Ehlers-Danlos-Like Dermal Abnormalities in Women with Recurrent Preterm Premature Rupture of Fetal Membranes

Abstract

Preterm premature rupture of membranes (PPROM) likely results from weakening of the constituent connective tissue. It is uncertain if the alterations are limited to the fetal membranes or are also present in other sites such as the skin. The aim of the study was to compare the dermal structure of women suffering from recurrent PPROM with the dermis of both non-pregnant women and women with uneventful gestation. Skin biopsies were taken from 42 women who recently underwent PPROM, 33 women with uneventful gestation and 33 non-pregnant women. Histochemistry, immunohistochemistry, and electron microscopy were performed on these specimens and analyzed blindly. Morphologic changes were found in the dermis of most (33 of 42 at optical microscopy and 40 of 42 at ultrastructure) of the women suffering from PPROM. They were reminiscent of those found in some types of Ehlers-Danlos Syndrome (EDS). However, there was no clinical evidence suggesting a recognized form of EDS. We conclude that some cases of PPROM are a systemic connective tissue disorder representing a yet unidentified type of EDS.