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Autologous plasma is becoming increasingly popular as a minimally invasive and non-invasive method of treatment and prevention of a wide range of diseases and conditions. Traditionally, its various forms are used in orthopedic and sports medicine to relieve pain by naturally stimulating healing in musculoskeletal diseases such as tendinitis, arthritis, sprains. In sports injuries, it leads to accelerated healing, a quick return to regular activities and complete pain relief. The advantages of injectable plasma and fibrin clot are highly appreciated by dentists, and all variations of plasma therapy have long been included in the practice of dermatologists and cosmetologists.
Autologous plasma products are obtained from whole human blood by centrifugation to remove red blood cells. Depending on the tubes used and centrifugation modes, plasma with different levels of platelets, proteins, amino acids and fibrin is obtained. In the medical and scientific community, the division of the obtained plasma into PRP – plasma enriched with platelet growth factors; plasma with platelet levels close to normal compared to whole blood – but it has an expanded protein-amino acid complex; and plasma with increased levels of platelets and fibrin. The theory behind autologous plasma therapy was formed from the study of natural healing processes, since the body’s first response to tissue damage is the delivery of platelets to the damaged area. Platelets promote healing and attract stem cells to the site of injury. Moving from basic science to clinical practice, plasma injections have been applied to weakened ligaments, tendons, and joints, with excellent recovery results.
The purpose of our review is to highlight studies on the use of autologous plasma products (differentiated plasma forms, plasma preparations) in the field of gynecology, as well as the observations of our specialists, since clinical experience in their use for the treatment of gynecological diseases is limited to a narrow circle of gynecologists who use this technique and is not sufficiently disclosed in specialized studies.
The use of plasma products used in gynecology for the treatment of various diseases is also based on the mechanisms of regeneration, which include the wound healing process and the initiation of inflammatory reactions described above, so it is worth highlighting their use in surgical gynecology as a separate block.
It is worth separating the preoperative preparation of the patient and postoperative rehabilitation using plasma preparations. The correct choice of treatment tactics and selection of the appropriate drug, in combination with classical methods, will allow to accelerate wound healing and reduce the risk of postoperative complications, both in planned and urgent patients, and if necessary, to adjust the treatment process, especially in cases where ulcers occur and wounds heal poorly
If we consider specialized studies, it is worth noting the observations of a clinical group led by Tehranian, which studied the effect of PRP on wound healing processes in women who underwent cesarean section from the risk group of complications. Having divided 141 patients into two groups, they used PRP in the treatment of 70 clinical cases and compared them with 71 patients from the control group without the use of PRP. The criteria for inclusion in the risk group of complications were: body mass index (BMI)> 25 kg/m2, previous cesarean section, diabetes, recurrent pregnancy, corticosteroid use, and anemia. There was a significant reduction in redness, swelling, ecchymosis, and discharge in patients receiving PRP compared to the control group (85.5%/72%). The Tehranian group concluded that PRP is an effective therapeutic approach to wound healing and that faster wound healing can be expected with its use due to the presence of more platelets and growth factors.
These data correlate with the data of a study by Fenning conducted on 55 patients who underwent major gynecological surgery, in which plasma products were directly applied to the surgical area. The authors found that plasma injections in gynecological surgery were effective in reducing pain syndromes with traumatic surgical effects and did not have any side effects.
Our own observations have shown the effectiveness of managing planned patients with preoperative preparation, which includes the use of injections of plasma with platelet concentration “Norma” into the surgical area for two weeks before the date of surgery with an interval of 3-5 days, as well as the inclusion of plasma injections in the postoperative care program, starting from the third day. The healing time of wound surfaces and therefore the patient’s stay in bed was reduced by an average of 10-15%, while no postoperative complications were detected, compared to patients who received classical treatment and care without including plasma therapy in the treatment program.
The use of platelet-rich plasma or plasma with an increased level of platelets and fibrin is advisable in the management of urgent patients in postoperative care, while the latter form of plasma is effective for the treatment of poorly healing scars.
For treatment, we used tubes of the Ukrainian brand “MM Medic”, as they meet the requirements of sterility and safety, as well as the stability of the characteristics of the resulting material. We strongly advise against using tubes that have not passed the conformity assessment as medical devices of safety class II or III or recognized as in vitro medical devices, as there is a risk of introducing concomitant substances to the patient that could harm his health or infect him due to insufficient sterility. In addition, the stability of the resulting plasma product in uncertified tubes may vary significantly from product to product.
