Application of Tissue Engineering and Regenerative Medicine in Maternal-Fetal Medicine.

A rapid development of ultrasonography has enabled physicians to make earlier prenatal diagnosis of various fetal congenital diseases, in maternal-fetal medicine. Due to the significant mortality and irreversible damage to fetal vital organs during pregnancy, fetal surgeries have been tried in some congenital disease including congenital diaphragmatic hernia, twin-to-twin transfusion syndrome (TTTS), myelomeningocele (MMC), and lower urinary tract obstruction. However, open fetal surgery requires laparotomy followed by hysterotomy, which can cause preterm premature rupture of membrane (pPROM), oligohydramnios, preterm delivery, dehiscence of uterine wall, and other maternal complications during pregnancy. Minimally invasive approach using fetoscopy has been tried, and fetoscopic laser photocoagulation of vascular communications is currently considered as a treatment of choice for TTTS before 26 weeks' gestation. However, more development of surgical instrument and innovative materials using tissue engineering are required to improve outcomes of fetoscopic surgery. Because iatrogenic pPROM is the major challenge after fetoscopic surgery, this review focuses on current development of materials for treatment of spontaneous or iatrogenic pPROM and recent experimental progress of tissue engineering-based technology in prenatal treatment of MMC. Placental tissue is an emerging material for regenerative medicine. This chapter will also review regenerative potential and experiments of placenta and placenta-derived stem cells, as well as prospects of "in utero stem cell therapy."