and reduces scarring of murine skin wounds. Cell Transplant. 2017; 26(1): 103-13. https://dx.doi.org/10.3727/096368916X692249.
  8. Takeda Y.S., Xu Q. Neuronal differentiation of human mesenchymal stem cells using exosomes derived from differentiating neuronal cells. PLoS One. 2015;10(8): e0135111. https://dx.doi.org/10.1371journal.pone.0135111.
  9. Furuta T., Miyaki S., Ishitobi H., Ogura T., Kato Y., Kamei N. et al. Mesenchymal stem cell-derived exosomes promote fracture healing in a mouse model. Stem Cells Transl. Med. 2016; 5(12): 1620-30. https://dx.doi.org/10.5966/ sctm.2015-0285.
  10. Narayanan R., Huang C.C., Ravindran S. Hijacking the cellular mail: exosome mediated differentiation of mesenchymal stem cells. Stem Cells Int. 2016; 2016: 3808674. https://dx.doi.org/10.1155/2016/3808674.
  11. Van der Pol E., Böing A. N., Harrison P., Sturk A., Nieuwland R. Classification, functions, and clinical relevance of extracellular vesicles. Pharmacol. Rev. 2012; 64(3): 676-705. https://dx.doi.org/10.1124/pr.112.005983.
  12. Akers J.C., Gonda D., Kim R., Carter B.S., Chen C.C. Biogenesis of extra-cellular vesicles (EV): exosomes, microvesicles, retrovirus-like vesicles, and apoptotic bodies. J.f Neurooncol. 2013; 113(1): 1-11. https://dx.doi.org/10.1007/ s11060-013-1084-8.
  13. Février B., Raposo G. Exosomes: endosomal-derived vesicles shipping extracellular messages. Curr. Opin. Cell Biol. 2004; 16(4): 415-21. https://dx.doi.org/10.1016/j.ceb.2004.06.003.
  14. Пекарева Е.О., Баранов И.И., Пекарев О.Г. Применение клеточных технологий в экспериментальной и клинической акушерской практике (обзор литературы). Акушерство и гинекология: новости, мнения, обучение. 2022; 10(4): 31-7. [Pekareva E.O., Baranov I.I., Pekarev O.G. Use of cell technologies in experimental and clinical obstetric practice (literature review). Obstetrics and Gynecology: News, Opinions, Training. 2022; 10(4): 31-7. (in Russian)]. https://dx.doi.org/10.33029/2303-9698-2022-10-4-31-37.
  15. Pekarev O.G., Pekareva E.O., Mayborodin I.V., Silachev D.N., Baranov I.I., Pozdnyakov I.M. et al. The potential of extracellular microvesicles of mesenchymal stromal cells in obstetrics. J. Matern. Fetal Neonatal Med. 2022; 35(25): 7523-5. https://dx.doi.org/10.1080/14767058.2021.1951213.
  16. Сухих Г.Т., Пекарева Е.О., Пекарев О.Г., Силачев Д.Н., Майбородин И.В., Баранов И.И., Поздняков И.М., Бушуева Н.С. Возможности родоразрешения пациенток, которым в ходе предшествующего кесарева сечения вводились экстрацеллюлярные микровезикулы мезенхимальных стромальных клеток. Акушерство и гинекология. 2022; 4: 103-14. [Sukhikh G.T., Pekareva E.O., Pekarev O.G., Silachev D.N., Maiborodin I.V., Baranov I.I., Pozdnyakov I.M., Bushueva N.S. Feasibility of delivery in patients receiving mesenchymal stromal cell-derived extracellular microvesicles during the previous caesarean section. Obstetrics and Gynecology. 2022; (4): 103-14. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.4.103-114.
