The Collection and Application of Autologous Amniotic Fluid to Cesarean Delivery Closure

Abstract

Background Amniotic fluid and amnion membranes have been used in surgery specialties to improve wound healing and decrease surgical adhesion formation.

Objective The objective was to determine if amniotic fluid could be collected at cesarean delivery and then reapplied to the layers of the closure using the CeaLogic Specimen Collection and Ratio Applicator Kit.

Study Design Twenty pregnant individuals who met inclusion and exclusion criteria were enrolled. Amniotic fluid was collected at artificial rupture of the membranes using the collection kit. Autologous amniotic fluid was then transferred to the applicator kit, mixed with calcium chloride solution, and applied directly to each of the surgical repair layers during closure: closed hysterotomy incision, closed fascial incision, closed subcutaneous layer (if applicable), and closed skin. Subjects were then followed for six weeks. Photographs of the incision were taken immediately following surgery, one-week following surgery, and at the four-week postpartum visit. The Modified Hollander Cosmesis Score was used to assess wound appearance.

Results Twenty pregnant individuals who met inclusion and exclusion criteria were enrolled and all completed the study. The mean volume of amniotic fluid collected was 30 ± 19 mL. The median (IQR) Modified Hollander Cosmesis Score (Range 0-best, to 6-worst) at the one week and four-week postpartum visits was 0 (0,1) and 0 (0,2), respectively. There were no wound complications nor surgical site infections among the cohort. Further, there were no unscheduled visits for wound issues among any of the subjects.

Conclusion The CeaLogic Specimen Collection and Ratio Applicator Kits can be used to collect and reapply autologous amniotic fluid at the time of cesarean delivery. Future studies are needed to determine if the application of autologous amniotic fluid to cesarean delivery closure can improve cosmesis and wound healing, as well as decrease the risk for the development of intraabdominal adhesions.

Keywords

allograft - amniotic fluid - autologous - cesarean delivery - postsurgical adhesions - scar tissue - surgical site infection - wound complications - wound cosmesis - wound infection

