Use of Platelet-RichPlasma in the
Obs/Gynaecological Clinical Setting
BY: DR. SANA ALAM
2.
Abstract
• PRP -highlevel of platelets is concentrated with growth factors
concentration 3 to 5 times greater than plasma.
• alpha granules of platelets -chemical mediators that trigger tissue
regeneration, by promotion of angiogenesis and the initiation of
cell regeneration.
• (PDGF), (TGF-β), (VEGF), (EGF), (FGF), (IGF) - Growth factors promote
wound healing by :
• Tissue necrosis resolution • Chemotaxis • Cell regeneration • Cell
proliferation and migration • Extracellular matrix synthesis • Remodeling •
Angiogenesis • Epithelialization
4.
INTRODUCTION:
Nowadays, PRP representsa major breakthrough in the treatment of many
medical conditions in :
• Infertility treatment, Gynaecological procedures
• plastic surgery,
• maxillofacial surgery,
• dentistry and oral surgery,
• medical aesthetics,
• tissue engineering and research,
• cardiovascular surgery, orthopedic surgery and sports medicine,
• gastroenterology and urology.
Preparation and Composition
Wholeblood collected and mixed with an anticoagulant factor,
prior to centrifugation, which separates red blood cells (RBCs)
from platelet-poor plasma (PPP) and the “buffy coat,” which
contains the concentrated platelets and leukocytes.
The platelet-concentrated layer is then isolated using several
processing techniques and RBC and PPP layers may be discarded
8.
STEPS OF PRPTHERAPY:
• • Step 1–Collection of blood from the patient
• • Step 2–Separation of platelet-rich plasma
• • Step 3–Processing the separated autologous plasma
• • Step 4–Injecting the patient with PRP
9.
• 4 maincategories based on the cellular content (primarily
leukocytes) and the fibrin architecture:
• P-PRP and L-PRP can be used as liquid solutions (injected) or in an
activated gel form (placed on a skin wound or suture). P-PRF and
L-PRF are in gel form and cannot be injected. They can be handled
like a real solid material for other applications.
11.
PRP in gynaecologicalapplications
PRP in wound healing:
• After caesarean section surgery, prior to skin closure, PRP was directly applied
to the subcutaneous tissue of the wound site
Eight weeks after surgery, patients treated with PRP showed a significantly
greater reduction in Redness, Oedema, Ecchymosis, Discharge,
greater reduction in pain, keloids, and hypertrophic scar formation for the
PRP group
• Significant reduction in pain on the day of surgery and on first postoperative
day undergoing gynaecologic surgeries
• Radical vulvectomy and inguinofemoral node dissection : significantly
decreased Wound infection, wound breakdown, postoperative fever rate and
duration of hospital stay
12.
• Lichen Sclerosus:
•Lichen Sclerosus (LS) is a chronic inflammatory dermatological
condition which mainly affects the anogenital region.
• genetic predisposition and autoimmunity as a pathogenic mechanism.
• PRP injections could be considered an effective alternative to
corticosteroids for the treatment of vulvovaginal autoimmune
conditions such as LS
• clinical improvements in the size of their lesions with minimal pain and
no complications. In many cases, the lesions completely disappeared.
13.
• Cervical ectropion
•Cervical ectropion / or erosion) occurs when eversion of the endocervix exposes
epithelium to the vaginal milieu.
• Reported treatment modalities include laser ablation, cryotherapy, ultrasound
therapy, microwave ablation
• Also, PRP is being used for treatment and No statistical difference was found for the
complete cure rate between the two groups (93.7% and 92.4% for PRP and laser
respectively).
• However, the mean time to re-epithelialisation was significantly shorter in the PRP
group
14.
Urogenital applications
• Vesicovaginalfistula : PRP injection and PRF glue interposition
in the tract constitute a safe and effective approach for the
fistula closure.
• In vaginal surgery, PRF has been proposed to act as a graft
material with better healing and functional outcomes.
• In pelvic organ prolapse and urinary incontinence. :PRP helps
to regulate tissue reconstruction and the restoration of
ligament strength;
15.
• PRP inReproductive Medicine
• Improves egg quality, endometrial receptivity, pregnancy outcomes, especially
in recurrent implantation failure.
• One study demonstrated non-surgical autologous PRP ovarian infusions to
treat 3 extreme poor responder patients, with recurrent cancelled cycles, poor
oocyte yield following stimulation, high follicle-stimulating hormone (FSH) and
low Anti-Müllerian hormone (AMH) levels.
• Five mL of PRP was infused into each ovary using a non-surgical, transvaginal
ultrasound-guided multifocal intramedullary injection and diffusion in the
subcortical layers.
• The authors recorded a mean decline of 67.33% in FSH and an increase of
75.18% in AMH following PRP administration, resulting in succesful
pregnancies.
16.
Thin endometrium
• Endometrialreceptivity has been acknowledged as a key
factor for the success of IVF.
• ET below 6-8 mm was considered a negative predictive
indicator for IVF outcomes;
• PRP was infused into the uterine cavity on the 10th day of FET
cycle- Successful endometrial expansion and pregnancy were
observed in all the patients after PRP infusion.
17.
Mechanism of action
•PRP - release of the biologically active substances causing tissue
regeneration, the enhancement of anabolic signalling pathways, cell
differentiation and proliferation, angiogenesis initiation and control.
• PRP enhances primordial and primary preantral follicles development
• Through PRP administration,cytokines and growth factors necessary for
enhancing endometrial receptivity and improving implantation rate, are
secreted which activate stromal cells and recruit leukocytes to promote
angiogenesis and induce repair mediated by cell proliferation and
migration.
• Recent in vitro evidence provided novel information that PRP enhances
migration and proliferation of human endometrial epithelial cells,
endometrial stromal fibroblasts, endometrial mesenchymal stem cells.
18.
• PRP’s anti-microbialand anti-inflammatory properties may
explain the favourable environment for the endometrial growth
and receptivity
• It stimulate the mitogenesis and proliferation of endometrial
cells or endometrial stem cells, and then activate endocrine-
paracrine pathways for improving the endometrial response to
promote embryo implantation and pregnancy.
• Pain reduction observed with the use of PRP in the wound
management after caesarean section surgery is thought to be
explained by the action of serotonin released from platelets
19.
• Conclusion
• PRPis a simple, efficient and minimally invasive method for
obtaining a natural concentration of autologous growth
factors and biologically active molecules with strong potential
for improving tissue healing and promoting regeneration.
• autologous origin and minimally invasive collection technique,
the risks of infection or immune reactions are minimised.
20.
REFERENCE:
• Vasileios Sanoulis1, Nikolaos Nikolettos2 , Nikolaos Vlahos3 1
Aretaieion Hospital, Athens, Greece, 2 Demokriteion University of
Thrace, Alexandroupolis, Greece, 3 Kapodistrian University of Athens,
Athens, Greece
Hellenic Journal of Obstetrics & Gynecology ISSN: 2241-
9276
