Premature Rupture Of Fetal Membranes Research Articles

Drastic induction of MMP-7 by cortisol in the human amnion: implications for membrane rupture at parturition.

Preterm premature rupture of fetal membranes precedes 30-40% of preterm births. Activation of matrix metalloproteases (MMPs) is the one of the major causes of extracellular matrix (ECM) degradation in membrane rupture. Increased cortisol, regenerated by 11β-hydroxysteroid dehydrogenase 1 in the amnion at parturition, is known to participate in a number of parturition-pertinent events. However, whether cortisol has a role in the regulation of MMPs in the membranes is not known. Here, we addressed this issue using human amnion tissue, the most tensile layer of the membranes. RNA-sequencing revealed that cortisol induced MMP7 expression dramatically in amnion fibroblasts, which was confirmed by real-time quantitative RT-PCR and Western blotting analysis in cortisol-treated amnion explants and fibroblasts. Measurement of collagen IV α5 chain (COL4A5), a substrate for MMP-7, showed that cortisol reduced its extracellular abundance, which was blocked by an antibody against MMP-7. Moreover, increased MMP-7 but decreased COL4A5 abundance was observed in the amnion tissue following labor-initiated spontaneous rupture of membranes. Mechanistic studies showed that cortisol increased the phosphorylation of c-Jun and the expression of c-Fos, the 2 major components of activated protein 1 (AP-1), respectively. The knocking down of c-Fos or c-Jun significantly attenuated the induction of MMP7 expression by cortisol. Chromatin immunoprecipitation assays showed that cortisol stimulated the enrichment of c-Fos and c-Jun at the AP-1 binding site in the MMP7 promoter. The data suggest that induction of MMP7 by cortisol via AP-1 may be a contributing factor to ECM degradation in membrane rupture at parturition.-Wang, L.-Y., Wang, W.-S., Wang, Y.-W., Lu, J.-W., Lu, Y., Zhang, C.-Y., Li, W.-J., Sun, K., Ying, H. Drastic induction of MMP-7 by cortisol in the human amnion: implications for membrane rupture at parturition.

Visualisation of the insertion of a membrane for the treatment of preterm rupture of fetal membranes using a synthetic model of a pregnant uterus.

Preterm premature rupture of fetal membranes is a leading cause of preterm delivery. Preterm labour can compromise fetal survival, and even if a pregnancy affected by preterm premature rupture of fetal membrane continues, major complications associated with leakage of amniotic fluid and risk of infection can affect the normal development and survival of the baby. There are limited management options for preterm premature rupture of fetal membrane other than delivery of the baby if ascending infection (chorioamnionitis) is suspected. We have previously reported the development and characterisation of an implantable membrane with the aim of using it to occlude the internal os of the cervix, in order to prevent amniotic fluid loss, allow fluid reaccumulation and reduce the risk of chorioamnionitis. For this, an electrospun biocompatible and distensible bilayer membrane was designed with mechanical properties similar to the human amniotic membrane. In this study, we consider the effects of sterilization on the membrane, how to insert the membrane and visualise it using routine clinical methods. To do this, we used e-beam sterilisation and examined the ability of the membrane to adhere to ex vivo human cervical tissues. We also studied its insertion into a custom-synthesised model of a 20-week pregnant uterus and imaged the membrane using ultrasound. Sterilisation produced minor effects on physical and mechanical properties, but these did not affect the capacity of the membrane to be sutured or to provide a fluid barrier. We demonstrated that fibrin glue can successfully adhere the bilayer membrane to cervical tissues. Finally, we demonstrated that the membrane can be inserted through the cervix as well as visualized in place using ultrasound imaging and an endoscope. In summary, we suggest this membrane is a candidate for further development in an appropriate animal model, supported by appropriate imaging, to precede possible future human studies if judged to demonstrate satisfactory safety and efficacy profiles.

