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

2018 ◽  
Vol 33 (2) ◽  
pp. 234-244
Author(s):  
Sabiniano Roman ◽  
Christopher Hillary ◽  
Brenda Narice ◽  
Anthony J Bullock ◽  
Dilly OC Anumba ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Amniotic Fluid ◽  
Bilayer Membrane ◽  
Fetal Membrane ◽  
Fetal Membranes ◽  
Premature Rupture ◽  
Management Options ◽  
Pregnant Uterus ◽  
Fetal Survival ◽  
Preterm Premature Rupture

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.

scholarly journals Roles of Two Small Leucine-Rich Proteoglycans Decorin and Biglycan in Pregnancy and Pregnancy-Associated Diseases

2021 ◽  
Vol 22 (19) ◽  
pp. 10584
Author(s):  
Chidambra D. Halari ◽  
Michael Zheng ◽  
Peeyush K. Lala
Keyword(s):  
Fetal Membranes ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Pregnant Uterus ◽  
Surface Receptors ◽  
Preterm Premature Rupture ◽  
Associated Diseases ◽  
Binding Partners ◽  
Multiple Binding ◽  
Structure And Functions

Two small leucine-rich proteoglycans (SLRP), decorin and biglycan, play important roles in structural–functional integrity of the placenta and fetal membranes, and their alterations can result in several pregnancy-associated diseases. In this review, we briefly discuss normal placental structure and functions, define and classify SLRPs, and then focus on two SLRPs, decorin (DCN) and biglycan (BGN). We discuss the consequences of deletions/mutations of DCN and BGN. We then summarize DCN and BGN expression in the pregnant uterus, myometrium, decidua, placenta, and fetal membranes. Actions of these SLRPs as ligands are then discussed in the context of multiple binding partners in the extracellular matrix and cell surface (receptors), as well as their alterations in pathological pregnancies, such as preeclampsia, fetal growth restriction, and preterm premature rupture of membranes. Lastly, we raise some unanswered questions as food for thought.

Mid-trimester preterm premature rupture of membranes (PPROM): etiology, diagnosis, classification, international recommendations of treatment options and outcome

2018 ◽  
Vol 46 (5) ◽  
pp. 465-488 ◽  
Author(s):  
Michael Tchirikov ◽  
Natalia Schlabritz-Loutsevitch ◽  
James Maher ◽  
Jörg Buchmann ◽  
Yuri Naberezhnev ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Neonatal Outcome ◽  
Fetal Membrane ◽  
Average Risk ◽  
Causative Role ◽  
Close Monitoring ◽  
Premature Rupture Of Membranes ◽  
Premature Rupture ◽  
Preterm Premature Rupture ◽  
Increased Risk

AbstractMid-trimester preterm premature rupture of membranes (PPROM), defined as rupture of fetal membranes prior to 28 weeks of gestation, complicates approximately 0.4%–0.7% of all pregnancies. This condition is associated with a very high neonatal mortality rate as well as an increased risk of long- and short-term severe neonatal morbidity. The causes of the mid-trimester PPROM are multifactorial. Altered membrane morphology including marked swelling and disruption of the collagen network which is seen with PPROM can be triggered by bacterial products or/and pro-inflammatory cytokines. Activation of matrix metalloproteinases (MMP) have been implicated in the mechanism of PPROM. The propagation of bacteria is an important contributing factor not only in PPROM, but also in adverse neonatal and maternal outcomes after PPROM. Inflammatory mediators likely play a causative role in both disruption of fetal membrane integrity and activation of uterine contraction. The “classic PPROM” with oligo/an-hydramnion is associated with a short latency period and worse neonatal outcome compared to similar gestational aged neonates delivered without antecedent PPROM. The “high PPROM” syndrome is defined as a defect of the chorio-amniotic membranes, which is not located over the internal cervical os. It may be associated with either a normal or reduced amount of amniotic fluid. It may explain why sensitive biochemical tests such as the Amniosure (PAMG-1) or IGFBP-1/alpha fetoprotein test can have a positive result without other signs of overt ROM such as fluid leakage with Valsalva. The membrane defect following fetoscopy also fulfils the criteria for “high PPROM” syndrome. In some cases, the rupture of only one membrane – either the chorionic or amniotic membrane, resulting in “pre-PPROM” could precede “classic PPROM” or “high PPROM”. The diagnosis of PPROM is classically established by identification of nitrazine positive, fern positive watery leakage from the cervical canal observed duringin speculainvestigation. Other more recent diagnostic tests include the vaginal swab assay for placental alpha macroglobulin-1 test or AFP and IGFBP1. In some rare cases amniocentesis and infusion of indigo carmine has been used to confirm the diagnosis of PPROM. The management of the PPROM requires balancing the potential neonatal benefits from prolongation of the pregnancy with the risk of intra-amniotic infection and its consequences for the mother and infant. Close monitoring for signs of chorioamnionitis (e.g. body temperature, CTG, CRP, leucocytes, IL-6, procalcitonine, amniotic fluid examinations) is necessary to minimize the risk of neonatal and maternal complications. In addition to delayed delivery, broad spectrum antibiotics of penicillin or cephalosporin group and/or macrolide and corticosteroids have been show to improve neonatal outcome [reducing risk of chorioamnionitis (average risk ratio (RR)=0.66), neonatal infections (RR=0.67) and abnormal ultrasound scan of neonatal brain (RR=0.67)]. The positive effect of continuous amnioinfusion through the subcutaneously implanted perinatal port system with amniotic fluid like hypo-osmotic solution in “classic PPROM” less than 28/0 weeks’ gestation shows promise but must be proved in future prospective randomized studies. Systemic antibiotics administration in “pre-PPROM” without infection and hospitalization are also of questionable benefit and needs to be further evaluated in well-designed randomized prospective studies to evaluate if it is associated with any neonatal benefit as well as the relationship to possible adverse effect of antibiotics on to fetal development and neurological outcome.

