Objective Bacterial colonization of the fetal membranes and its role in
April 9, 2017
Objective Bacterial colonization of the fetal membranes and its role in pathogenesis of membrane rupture is poorly understood. Fluorescence hybridization BAPTA was performed using broad range 16 s ribosomal RNA probe. Images were evaluated chorion Rabbit polyclonal to Caspase 10. and choriodecidua were measured and bacterial fluorescence scored. Chorion thinning and bacterial presence were compared among and between groups using Student’s t-test linear mixed effect model and Poisson regression model (SAS Cary NC). Results In all groups the fetal chorion cellular layer was thinner at rupture compared to distant site (147.2 vs. 253.7 μm p<0.0001). Further chorion thinning was greatest among PPROM subjects compared to all other groups combined regardless of site sampled [PPROM(114.9) vs. PTL(246.0) vs. PTNL(200.8) vs. TL(217.9) vs. TNL(246.5)]. Bacteria counts were highest among PPROM subjects compared to all other groups regardless of site sampled or histologic infection [PPROM(31) vs. PTL(9) vs. PTNL(7) vs. TL(7) vs. TNL(6)]. Among all subjects at both sites bacterial counts were inversely correlated with chorion thinning even excluding histologic chorioamnionitis (p<0.0001 and p?=?0.05). Conclusions Fetal chorion was uniformly thinner at rupture site compared to distant sites. In PPROM BAPTA fetal chorion we demonstrated pronounced global thinning. Although cause or consequence is uncertain bacterial presence is greatest and inversely correlated with chorion thinning among PPROM subjects. Introduction Complications of preterm birth are complex costly and not limited to birth. Mothers of preterm infants have increased rates of: postpartum depression and operative delivery with longer hospital stays. Neonatal consequences are both immediate such as respiratory distress  necrotizing enterocolitis and feeding difficulties as well as delayed: childhood challenges with behavior learning   motor  and visual impairment  chronic lung diseases       and higher rates of infertility in adult survivors . Nearly one-third of all deliveries occurring preterm are BAPTA associated with preterm premature rupture of membranes (PPROM) . The need for an improved understanding of the factors initiating preterm membrane rupture is emphasized by the stable rate of preterm births over the last decade . Improved understanding of PPROM will lead to not only more successful treatment regimens but ultimately to prevention strategies. Women admitted with PPROM may develop clinical infection (chorioamnionitis) but many do not. Although patients do not have evidence of clinical infection bacteria can be found in their amniotic fluid and serum inflammatory markers may be elevated . The difference between pathologic bacterial presence (infection) versus symbiotic bacterial presence is not well understood. Further the correlation between bacterial presence and PPROM is not clear. It is likely that the ability to distinguish between intra-amniotic infection and intra-amniotic inflammation may be due to lack of methodology sensitive enough to detect organisms that are difficult to cultivate or are present in small quantities . Newer molecular techniques have improved the detection of fastidious organisms such as and that may be pathogenic in fetal membranes   . More recent studies have employed bacterial 16 s ribosomal sequencing to identify living and nonliving bacteria across broad taxonomic groups.   . However the impact of microbial invasion on fetal membrane architecture and integrity remains unclear in the pathogenesis of PPROM and deserves BAPTA further study. Fetal membrane integrity plays an important role in maintenance of pregnancy throughout gestation. The fetal membranes are primarily composed of two layers both derived from fetal tissue. The amnion is the innermost layer made up of a single layer of cuboidal epithelial cells and collagen . It provides the majority of tensile strength while in direct contact with the amniotic fluid. The chorion is a thicker outer layer with reticular and trophoblast cells and is in direct contact with maternal decidua. The chorion cell layer is metabolically.