Potent anti-inflammatory effects of honokiol in human fetal membranes and myometrium

BackgroundPreterm birth is the most prominent complication attributing to poor pregnancy and neonatal outcome. Infection is most commonly implicated in preterm birth; it initiates a cascade of inflammatory events that leads to the rupture of fetal membranes and spontaneous uterine contractions. Anti-inflammatory agents may thus be a therapeutic approach to prevent the premature rupture of fetal membranes and block contractions. In non-gestational tissues, the polyphenol honokiol has been shown to possess potent anti-inflammatory properties. PurposeThe aim of this study was to investigate the effect of honokiol on pro-inflammatory mediators in human gestational tissues. MethodsFetal membranes, myometrium and freshly isolated amnion cells and primary myometrial cells were treated with honokiol in the absence or presence of the products lipopolysaccharide (LPS) and fibroblast-stimulating lipopeptide-1 (fsl-1), the viral dsRNA analogue polyinosinic:polycytidylic acid (poly(I:C)) or the pro-inflammatory cytokines TNF or IL1B. A luciferase assay was used to determine the effect of honokiol on nuclear factor kappa B (NF-κB) RelA transcriptional activity. ResultsHonokiol significantly decreased pro-inflammatory cytokine (IL1A, IL6) and chemokine (CXCL8, CXCL1, CCL2) mRNA expression and secretion from fetal membranes (amnion and choriodecidua) and myometrium stimulated with LPS, fsl-1 or poly(I:C). In amnion cells, honokiol also significantly decreased the expression and secretion of the extracellular matrix degrading enzyme MMP9. Moreover, in myometrium, honokiol significantly suppressed the expression of the contraction associated protein PTGFR, the secretion of the uterotonic prostaglandins PGE2 and PGF2α, and blocked TNF-induced myometrial cell contractility. Finally, honokiol significantly suppressed IL1B- and TNF-induced NF-κB RelA transcriptional activity in primary amnion and myometrial cells. ConclusionsHonokiol reduced the expression of pro-inflammatory and pro-labour mediators in human amnion, choriodecidua and myometrium and that this may be facilitated through the suppression of NF-κB activation. These results indicate that the polyphenol honokiol may be a potent therapeutic for the prevention of preterm birth.

Promcomplete as an Aid in Diagnosis of Premature Rupture of Fetal Membranes

Promcomplete as an Aid in Diagnosis of Premature Rupture of Fetal Membranes

Клінічна ефективність профілактики акушерських та перинатальних ускладнень у вагітних із первинною артеріальною гіпертензією на тлі йододефіциту