Publikationsverlauf

Eingereicht: 28. Mai 2024

Angenommen: 15. Oktober 2024

Accepted Manuscript online:
18. Oktober 2024

Artikel online veröffentlicht:
18. November 2024

• References

• 1 Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: final data for 2021. Natl Vital Stat Rep 2023; 72 (01) 1-53
• 2 Caughey AB, Cahill AG, Guise JM, Rouse DJ. American College of Obstetricians and Gynecologists (College), Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 2014; 210 (03) 179-193
• 3 Morales KJ, Gordon MC, Bates Jr. GW. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol 2007; 196: 461 e1-e6
• 4 Larsson C, Djuvfelt E, Lindam A, Tunón K, Nordin P. Surgical complications after caesarean section: a population-based cohort study. PLoS One 2021; 16 (10) e0258222
• 5 Poole JH. Adhesions following cesarean delivery: a review of their occurrence, consequences and preventative management using adhesion barriers. Womens Health (Lond Engl) 2013; 9 (05) 467-477
• 6 Nuamah MA, Browne JL, Öry AV, Damale N, Klipstein-Grobusch K, Rijken MJ. Prevalence of adhesions and associated postoperative complications after cesarean section in Ghana: a prospective cohort study. Reprod Health 2017; 14 (01) 143
• 7 Almeida EC, Nogueira AA, Candido dos Reis FJ, Rosa e Silva JC. Cesarean section as a cause of chronic pelvic pain. Int J Gynaecol Obstet 2002; 79 (02) 101-104
• 8 Faulk WP, Matthews R, Stevens PJ, Bennett JP, Burgos H, Hsi BL. Human amnion as an adjunct in wound healing. Lancet 1980; 1 (8179): 1156-1158
• 9 ElHeneidy H, Omran E, Halwagy A, Al-Inany H, Al-Ansary M, Gad A. Amniotic membrane can be a valid source for wound healing. Int J Womens Health 2016; 8: 225-231
• 10 Gomes JA, Romano A, Santos MS, Dua HS. Amniotic membrane use in ophthalmology. Curr Opin Ophthalmol 2005; 16 (04) 233-240
• 11 Huddleston HP, Cohn MR, Haunschild ED, Wong SE, Farr J, Yanke AB. Amniotic product treatments: clinical and basic science evidence. Curr Rev Musculoskelet Med 2020; 13 (02) 148-154
• 12 Moore ML, Deckey DG, Pollock JR, Smith JH, Tokish JM, Neal MT. The effect of amniotic tissue on spinal interventions: a systematic review. Int J Spine Surg 2023; 17 (01) 32-42
• 13 Maljaars LP, Bendaoud S, Kastelein AW, Guler Z, Hooijmans CR, Roovers JWR. Application of amniotic membranes in reconstructive surgery of internal organs-a systematic review and meta-analysis. J Tissue Eng Regen Med 2022; 16 (12) 1069-1090
• 14 Cavallo C, Roffi A, Grigolo B. et al. Platelet-rich plasma: the choice of activation method affects the release of bioactive molecules. BioMed Res Int 2016; 2016: 6591717
• 15 Singer AJ, Arora B, Dagum A, Valentine S, Hollander JE. Development and validation of a novel scar evaluation scale. Plast Reconstr Surg 2007; 120 (07) 1892-1897
• 16 Hollander JE, Singer AJ, Valentine S, Henry MC. Wound registry: development and validation. Ann Emerg Med 1995; 25 (05) 675-685
• 17 Murtha AP, Kaplan AL, Paglia MJ, Mills BB, Feldstein ML, Ruff GL. Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg 2006; 117 (06) 1769-1780
• 18 Haugh AM, Witt JG, Hauch A. et al. Amnion membrane in diabetic foot wounds: a meta-analysis. Plast Reconstr Surg Glob Open 2017; 5 (04) e1302
• 19 Kesting MR, Wolff KD, Hohlweg-Majert B, Steinstraesser L. The role of allogenic amniotic membrane in burn treatment. J Burn Care Res 2008; 29 (06) 907-916
• 20 Riboh JC, Saltzman BM, Yanke AB, Cole BJ. Human amniotic membrane-derived products in sports medicine: basic science, early results, and potential clinical applications. Am J Sports Med 2016; 44 (09) 2425-2434
• 21 Fairbairn NG, Randolph MA, Redmond RW. The clinical applications of human amnion in plastic surgery. J Plast Reconstr Aesthet Surg 2014; 67 (05) 662-675
• 22 Markets and Markets. Amniotic products market by type (cryopreserved amniotic membranes, dehydrated amniotic membranes), application (wound care, ophthalmology, orthopedics), end user (hospital & ambulator surgical centers)—global forecast to 2028, 2023 (vol 2024).
• 23 The Insight Partners. Amniotic membrane market size report ($2.80 billion by 2028) lead by cryopreserved amniotic membrane segment—exclusive report by The Insight Partners., 2023 (vol 2024).
• 24 Emergen Research. Amniotic products market, by type (amniotic membrane and amniotic suspensions), by application (wound care, orthopedics, ophthalmology, and others) by end-use, and by region forecast to 2032, 2023.
• 25 Data Intelligence. Ophthalmology amniotic membrane market is segmented by product type (cryopreserved amniotic membrane, lyophilization amniotic membrane), by end user (hospital, ambulatory surgical centers (ASCs), specialty clinics, research and academic institutes), and by region (North America, Latin America, Europe, Asia Pacific, Middle East, and Africa)—share, size, outlook, and opportunity analysis, 2023–2030, 2023 (vol 2024).
• 26 Jirsova K, Jones GLA. Amniotic membrane in ophthalmology: properties, preparation, storage and indications for grafting-a review. Cell Tissue Bank 2017; 18 (02) 193-204
• 27 Paolin A, Cogliati E, Trojan D. et al. Amniotic membranes in ophthalmology: long term data on transplantation outcomes. Cell Tissue Bank 2016; 17 (01) 51-58
• 28 Kjaergaard N, Hein M, Hyttel L. et al. Antibacterial properties of human amnion and chorion in vitro. Eur J Obstet Gynecol Reprod Biol 2001; 94 (02) 224-229
• 29 Duerr RA, Ackermann J, Gomoll AH. Amniotic-derived treatments and formulations. Clin Sports Med 2019; 38 (01) 45-59
• 30 Stock SJ, Kelly RW, Riley SC, Calder AA. Natural antimicrobial production by the amnion. Am J Obstet Gynecol 2007; 196: 255 e1-e6
• 31 Mao Y, Pierce J, Singh-Varma A, Boyer M, Kohn J, Reems JA. Processed human amniotic fluid retains its antibacterial activity. J Transl Med 2019; 17 (01) 68
• 32 Fukutake M, Ochiai D, Masuda H. et al. Human amniotic fluid stem cells have a unique potential to accelerate cutaneous wound healing with reduced fibrotic scarring like a fetus. Hum Cell 2019; 32 (01) 51-63
• 33 Klein JD, Turner CG, Steigman SA. et al. Amniotic mesenchymal stem cells enhance normal fetal wound healing. Stem Cells Dev 2011; 20 (06) 969-976
• 34 Luo H, Wang Z, Qi F, Wang D. Applications of human amniotic fluid stem cells in wound healing. Chin Med J (Engl) 2022; 135 (19) 2272-2281
• 35 Ochiai D, Abe Y, Fukutake M. et al. Cell sheets using human amniotic fluid stem cells reduce tissue fibrosis in murine full-thickness skin wounds. Tissue Cell 2021; 68: 101472