Mapping of zones of altered morphology and chorionic connective tissue cellular phenotype in human fetal membranes (amniochorion and decidua) overlying the lower uterine pole and cervix before labor at term

Abstract

Objective The purpose of this study was to determine the location, frequency, and extent of altered fetal membrane morphology before term labor and its relation to myofibroblast activation in their connective tissue layers. Study design Fetal membranes that were obtained from 10 women who underwent prelabor cesarean delivery at 38 to 39 weeks of gestation underwent biopsy examination with respect to the internal os of the cervix. The thickness of their constituent layers was measured, and the numbers of α-smooth muscle actin immunoreactive cells (ie, marker of myofibroblast activation) within the reticular layer were counted. Results A region that measured 119±21cm 2, that exhibited altered morphology of the fetal membranes from the lower uterine pole, and that was characterized by increased connective tissue thickness and decreased thickness of the cellular layers was demonstrated in all patients. In 8 of 10 patients, this region was centered on the location of the Babcock tissue forceps. Within this region was an area of fetal membranes that exhibited α-smooth muscle actin immunoreactivity in the cells of the reticular layer and whose number correlated with parameters of altered morphology. Conclusion All patients before labor at term possess an area of fetal membranes that are located in the lower uterine pole that exhibit altered morphology that is associated with myofibroblastic activation in the chorionic connective tissue.