The objective: reduction in the incidence of obstetric and perinatal complications in pregnant women with primary hypertension in conditions of endemic iodine deficiency based on the study of pregnancy and childbirth course, fetal and newborn conditions after the introduction of the developed complex of preventive and therapeutic measures. Materials and methods. A clinical analysis of 100 pregnant women has been conducted: – control group (KG) – 30 healthy pregnant women living in conditions of endemic iodine deficiency, give birth to the first time, without somatic pathology, had vaginal delivery; – And the group – 30 pregnant women with primary hypertension, who live in conditions of endemic iodine deficiency and received the usual medical and preventive measures; – II group – 40 pregnant women with primary hypertension who live in conditions of endemic iodine deficiency and received the method of prevention of obstetric and perinatal complications developed by us. Clinical and statistical analysis of the course of pregnancy, childbirth and condition of the fetus and the newborn after the introduction of the developed complex of treatment and preventive measures has been carried out. The obtained data are processed by the statistical method using the Microsoft Excel computer program. Results. Due to the use of proposed by us method, we managed to reliably reduce the frequency of gestational anemia (I group – 43.3% vs. 22.5% in group II, p<0.05), development of gestational diabetes (I group – 13.3% vs. 5.0% in the 2nd group, p<0.05), the threat of preterm labor (I group – 16.6% vs. 7.5% in the second group, p<0.05), placental dysfunction (group I – 63.3% vs. 22.5% in the second group, p<0.05); violation of microbiocenosis of the genital tract (group I – 53.3% vs. 17.5% in group ІІ, p<0.05). In addition, a significant reduction in the level of combined preeclampsia (group I – 40.0% vs. 20.0% in group II, p<0.05) and change in the incidence of FGR syndrome (group I – 40.0% vs. 22.5% in the second group, p <0.05). Significant decline in the incidence of developmental delivery complications: premature rupture of fetal membranes (I group – 26.7% vs. 15.0% in group II, p<0.05); preterm labor (group I – 13.3% vs. 5.0% in group II, p<0.05); Fetal distress (group I – 36.6% versus 15.0% in group II, p<0.05). It should be noted that the absence of PDNLP in pregnant group II versus 6.7% incidence of pregnant in group I. Reduction in the level of various forms of newborn asphyxiation: from 26.7% in group I to 15.0% in group II, p<0.05 against the background of the use of the proposed method, severe asphyxia was absent in newborns from pregnancy group II versus 3.3% cases in group І. The total incidence of newborns in the early neonatal period has significantly decreased by 1.7 times (60.0% in group I versus 35.0% in group II, p<0.05). There is no perinatal loss in group II, which also confirms the effectiveness of our proposed method. Conclusions. The proposed therapeutic and prophylactic technique for the prevention of obstetric and perinatal complications in pregnant women with primary hypertension in the background of natural iodine deficiency has made it possible to reliably reduce the frequency of obstetric and perinatal complications. This makes it possible for the proposed method to be recommended for use in therapeutic practice. Key words: course of pregnancy, childbirth, condition of newborn, obstetric and perinatal complications, primary arterial hypertension, iodine deficiency.

Progress on influencing factors regarding the neonatal group B streptococcal infectious diseases

Group B streptococcus (GBS) is one of the severe pathogenic bacteria during the perinatal period, both on pregnant women and newborns. GBS infection may lead to pneumonia, septicemia, meningitis or other severe disease, even death in neonates. Although only 1%-2% infections will develop into GBS disease among the neonates, the etiological mechanism of which is worth researching. This review summarizes the possible factors related to GBS infection or occurrence of the disease, including the risk in gestation period (for example, colonization of GBS on vagina of pregnant women, preterm birth or premature rupture of fetal membranes and so on), related pathogens (bacteria strains, loads or virulence), immune level (inflammatory factor or neutralizing anticytokine auto-Abs), gene defect or primary immunodeficiencies of the hosts.

Vaginal fluid prolactin in cases of suspected premature rupture of fetal membranes

Vaginal fluid prolactin in cases of suspected premature rupture of fetal membranes

Viral Infection Sensitizes Human Fetal Membranes to Bacterial Lipopolysaccharide by MERTK Inhibition and Inflammasome Activation.

Chorioamnionitis, premature rupture of fetal membranes (FMs), and subsequent preterm birth are associated with local infection and inflammation, particularly IL-1β production. Although bacterial infections are commonly identified, other microorganisms may play a role in the pathogenesis. Because viral pandemics, such as influenza, Ebola, and Zika, are becoming more common, and pregnant women are at increased risk for associated complications, this study evaluated the impact that viral infection had on human FM innate immune responses. This study shows that a herpes viral infection of FMs sensitizes the tissue to low levels of bacterial LPS, giving rise to an exaggerated IL-1β response. Using an ex vivo human FM explant system and an in vivo mouse model of pregnancy, we report that the mechanism by which this aggravated inflammation arises is through the inhibition of the TAM receptor, MERTK, and activation of the inflammasome. The TAM receptor ligand, growth arrest specific 6, re-establishes the normal FM response to LPS by restoring and augmenting TAM receptor and ligand expression, as well as by preventing the exacerbated IL-1β processing and secretion. These findings indicate a novel mechanism by which viruses alter normal FM immune responses to bacteria, potentially giving rise to adverse pregnancy outcomes.

Effect of three regimens of prophylactic antibiotics in pregnant women with preterm premature rupture of fetal membranes: A randomised comparative study.