  17. Сухих Г.Т., Пекарев О.Г., Майбородин И.В., Силачев Д.Н., Шевцова Ю.А., Горюнов К.В., Оноприенко Н.В., Майбородина В.И., Галенок Р.В., Новиков А.М., Пекарева Е.О. К вопросу о сохранности экстрацеллюлярных микровезикул мезенхимных стромальных клеток после абдоминального родоразрешения в эксперименте. Клеточные технологии в биологии и медицине. 2020; 1: 3-11. [Sukhikh G.T., Pekarev O.G., Mayborodin I.V., Silachev D.N., Shevtsova Yu.A., Goryunov K.V., Onoprienko N.V., Mayborodina V.I., Galenok R.V., Novikov A.M., Pekareva E.O. On the question of the preservation of extracellular microvesicles of mesenchymal stromal cells after abdominal delivery in the experiment. Cell Technologies in Biology and Medicine. 2020; (1): 3-11. (in Russian)].
  18. Sukhikh G.T., Pekarev О.G., Maiborodin I.V., Silachev D.N., Shevtsova Y.А., Gоrуunоv K.V., Onoprienko N.V., Maiborodina V.I., Galenok R.V., Novikov A.M., Pekareva Е.О. Preservation of mesenchymal stem cell-derived extracellular vesicles after abdominal delivery in the experiment. Bull. Exp. Biol. Med. 2020; 169(1): 122-9. https://dx.doi.org/10.1007/s10517-020-04838-1.
  19. Сухих Г.Т., Пекарев О.Г., Пекарева Е.О., Майбородин И.В., Силачев Д.Н., Баранов И.И., Поздняков И.М., Бушуева Н.С., Новиков А.М. Первые результаты клинического применения экстрацеллюлярных микровезикул мезенхимальных стромальных клеток после абдоминального родоразрешения. Акушерство и гинекология. 2021; 1: 52-60. [Sukhikh G.T., Pekarev O.G., Pekareva E.O., Maiborodin I.V., Silachev D.N., Baranov I.I., Pozdnyakov I.M., Bushueva N.S., Novikov A.V. Initial results of clinical application of mesenchymal stromal stem cell-derived extracellular microvesicles after abdominal delivery. Obstetrics and Gynecology. 2021; (1): 52-60. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.1.52-60.
  20. Pekarev O.G., Pekareva E.O., Mayborodin I.V., Silachev D.N., Baranov I.I., Pozdnyakov I.M., Bushueva N.S., Novikov A.M., Sukhikh G.T. The potential of extracellular microvesicles of mesenchymal stromal cells in obstetrics. J. Matern. Fetal. Neonatal. Med. 2022; 35(25): 7523-5. https://dx.doi.org/10.1080/ 14767058.2021.1951213.
  21. Пекарева Е.О. Предварительные итоги экспериментального и клинического применения экстрацеллюлярных микровезикул мезенхимальных стромальных клеток после кесарева сечения. Акушерство и гинекология: новости, мнения, обучение. 2021; 9(4): 36-43. [Pekareva E.O. The results of experimental and clinical application of extracellular microvesicles of mesenchymal stromal cells after caesarean section. Obstetrics and Gynecology: News, Opinions, Training. 2021; 9(4): 36-43. (in Russian)]. https://dx.doi.org/10.33029/2303-9698-2021-9-4-36-43.
  22. Министерство здравоохранения Российской Федерации. Клинические рекомендации «Роды одноплодные, родоразрешение путем кесарева сечения». М.; 2021. 98с. [Russian Society of Obstetricians-Gynecologists, Association of Anesthesiologists-Resuscitators, Association of Obstetric Anesthesiologists-Resuscitators. Clinical guidelines "Childbirth is singular, delivery by caesarean section". Moscow; 2021. 98p. (in Russian)].
  23. Silachev D.N., Goryunov K.V., Shpilyuk M.A., Beznoschenko O.S., Morozova N.Y., Kraevaya E.E. et al. Effect of MSCs and MSC-derived extracellular vesicles on human blood coagulation. Cells. 2019; 8(3): 258. https://dx.doi.org/10.3390/cells8030258.
  24. Министерство здравоохранения Российской Федерации «Роды одноплодные, самопроизвольное родоразрешение в затылочном предлежании (нормальные роды)». М.; 2021. 66с. [Ministry of Health of the Russian Federation "Single births, spontaneous delivery in the occipital region (normal childbirth)". Moscow; 2021. 66p. (in Russian)].

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