Doctors Celia Casares and Mercedes González are in luck. In one of the operating rooms at the Getafe University Hospital in Madrid, they process the last donated placenta. It was a twin birth and that means they will make the most of the donation. They have in their hands a quality placenta that will provide them with more than the 70 usual treatments that they usually get with a conventional one. With great delicacy, they look for the amniotic membrane, the innermost layer that is in contact with the baby, and it is the only one that is used. Thin and transparent, you can almost see through it. This is just one of its many virtues that have made it an essential resource for ophthalmology, among many other specialties. The placenta is the only ephemeral organ in the human organism. During pregnancy, it provides the fetus with the nutrients and antibodies necessary for its development and protects it against infections and toxins. After birth, it continues to have value due to its richness in stem cells, collagen and cytokines that make it a unique tissue for medicine. Above all, its innermost layer.Related news report Yes ABC HEALTH AWARDS UGRSKIN: the first human artificial skin designed in Spain Rafael Ibarra report Yes The 10 main medical advances of 2024 and by 2025 Rafael IbarraThe amniotic membrane has essential biochemical and mechanical characteristics for treating burns and eye ulcers, or when skin wounds never heal. But, increasingly, it is a unique resource in surgery, in specialties as different as gynecology, urology, neurosurgery or orthopedic surgery. The list of applications that the United States National Institutes of Health is increasingly broad and ranges from its use in the repair of the dura mater, one of the layers that protects the meninges, to the cartilage of the knee or maxillofacial or breast reconstructions. In reality, its use depends almost on the creativity of each surgeon. In the same way that the amniotic membrane functions as a barrier between the mother and her child, surgeons use it to make patches with which to repair external and internal injuries during their surgical interventions. The first to realize its properties was Dr. Davis in 1910, at the Johns Hopkins hospital (Baltimore, USA). This pioneer was the first to demonstrate that amniotic membrane was capable of repairing skin damage better than any patch made from human or animal dermis. After those first transplants, its use became widespread in the 20th century to treat burns and wounds that were difficult to heal and it was concluded that there was nothing better for the treatment of a complicated wound, it was enough to put it on top. Until HIV became a pandemic in the 1980s and fear of transmission of the AIDS virus returned placentas to the hospital trash. The placenta, before its preparation IGNACIO GIL Medical enthusiasm returned, little by little , with ophthalmological applications and now it is once again in full swing. «It is a wonderful tissue, it does not generate rejection and has properties that make it very valuable for the treatment of numerous diseases. It promotes re-epithelialization, calms pain, reduces inflammation and the risk of infections, while preventing the appearance of scars… This is basic for an ophthalmologist,” says Mercedes González, doctor attached to the Ophthalmology service at the Getafe hospital. “Membrane patches calm pain, reduce inflammation and are antibacterial” Mercedes González Ophthalmologist In this Madrid center it is used to primarily treat eye injuries and burns, such as those caused by handling bleach or other products. caustics. The membrane patch stops inflammation and repairs the burn when it is not very deep. It is also the best treatment against two little-known diseases, Stevens-Johnson syndrome and toxic epidermal necrolysis, which can arise suddenly as a reaction to common and widely consumed medications such as ibuprofen or certain antibiotics.Recovering vision«The reaction immune system produces lesions in the cornea and other mucous membranes. It is an incredible disease that can affect anyone. Age or health status does not matter. Previously, without amniotic membrane, patients went blind. There has been a before and after in the treatment of this problem,” says the ophthalmologist, who recalls the case of two young students who were on Erasmus in Madrid. “I have stopped taking ibuprofen,” confesses Mercedes González and Celia Casares, the person in charge of the tissue bank at the Getafe Hospital, nods at her side. In this bank in Madrid, the amniotic membrane is preserved in square patches of 3×3 and 5×5 centimeters. Once chopped, it is taken to the microbiology service in search of possible pathogens, before it is frozen and stored at -80 degrees in the tissue bank, waiting for its use. The microbiological is a double security control because previously a ‘casting’ of donors is carried out. «Not all placentas can be donated. They must come from healthy women, with an uncomplicated pregnancy and without a family history of serious diseases such as cancer, who undergo serological tests to rule out infections. In reality, it is treated like any tissue for transplant and we need to ask permission for the donation, even if its final destination was the garbage,” explains Casares. Doctors González and Casares prepare the amniotic membrane patches in the operating room to promote the sterility of the process. IGNACIO GILIn this hospital in Madrid, only those donated after a scheduled pregnancy and cesarean section are used to avoid contamination in the birth canal. However, the Barcelona Tissue Bank has launched a pioneering system that allows the use of placentas from vaginal births. «We know that the birth canal is not sterile and contamination is easier. To prevent this, the placenta is decontaminated in several stages. In the last part of the process, it undergoes low-dose irradiation,” details its manager Anna Vilarrodona, director of the Barcelona Tissue Bank. “We are treating patients with dry eye with amniotic membrane extract who did not respond to any treatment.” Anna Vilarrodona Dtra. Barcelona Tissue BankIn this bank, the amniotic membrane is preserved in the form of patches and is also crushed to turn it into powder with which a type of eye drops is then manufactured from the amniotic membrane extract. «We began to treat patients with dry eye who are desperate because they do not respond to any treatment. Before, they were given the amniotic membrane patch and the ophthalmologists asked us for a resource that was easier to use, so that it would not be necessary to put it on in the operating room. From there came the idea of transforming it into powder, a product that can be dispensed directly by the ophthalmologist,” he says. The donation that is growing the most In Spain, 95 percent of placenta applications are related to ophthalmology, as shown by the latest data from the ONT, the National Transplant Organization. Its majority use in 2023 was precisely the application of amniotic membrane extract drops. These data also show that, despite being unknown, it is one of the fastest growing donations in the country. In absolute numbers, however, the figures still fall short. Last year, 948 women donated, so most of the delivered placentas ended up incinerated as more surgical waste. Despite being the best option for burns, in Spain patches are rarely used for burns. “We have easy access to cadaver skin and this allows us to treat larger surfaces,” clarifies Vilarrodona. It is used to repair skin ulcers that never heal, such as those suffered by people with diabetes. Here the amniotic membrane has no competition. It is as if it were capable of reprogramming the most damaged tissue so that it heals itself. “It soothes pain, has antibacterial properties, allows wounds to close and is reabsorbed… I also wonder why it is not used more,” confesses Vilarrodona. Why you should not eat it All of these properties are backed by science. What has no scientific support is placentophagy or eating the placenta after giving birth to prevent postpartum depression or recover after giving birth. There are those who prepare it in shakes or put it in a capsule to take it in a pill. It is first vaporized and dehydrated, although none of the preparations completely eliminate the risks. It has no use and can also cause infections in both mothers and babies, if they are breastfeeding, as recalled by the United States Center for Disease Control and Prevention. There is no benefit and much to lose, but it is a fashionable practice that some public figures have favored. Behind this pseudotherapy there is an attempt to imitate Nature. Most mammals do it after giving birth to their young because at that time they are very vulnerable and the placenta is a magnet for predators due to its smell. So the best option is to eat it. They never would if they were safe in a hospital.
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