Effect of three regimens of prophylactic antibiotics in pregnant women with preterm premature rupture of fetal membranes: A randomised comparative study.

Qualitative Determination of Human Chorionic Gonadotropin in Vaginal Washings for the Early Diagnosis of Premature Rupture of Fetal Membranes.

Purpose This study aimed to evaluate and validate the qualitative human chorionic gonadotropin β subunit (β-hCG) test of the vaginal fluid washings of pregnant women with premature rupture of fetal membranes (PROM). Methods Cross-sectional study of pregnant women between gestational weeks 24 and 39 who underwent consultations in one of our institutions. They were divided into two groups: group A (pregnant women clinically diagnosed with PROM) and group B (pregnant women without loss of amniotic liquid). The patients were subjected to a vaginal fluid washing with 3 mL of saline solution, which was aspirated subsequently with the same syringe. The solution was immediately sent to the laboratory to perform the vaginal β-hCG test with cut-off points of 10 mIU/mL (β-hCG-10) and/or 25 mIU/mL (β-hCG-25). Results The β-hCG-10 test of the vaginal secretion was performed in 128 cases. The chi-squared test with Yates' correction showed a statistically significant difference between the 2 groups (p = 0.0225). The sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy parameters were 77.1%, 43.6%, 52.3%; 70.4%; and 58.6% respectively. The β-hCG-25 test of the vaginal washing was performed in 49 cases. The analysis by Fisher's exact test showed a statistically significant difference between the groups (p = 0.0175). The sensibility, specificity, PPV, NPV, and accuracy parameters were 44.4%, 87.1%, 66.6%; 72.9%; and 71.4% respectively. Conclusions The β-hCG-25 test showed better accuracy for the diagnosis of PROM, and can corroborate the early diagnosis of PROM because it is a simple and quick exam.

Ubiquitin-Proteasome-Collagen (CUP) Pathway in Preterm Premature Rupture of Fetal Membranes.

Spontaneous preterm birth (sPTB) occurs before 37 gestational weeks, with preterm premature rupture of the membranes (PPROM) and spontaneous preterm labor (sPTL) as the predominant adverse outcomes. Previously, we identified altered expression of long non-coding RNAs (lncRNAs) and message RNAs (mRNAs) related to the ubiquitin proteasome system (UPS) in human placentas following pregnancy loss and PTB. We therefore hypothesized that similar mechanisms might underlie PPROM. In the current study, nine pairs of ubiquitin-proteasome-collagen (CUP) pathway–related mRNAs and associated lncRNAs were found to be differentially expressed in PPROM and sPTL. Pathway analysis showed that the functions of their protein products were inter-connected by ring finger protein. Twenty variants including five mutations were identified in CUP-related genes in sPTL samples. Copy number variations were found in COL19A1, COL28A1, COL5A1, and UBAP2 of sPTL samples. The results reinforced our previous findings and indicated the association of the CUP pathway with the development of sPTL and PPROM. This association was due not only to the genetic variation, but also to the epigenetic regulatory function of lncRNAs. Furthermore, the findings suggested that the loss of collagen content in PPROM could result from degradation and/or suppressed expression of collagens.

IL-10 and pregnancy complications

Successful pregnancy depends on the ability of the mother's immune system to undergo a process of immunoregulation in order to tolerate the fetus, and also to create and sustain a nurturing environment during all the stages of pregnancy. Several reports point to interleukin 10 (IL-10) as being vital for normal pregnancy, and low IL-10 levels as being associated with preg- nancy complications. This study aimed to compare IL-10 levels in normal and complicated pregnancy conditions. The authors compared levels of IL-10 produced upon stimulation of maternal peripheral blood mononuclear cells (PBMC) from women at different stages of normal gestation with those produced by women with pregnancy complications, such as recurrent spontaneous miscarriage (RSM), preterm delivery (PTD), premature rupture of fetal membranes (PROM), pre-eclampsia, and intrauterine fetal growth retardation (IUGR). Median levels of IL-10 are statistically significantly lower in pathological conditions as com- pared to matching gestational ages of normal pregnancy. Healthy pregnancy is associated with higher levels of IL-10, while pathologic pregnancies are associated with lower levels of IL-10.

