Abstract
In approximately 8% of term births and 33% of pre-term births, the fetal membrane (FM) ruptures before delivery. In vitro studies of FMs after delivery have suggested the series of events leading to rupture, but no in vivo studies have confirmed this model. In this study, we used a three-dimensional constructive interference in steady state (3D-CISS) sequence to examine the FM at the cervical internal os zone during pregnancy; 18 pregnant women with one to three longitudinal MRI scans were included in this study. In 14 women, the FM appeared normal and completely intact. In four women, we noted several FM abnormalities including cervical funneling, chorioamniotic separation, and chorion rupture. Our data support the in vitro model that the FM ruptures according to a sequence starting with the stretch of chorion and amnion, then the separation of amnion from chorion, next the rupture of chorion, and finally the rupture of amnion ruptures. These findings hold great promise to help to develop an in vivo magnetic resonance imaging marker that improves examination of the FMs.
Highlights
During pregnancy, the fetus is surrounded by amniotic fluid contained within a fetal membrane (FM)
FM rupture before 37 weeks of gestation, termed preterm prelabor rupture of membranes (PPROM), is responsible for approximately one-third of preterm births and is the most common identifiable factor associated with preterm birth (Mathews and MacDorman, 2010; Waters and Mercer, 2011; Martin et al, 2012)
We proposed to visualize the FM near the internal cervical os using magnetic resonance (MR) images acquired with a sequence named three-dimensional constructive interference in steady state (3D-CISS)
Summary
The fetus is surrounded by amniotic fluid contained within a fetal membrane (FM). FM is composed of the amnion, which faces the fetus, and the chorion, which contacts the maternal decidua. The FM is critical for maintaining a pregnancy until delivery (Parry and Strauss, 1998; Menon and Richardson, 2017). In about 8% of pregnancies, the FM ruptures before labor, which is called premature rupture of membranes (PROM). FM rupture before 37 weeks of gestation, termed preterm prelabor rupture of membranes (PPROM), is responsible for approximately one-third of preterm births and is the most common identifiable factor associated with preterm birth (Mathews and MacDorman, 2010; Waters and Mercer, 2011; Martin et al, 2012). There is no easy way to predict PPROM in early pregnancy, and the prevention is very limited
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