scholarly journals Why Do the Fetal Membranes Rupture Early after Fetoscopy? A Review

2021 ◽  
pp. 1-11
Author(s):  
Benjamin J. Amberg ◽  
Ryan J. Hodges ◽  
Karyn A. Rodgers ◽  
Kelly J. Crossley ◽  
Stuart B. Hooper ◽  
...  
Keyword(s):  
Fetal Surgery ◽  
Fetal Membrane ◽  
Fetal Membranes ◽  
Preclinical Models ◽  
Premature Rupture ◽  
Domestic Species ◽  
New Therapies ◽  
Preterm Premature Rupture ◽  
Limited Success ◽  
Membrane Physiology

Iatrogenic preterm premature rupture of the fetal membranes (iPPROM) remains the Achilles’ heel of keyhole fetal surgery (fetoscopy) despite significant efforts in preclinical models to develop new therapies. This limited success is partially due to incomplete understanding why the fetal membranes rupture early after fetoscopy and notable differences in membrane physiology between humans and domestic species. In this review, we summarize aspects of fetoscopy that may contribute to iPPROM, the previous efforts to develop new therapies, and limitations of preclinical models commonly used in fetal membrane research.

scholarly journals Modulation of Amniotic Fluid Activin-A and Inhibin-A in Women With Preterm Premature Rupture of the Membranes and Infection-Induced Preterm Birth

2011 ◽  
Vol 67 (2) ◽  
pp. 122-131 ◽  
Author(s):  
Victor A. Rosenberg ◽  
Irina A. Buhimschi ◽  
Antonette T. Dulay ◽  
Sonya S. Abdel-Razeq ◽  
Emily A. Oliver ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Amniotic Fluid ◽  
Activin A ◽  
Premature Rupture ◽  
Inhibin A ◽  
Preterm Premature Rupture

Does preconditioning lower the rupture resistance of chorioamniotic membrane?

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Arash Dadkhah ◽  
Ata Hashemi
Keyword(s):  
Mechanical Properties ◽  
Cesarean Delivery ◽  
Fetal Membrane ◽  
Premature Rupture ◽  
Rupture Stress ◽  
Probe Diameter ◽  
Healthy Pregnancy ◽  
Probe Size ◽  
Puncture Force ◽  
The Mean

AbstractPremature rupture of fetal membrane occurs in about 3% of all pregnancies. The physical integrity of chorioamnion (CA) membrane should be retained until delivery for a healthy pregnancy. To explore the effect of pre-conditioning and probe size on the mechanical properties of human chorioamniotic sac, the mechanical properties of 17 human chorioamniotic membranes, collected from cesarean delivery, were examined using biaxial puncture tests with and without preconditioning by different probe sizes. For preconditioned samples, the mean ± std. of ultimate rupture stress was calculated to be 1.73 ± 0.13, 1.61 ± 0.29 and 1.78 ± 0.26 MPa for the probe sizes of 3, 5 and 7 mm, respectively. For samples with no preconditioning, these values were calculated to be 2.38 ± 0.29, 2.36 ± 0.37, and 2.59 ± 0.43 MPa for the above-mentioned probe sizes. The force to probe diameter for samples with no preconditioning was in the range of 1087–1301 N/m for the three probe diameters, well in the range of 850–1580 N/m reported by previous studies. Our results show that the preconditioned samples had significantly lower ultimate puncture force and ultimate stress compared to non-preconditioned samples. In addition, a correlation between the probe size and the magnitude of puncture force was observed, while the stress values were not significantly affected by changing probe size.

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