Preterm Rupture Of Fetal Membranes Research Articles

The problem of preterm rupture of fetal membranes in premature pregnancy complicated by chorioamnionitis

The problem of preterm rupture of fetal membranes in premature pregnancy complicated by chorioamnionitis

Tissue Glue-Based Sealing Patch for the in vivo Prevention of Iatrogenic Prelabor Preterm Rupture of Fetal Membranes

Introduction: One of the main concerns for all fetal surgeries is the risk of preterm delivery due to the preterm prelabor rupture of the fetal membranes (iPPROM). Clinical approaches to seal fetal membrane (FM) defects are missing due to the lack of appropriate strategies to apply sealing biomaterials at the defect site. Methods: Here, we test the performance of a previously developed strategy to seal FM defects with cyanoacrylate-based sealing patches in an ovine model up to 24 days after application. Results: Patches sealed tightly the fetoscopy-induced FM defects and remained firmly attached to the defect over 10 days. At 10 days after treatment, 100% (13/13) of the patches were attached to the FMs, and 24 days after treatment 25% (1/4) of the patches placed in CO₂ insufflation, and 33% (1/3) in NaCl infusion remained. However, all successfully applied patches (20/24) led to a watertight sealing at 10 or 24 days after treatment. Histological analysis indicated that cyanoacrylates induced a moderate immune response and disrupted the FM epithelium. Conclusion: Together, these data show the feasibility of minimally invasive sealing of FM defects by locally gathering tissue adhesive. Further development to combine this technology with refined tissue glues or healing-inducing materials holds great promise for future clinical translation.

Herpes simplex virus infection in pregnancy – An update

Herpes Simplex virus (HSV) infection is one of the most common sexually transmitted infections among women of the reproductive age. It is estimated to affect about 2−3% of pregnant women. Vertical transmission during pregnancy is rare occurring in less than 1% of cases but for those with active lesions or shedding the virus asymptomatically the risk of vertical transmission intrapartum is high. Neonates with HSV may develop severe consequences such as disseminated, central nervous system and skin, eye mouth/mucous disease or suffer mortality. A high index of suspicion, timely diagnosis and institution of appropriate treatment during acute and recurrent episodes will reduce the risk of vertical transmission and therefore neonatal consequences. Routine screening for HSV in pregnancy is not recommended. This review provides an overview of HSV in pregnancy, diagnosis and management especially around unique scenarios such as prelabour preterm rupture of fetal membranes and presentation with active disease in labour.

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.

Perinatal infections and cerebral palsy

There are many causes of cerebral palsy (CP) apart from hypoxic events during the perinatal period. Perinatal infections and systemic inflammatory response syndrome of the mother and infant can affect the development of CP significantly. The majority of premature infants are vulnerable to CP and the association between intraamniotic infections, preterm rupture of fetal membranes and the effect of preterm birth predispose the infant to CP. Incidence of intraventricular hemorrhage, white matter disease and periventricular leukomalacia has increased after preterm labor resulting from intraamniotic infections. Bacterial vaginosis, fever, periodontal disease of the mother, as well as bacterial, viral, protozoan and fungal infections of the newborn infant are effective during the development of CP. The balance between proinflammatory and anti-inflammatory cytokines and the combined effects of genetic predisposition, hypoxia, cytokines and bacterial products may initiate the unfavorable process. Treatments directed towards cytokines and bacterial products have not been effective until now. Fetuses and neonates should be protected from perinatal infections as much as possible and all infections should be treated promptly in order to prevent short-term and long-term adverse outcomes.

Association of ESR1 gene polymorphism with preterm rupture of fetal membranes.

We examined 179 patients with and without preterm rupture of fetal membranes. The mothers and their newborns have been genotyped by two polymorphic loci of estrogen receptor α (ESR1) gene: -397T > C[PvuII] (rs2234693) and -351A > G[XbaI] (rs9340799). The CG haplotype of the fetus should be regarded as a risk factor of preterm rupture of fetal membranes, while haplotype TA as a protective factor. Genotype -351A/A is a marker of the protective haplotype in the fetus, while genotype -397C/C is a marker of the risk haplotype, which can be used in combined analysis of both markers. These data attest to an important role of fetal genotype in the formation of genetic predisposition to preterm rupture of fetal membranes.