The abandonment in utero of the placenta in prolonged twin pregnancy after premature rupture of membranes

Premature rupture of fetal membranes is associated with a substantial fetal morbidity and mortality. Immediate actions that can improve the future neonatal outcome are the administration of antenatal corticosteroid therapy, infection prophylaxis, tocolytic drugs and insurance of an appropriate neonatal nursery level. One of the essential points in the management of these cases is the attempt to extend as much as possible the gestational age, especially in mid trimester premature rupture of membranes and even more considering that the duration of the latency period inversely correlates with gestational age at membrane rupture. We present the case of a patient aged 41 years admitted as obstetric emergency for suspected leakage of clear fluid in context of dichorionic, diamniotic twin pregnancy, 22 weeks of gestation, obtained by in vitro fertilization due to primary infertility. Under continuous tocolytic and antibiotic treatment, the extension of the gestational age of the first fetus with 5 weeks was successfully obtained. The second fetus was born one week later as a result of the abandonment in utero of the placenta. Complications implied by preterm rupture of membranes in twin pregnancies are significantly influenced by the presence of chorioamnionitis and by placentation. We consider that the prognosis of the second fetus, perfectly normal developed during first 5 years, was positive and significantly influenced by the prolonged gestational age with almost one week.

Delivery modes and their influencing factors of pregnant women with previous cesarean section: a retrospective study of 474 gravidas

Objective To investigate the safety of vaginal delivery in gravidas with previous cesarean section and its influencing factors. Methods Four hundred and seventy-four full-term gravidas who received cesarean section at the Department of Obstetrics and Gynecology of Peking University First Hospital from January 1, 2012 to August 31, 2014 were enrolled in this study. Among those subjects, 38 who underwent successful vaginal delivery were grouped into vaginal birth after cesarean (VBAC) group, and the other 436 accepting repeated cesarean section were grouped into cesarean group. Delivery outcomes and maternal/neonatal complications of the two groups were retrospectively analyzed with two-sample t-test and Chi-square test. Results Among the 45 patients (9.5%) who attempted VBAC, seven underwent cesarean section for suspected fetal distress and the other 38 (84.4%) succeeded in vaginal birth without uterine rupture. The amount of postpartum hemorrhage in patients of cesarean group was more than that of VBAC group [(330.8±94.8) vs (257.7±199.7) ml, t=2.021, P<0.01] after exclusion of three patients with dangerous placenta previa, and the postpartum hospital stay was shorter than that of cesarean group [(2.5±1.4) vs (4.5±1.3) d, t=7.952, P<0.01]. There were three newborns with neonatal asphyxia, twelve with neonatal infections and forty transferred to the Pediatrics Department following cesarean section. Besides, complications of headache and urinary retention occurred in 20 and 32 mothers after cesarean section, respectively. However, no complication occurred in VBAC group. Sixty-three cesarean sections were indicated as thin lower uterine segment and among them, fourteen (22.2%) had muscular rupture. Among the six patients who complained of tenderness in lower uterine segment, three were found having muscular rupture during cesarean section. Conclusion VBAC is an option for gravidas with history of cesarean section only if they meet the criteria for VBAC attempt. VBAC could lower the cesarean section rate without increase the incidence of complications. The rate of trial of labor after cesarean was low, patients education should be strengthened to increase it. Key words: Vaginal birth after cesarean; Trial of labor; Premature rupture of fetal membranes; Natural childbirth

Nivel de proteína C-reactiva en comparación con el recuento leucocitario materno en la predicción de corioamnionitis histológica en gestantes con rotura prematura de membranas pretérmino

