Fetal membrane healing after spontaneous and iatrogenic membrane rupture: A review of current evidence

Abstract

In view of the important protective role of the fetal membranes, wound sealing, tissue regeneration, or wound healing could be life saving in cases of preterm premature rupture of the membranes. Although many investigators are studying the causes of preterm premature rupture of membranes, the emphasis has not been on the wound healing capacity of the fetal membranes. In this review, the relevant literature on the pathophysiologic condition that leads to preterm premature rupture of membranes will be summarized to emphasize a continuum of events between rupture and repair. We will present the current knowledge on fetal membrane wound healing and discuss the clinical implications of these findings. We will critically discuss recent experimental interventions in women to seal or heal the fetal membranes after preterm premature rupture of membranes. KeywordsPreterm premature rupture of membranes; Pregnancy outcome Intact fetal membranes during pregnancy are important to the maintenance of amniotic fluid homeostasis and in the defense against ascending infection. Although the association with preterm premature rupture of membranes (PROM) and adverse pregnancy outcomes have been well-described, data regarding the capacity of the fetal membranes for healing and repair remain limited. Multiple potential therapies have been advocated for the treatment of preterm PROM with some success, especially in cases of postprocedural fetal membrane rupture. However, before incorporation in clinical practice, potential therapies should be studied further in animal models and human fetal membrane explants to determine the efficacy and optimal treatment regimens.The amnion, chorion, and contiguous maternal decidua form the human fetal membranes in the second and third trimester of pregnancy. The membranes form an adjustable bio-container * Reprint requests: Roland Devlieger, MD, PhD, Department of Obstetrics and Gynecology, University Hospital Leuven, Herestraat 49, B-3000 Leuven, Belgium. E-mail: roland.devlieger@uz.kuleuven.ac.be. This review discusses human fetal membrane healing by focusing on cause, clinical consequences, and potential therapies to prevent and treat preterm premature rupture of membranes.

Amnioinfusion in preterm PROM: effects on amnion and cord histology

“…Alternatively, characteristics of membrane rupture (for example, size or location of the defect in relation to the internal cervical os) may be responsible for a more prompt loss of the infused solution. 9 We confirm previous reports that amnioinfusion is associated with prolonged latency period and thus with improved perinatal outcome. In light of the negligible effects of amnioinfusion on histologic placental characteristics, the procedure should be considered for cases of extremely preterm PROM with severe oligohydramnios.…”

Absorbable gelatin plug does not prevent iatrogenic preterm premature rupture of membranes after fetoscopic laser surgery for twin–twin transfusion syndrome

“…There was one case of PPROM within 3 weeks of the procedure. However, the overall gestational age at delivery in their series was 28.4 weeks with a procedure-to-delivery interval of 6.5 (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] weeks. This gestational age at delivery was 3-4 weeks lower than in other published series.…”

“…This is often associated with a mean reduction of 2 weeks in the gestational age at birth 2 . iPPROM has been attributed to a persistent fetal membrane defect at the trocar entry site 3,4 . Investigators have explored intra-amniotic or extra-amniotic 5 instillation of platelets and/or maternal blood to treat iPPROM, and mixed results have been obtained.…”

A model for the compressible, viscoelastic behavior of human amnion addressing tissue variability through a single parameter

“…Such a model represents the first step towards the development of numerical simulation tools to address clinical questions, as for example potential structural weakening caused by prenatal surgery [Devlieger et al, 2006;Beck et al, 2012] or increased rupture risk associated with cervical opening or pelvic floor laxity [Menon et al, 2015].…”