Intrauterine infection and the perinatal outcomes in seven tertiary hospitals in Beijing

Objective To investigate the distribution of different flora, and to explore the effect of intrauterine infection (IUI) on perinatal outcomes in some hospitals in Beijing. Methods A retrospective analysis was conducted on 176 IUI cases, which were divided into preterm (n=77) and term group (n=99), from 7 tertiary hospitals in Beijing from January 1, 2007 to December 31, 2007. The basic information, clinical presentations, laboratory tests results and placenta pathology reports of all cases were collected and analyzed. Analysis of the microbial population was perfomed according to the results of bacterial culture and the relationship between IUI and the perinatal outcomes was tested. Results The incidence of IUI in 2007 was 0.67% among all deliveries (176/26 204) and 3.91% of all preterm deliveries(77/1969), and 84. 4% of the preterra women were complicated with preterm premature rupture of fetal membranes (PPROM) (65/77). Significant difference was found between the two groups in the incidence of cesarean section, premature rapture of fetal membrane and artificial rupture of fetal membrane, and duration from membranes rupture to delivery (P<0.05). Neither the rate of puerperiurn infection [3.0% (3/99) vs 2.6% (2/77)] nor the neonatal infection rate [30.3%(30/99) vs 25.9%(20/77)] in the term and preterm group showed significant difference. The rate of neonatal death was higher in the preterm group than in the term group(7.8% vs 0,P<0.05). The primary infected bacteria was E. coli, which accounted for 37.3% (22/59) of those with positive results of culture, followed by group B streptococcus(GBS) [32.2%(19/59)] and Staphylococci [23.7%(14/59)3. Conclusions The incidence of IUI is higher in preterm labor women, especially those with PPROM. The common bacteria of chorioamnionitis are E. coli and GBS. Sensitive antibiotics should be administered according to bacterial culture results. Key words: Fatal membranes, premature rupture; Chorioamnionitis; Escherichia coli; Streptococcus, agalactiae; Prognosis

Aerosolized Iloprost in the Treatment of Pulmonary Hypertension in Extremely Preterm Infants: A Pilot Study

In premature infants with preterm prolonged rupture of membranes, death after birth is often due to persistent pulmonary hyper-tension. Aerosolized iloprost was used to treat pulmonary hypertension due to prolonged preterm rupture of fetal membranes (7-56 days) in four extremely low-birthweight neonates (23-25 weeks' gestation, weight 448-645 g) under spontaneous breathing supported by nasal continuous positive airway pressure. Inhalation dose was 2 microg/kg b.w. and between 44 and 65 inhalations were performed in each patient starting within the first hour of life over a total of several days. Single inhalations lasted 5 min and were not repeated until 60 min had elapsed. After the first inhalation, the PaO2/FiO2 mean ratio increased from 65 (range 35-114) to 194 (148-250) mmHg and oxygenation requirements decreased within the next 7 days. Echocardiography similarly showed reduction in pulmonary resistance. We observed no severe side effects on blood pressure or prolonged bleeding time during inhalation. Iloprost inhalation might therefore be an additional treatment for improving oxygenation in cases of persistent pulmonary hypertension in extremely low-birthweight infants under spontaneous breathing. Further randomized clinical studies are required to establish the role of iloprost in this setting.