Objetivo: Demostrar la utilidad del nivel de proteína C-reactiva en comparación con el recuento eucocitariomaterno en la predicción de corioamnionitis histológica en gestantes con rotura prematura de membranas pretérmino. Diseño: Estudio no experimental, tipo validación de prueba diagnóstica. Institución: Instituto Nacional Materno Perinatal, Lima, Perú. Participantes: Gestantes con rotura prematura de membranas pretérmino, entre enero y junio del 2013. Intervenciones: Se incluyó gestantes pretérmino con edad gestacional ≥22 semanas y &lt;37 semanas, con rotura prematura de membranas, fetos únicos e historia clínica disponible con información requerida completa. Para el análisis estadístico se usó el programa SPSS 19. Principales medidas de resultados: Índices diagnósticos del nivel de proteína C-reactiva y recuento leucocitario. Resultados: La incidencia de corioamnionitis histológica fue 76,3% (71/93). La edad promedio de las gestantes fue 29,0 +- 6,6 años. La rotura ocurrió con más frecuencia con edad materna de 25 a 30 años (31,2%) y en nulíparas; la edad gestacional promedio fue 29,2 + 3,4 semanas, más frecuente entre las 27 y 31 semanas (51,6%) y en nulíparas de riesgo social mediano. El periodo de latencia promedio fue 12,6 + 10,9 días y el parto ocurrió dentro de los 15 días de la rotura (74%). El nivel de PCR promedio fue 29,6 + 26,9 mg/L, con diferencia altamente significativa (p=0,00) para la corioamnionitis histológica. Su sensibilidad fue 98,6%, especificidad 45,5%, valor predictivo positivo 85,4% y valor predictivo negativo 90,9%. La curva ROC predijo corioamnionitis histológica con un área bajo la curva de 0,861 (IC95%: 0,77 a 0,95) (p = 0,000); estableciendo en 12,45 mg/L el punto de corte por encima del cual se puede predecir el riesgo de corioamnionitis histológica. El recuento leucocitario fue 15 519,5 + 4 410,5 cel/mL, sin diferencia significativa (p=0,790). Su sensibilidad fue 52,1%, especificidad 63,6%, valor predictivo positivo 82,2% y valor predictivo negativo 29,2%.El área bajo la curva ROC 0,714 (IC 95% 0,587 a 0,84) demostró significancia estadística (p= 0,002), teniendo como punto de corte 13 490 cel/mL.Conclusiones: El nivel de proteína C-reactiva fue más confiable que el recuento leucocitario materno en la predicción de corioamnionitis histológica en gestantes con rotura prematura de membranas pretérmino.

The course of pregnancy and blood coagulation system

Pregnancy represents the procoagulant state, giving rise in the high prevalence rate of thrombotic complications. An imbalance between coagulation and anticoagulation systems of blood during pregnancy can lead to the development of pre-eclampsia, intrauterine growth retardation, preterm labor, premature rupture offetal membranes and fetal death. These complications are mostly caused by the impaired generation of thrombin as well as changes in the concentration and activity of tissue factor TFPI (tissue factor pathway inhibitor), TAT III complex and protein Z. Nevertheless, it should be noted that the thrombotic complications during pregnancy depend not on the elevation of the concentrations of specific coagulation factors or lack of the activity of anticoagulant proteins, but on the shift in the whole system toward the procoagulant state. These disorders most of all lead to thromboses ofplacental vessels, causing disorders ofperfusion of the affected area. Placental pathology can develop as from the maternal as from the fetal side. Despite the fact that changes in the blood coagulation system occur from the very beginning of pregnancy, and often are adaptive in nature, i.e., do not require special medical intervention, the prompt diagnosis and treatment of hemostatic disorders as main pathogenetic link in the development of thrombosis is extremely important.