A research team led by Hua conducted a randomized clinical trial to compare the effectiveness of autologous plasma with laser treatment of benign cervical erosion in 120 patients. They injected PRP twice into the area of cervical erosion at an interval of 1 week in 60 patients, while the other 60 patients received laser treatment. They found that the complete cure rate was 93.7% in the plasma therapy group and 92.4% in those patients who received laser therapy. The median time to epithelial recovery was significantly shorter in the plasma group. The incidence of treatment side effects (e.g., vaginal discharge or vaginal bleeding) was much lower in the autologous plasma group than in the laser group. Thus, the use of autologous plasma products has shown promise for the treatment of cervical erosion, as it provides a shorter tissue healing time and milder side effects than laser treatment.
Our observations also confirm the positive effect of plasma products on the mucous surfaces of the vaginal-uterine complex, the cessation of destructive and erosive processes and the restoration of the endometrium.
3) treatment of the symptom of vulva dystrophy in many dermatological and autoimmune diseases using autologous platelet-rich plasma.
Dystrophic phenomena in the treatment of lichen sclerosus or eczema, which do not respond to treatment with corticosteroids. Lichen sclerosus causes extensive scarring with progressive loss of the labia minora, sealing of the clitoral hood and its destruction, as well as progressive itching, dyspareunia and genital bleeding. It has a significant negative impact on the quality of life of patients, causing impaired physical and sexual activity, thereby developing emotional and psychological problems. This disease is treated with local and systemic corticosteroids. The use of plasma products in steroid-resistant cases was tested by Behnia-Willison in 28 patients. Patients received three PRP treatments at 4 to 6 week intervals and a repeat course after 12 months. Almost all patients had a clinical reduction in the size of their lesions, and in 28.6% of patients the lesions disappeared completely after PRP treatment. Pain was reduced and there were no complications. The researchers concluded that PRP injections can therefore be considered an effective therapy for lichen sclerosus.
Differentiated plasma forms are also effective in urogenital disorders.
1) Genital fistulas are treated with many conservative and surgical treatments. The Bodner-Adler team, in their systematic review, determined that small fistulas can be treated conservatively with various treatments, including PRP, with success rates ranging from 67% to 100%. PRP has been tested in the treatment of vesicovaginal fistulas as a new, minimally invasive approach. Shirvan et al., conducted a study on 12 patients who received PRP injections into the tissue around the fistula and its surface was treated with injectable fibrin. The observation lasted for 6 months and showed clinical recovery in 11 patients, confirmed by transvaginal examinations and cystography. The combination of PRP and PRF has been shown to be a safe, effective, minimally invasive approach to the treatment of vaginal fistulas, obviating the need for open surgery. Mongardini reviewed the positive treatment of a clinical episode of a complex iatrogenic low rectovaginal fistula treated with a buccal mucosal implant and PRP.
Of particular relevance is the prevention and treatment of fistulas and neovaginal fistulas in transsexual patients after gender-reconstructive surgery, which pose the greatest risk to their health and the functionality of the entire newly created urogenital complex. We are currently continuing our research in this area, but preliminary data are already promising.
2) Genital prolapse. Gorlero et al. conducted a prospective observational study of 10 patients who required surgery for recurrent prolapse (stage II or higher). Combining surgical techniques with PRF injections. The success rate of the intervention was 80%. Sexual activity increased by 20% without dyspareunia. They concluded that the use of PRF for prolapse repair was associated with good functional outcomes.
3) PRP in thin endometrium. The endometrium plays an important role in achieving optimal results of assisted reproductive technologies. Endometrial growth after inadequate ovarian stimulation may be insufficient, leading to poor results of IVF cycles. Various strategies have been proposed to improve endometrial thickness, especially in resistant cases. PRP is a new therapy that has been tested in such patients. The group of authors led by Colombo studied eight patients who underwent PRP treatment. Inclusion criteria were women with more than three canceled cryotransfers due to poor endometrial growth (<6 mm), women with negative hysteroscopic screening for endometrial pathology and women with negative bacteriological screening. After PRP, the endometrial thickness was satisfactory in seven cases. A positive beta-homochorionic gonadotropin test was detected in six women. The investigators concluded that multiple implantation failures were caused by ineffective expression of adhesion molecules that could potentially be improved by PRP. Similarly, Zadehmodarres et al., in their pilot study, enrolled 10 patients with a history of cycle cancellation due to inadequate growth (<7 mm). They found that endometrial thickness increased 48 hours after the first PRP application and reached >7 mm after the second PRP application in all patients. Embryo transfer was performed in all patients. Five patients became pregnant (50%), and four of them had normal pregnancies. They concluded that PRP was effective for endometrial growth in patients with thin endometrium.
You can learn about the use of differentiated forms of plasma in aesthetic gynecology, its combination with other treatment techniques, and the latest research in this area of gynecology at Tetyana Shevchuk’s webinar, which will be held under the auspices of “Multimed School”
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