Early Detection of Decreased Soluble HLA‐G Levels in the Maternal Circulation Predicts the Occurrence of Preeclampsia and Intrauterine Growth Retardation During Further Course of Pregnancy

Soluble (s) HLA-G1/G5 molecules may potentially affect immune homeostasis during pregnancy. The aim of this study was to determine changes of sHLA-G1/G5 plasma levels throughout normal pregnancy and to assess its predictive value for the occurrence of characteristic gestation-associated diseases during further course of pregnancy. sHLA-G1/G5 levels were estimated in plasma samples of 40 non-pregnant women, 291 women throughout normal pregnancy and 236 women affected by different complications. In comparison with non-pregnant women sHLA-G1/G5 levels strongly increased during the first trimenon and then decreased continuously toward term. Non-parametric discriminant analysis showed that women with significantly decreased sHLA-G1/G5 levels in the second trimenon had an increased risk of developing preeclampsia and/or intrauterine growth retardation (IUGR) during further course of pregnancy. However, in the third trimenon, sHLA-G1/G5 levels in affected women did not deviate significantly from those of non-affected women. Surprisingly, significantly increased sHLA-G1/G5 levels were detected in third trimenon women with uncontrollable preterm labor, but not in women with prolonged preterm rupture of fetal membranes. For the identification of women with an increased risk of IUGR and/or preeclampsia, measurement of sHLA-G1/G5 plasma levels may be a powerful new tool in prenatal diagnostics.

Prolonged Preterm Rupture of Fetal Membranes, a Consequence of an Increased Maternal Anti-fetal T Cell Responsiveness

A fetus, although semi-allogeneic, is usually accepted by the maternal immune system. However, complications, including alloresponsive mechanisms, are thought to be potentially detrimental for a successful pregnancy. Therefore, we compared allogeneic T cell responses of nonpregnant women with the response of healthy pregnant women and pregnant women who have various gestation-associated diseases. Peripheral blood mononuclear cells (PBMCs) of all three groups were stimulated with PBMCs from unrelated volunteers. Pregnant women had significantly reduced stimulation indices (SIs) compared with nonpregnant women. Exposing PBMCs from pregnant women to PBMCs of their own fetus led to a further significant decrease of SIs. Among the two groups of pregnant individuals, SIs of women with prolonged preterm rupture of fetal membranes (PPROM) were significantly higher when the maternal PBMCs were stimulated with PBMCs of their own fetus. This phenomenon could not be observed after stimulation with PBMCs from unrelated volunteers. In addition, an increased humoral immune response was assessed for women with PPROM in comparison with women with uncontrollable preterm labor. Our results revealed a strongly reduced allogeneic T cell response of PBMCs from pregnant women that was further down-regulated when PBMCs from their own fetus were used as stimulators. By contrast, data from women with PPROM suggest an increased maternal T cell response specifically toward the fetal HLA antigens.

Activation of Human Progelatinase A/Promatrix Metalloproteinase 2 by Escherichia coli-Derived Serine Proteinase

Treatment of human uterine cervical fibroblasts with commercial lipopolysaccharide (LPS) preparations from different serotypes of Escherichia coli effectively augmented the processing of mammalian progelatinase A/promatrix metalloproteinase (proMMP)-2 to a 62-kDa form of MMP-2. When purified proMMP-2 was incubated with LPS preparations, the proenzyme was similarly processed into the 62-kDa active MMP-2 in a time- and dose-dependent manner. By contrast, progelatinase B/proMMP-9 and prostromelysin 1/proMMP-3 were not activated. A serine proteinase inhibitor, phenylmethylsulfonyl fluoride, completely interfered with this LPS-mediated activation of proMMP-2. This is novel evidence that E. coli serine proteinase is a specific activator of proMMP-2. Thus, it is very likely that E. coli infection plays a crucial role in the degradation of connective tissues via the activation of proMMP-2, and the resultant active MMP-2 participates in the dysfunction of connective tissues such as in the preterm rupture of fetal membranes.

Aetiological Factors in Low Birth Weight in a Nigerian Population

Low birth weight babies delivered at Wesley Guild Hospital, Ilesa, Nigeria, from January 1982 to December 1986 were reviewed. They constituted 11.5% of the total births within the period. The common aetiological factors were multiple pregnancy, nulliparity, preterm rupture of fetal membranes, hypertensive disorders, antepartum haemorrhage and anaemia in pregnancy.