Морфологічні особливості стану фетоплацентарного комплексу у жінок з ранніми передчасними пологами після застосування допоміжних репродуктивних технологій

The objective: the study of morphofunctional changes of the fetoplacental complex at 28–33 weeks of gestation in women with early preterm delivery after the application of ART. Patients and methods. We have examined 130 patients whose pregnancy occurred after the use of ART. This is the woman who gave birth at 28–33 weeks of gestation. Of these, 80 women had early premature births in the background premature rupture of fetal membranes, 50 – patients with early preterm delivery and timely rupture of fetal membranes (control group 2). The main group included 4 groups of 20 women with regard to the duration of anhydrous interval: 1.1 – anhydrous interval 5–6 hours (main group 1); 1.2 – anhydrous span 24 hours; 1.3 – anhydrous interval 45–48 hours; 1.4 – anhydrous period 5 days after PRFM. Results. Thus, the results of the research indicate that the main cause of early preterm birth in women after using ART are structural dezorhanization changes of collagen fibers of the connective tissue amnion and chorionic which lead to the appearance of microscopic defects – delamination its surface, causing premature rupture of fetal membranes the launch stage localized focal immediate type hypersensitivity reactions and restructuring epithelial cell membranes. Neutrophil macrophage properties in this case reduced and programmed to perform a cycle of incomplete phagocytosis, which increases the synthesis of inflammatory cytokines in the area of rupture of fetal membranes. Сonclusion. Reduced activity of neutrophils increases the effect of abuse and cytokine balance in favor predictor of early spontaneous labor at 28-33 weeks of gestation. Key words: morphological changes of the fetoplacental complex, early preterm birth, expectant tactics of childbirth.

All-trans retinoic acid promotes wound healing of primary amniocytes through the induction of LOXL4, a member of the lysyl oxidase family

Thirty percent of preterm births directly result from preterm premature rupture of fetal membranes (PPROM). Clinical management currently proposes using a collagen plug to mechanically stop loss of amniotic fluid. Vitamin A and its active metabolite (retinoic acid) have well-known pro-healing properties and could thus make good candidates as a proposable adjuvant to this mechanical approach. Here we investigate the molecular mechanisms involved in the pro-healing properties of all-trans retinoic acid (atRA) in fetal membranes via an approach using an in vitro primary amniocyte wound model and transcriptomics. The results demonstrate that atRA promotes migration in primary amniocytes, improving wound healing in vitro by up to 90%. This effect is mediated by the induction of LOXL4, which plays a crucial role in the dynamics of the extracellular matrix by regulating collagen reticulation. This new insight into how atRA exerts its pro-healing properties prompts us to propose using atRA as a candidate strategy to help prevent future PPROM.

Placental histologic patterns and neonatal seizure, in preterm premature rupture of membrane

Objective: To investigate the relationship between placenta and perinatal outcomes, in preterm infants born to mothers with preterm premature rupture of fetal membrane (PPROM).Methods: We report detailed histology of placentas and perinatal outcomes of infants from 79 PPROM pregnancies. Placental histologic pattern and adverse perinatal outcomes were assessed by logistic regression, adjusting for gestational age at birth, birth weight and interval from rupture of membrane to delivery.Results: Mean gestational age at membrane rupture was 29.5 ± 3.4 weeks. The incidence of histologic chorioamnionitis (HCA), fetal inflammatory response (FIR) and vascular thrombotic abnormalities in placental histologic examination were 63.3, 25.3 and 78.5%, respectively. Neonates with FIR showed significantly higher incidence of periventricular leukomalacia (PVL) (85% versus 59.3%, p = 0.0364) at brain ultrasonography, than neonates without FIR, in univariate analysis, but not in logistic regression analysis. In logistic regression analysis, the odds ratio of low Apgar score at 1 min in the neonates with clinical chorioamnionitis was 5.009 (95% CI, 1.242–20.195). The odds ratio of neonatal seizure in the neonates with FIR and vascular thrombotic problem was 7.486 (95% CI, 1.617–34.653).Conclusions: Our findings support the association between FIR with vascular thrombotic problem in placenta and neonatal seizure, in pregnancies with PPROM.

The co-stimulatory soluble B7-H4 molecule is elevated in early pregnancy in women with premature rupture of fetal membranes

The co-stimulatory soluble B7-H4 molecule is elevated in early pregnancy in women with premature rupture of fetal membranes