Bacteria localization and chorion thinning among preterm premature rupture of membranes.
Abstract
OBJECTIVE: Bacterial colonization of the fetal membranes and its role in pathogenesis
of membrane rupture is poorly understood. Prior retrospective work revealed chorion
layer thinning in preterm premature rupture of membranes (PPROM) subjects. Our objective
was to prospectively examine fetal membrane chorion thinning and to correlate to bacterial
presence in PPROM, preterm, and term subjects. STUDY DESIGN: Paired membrane samples
(membrane rupture and membrane distant) were prospectively collected from: PPROM = 14,
preterm labor (PTL = 8), preterm no labor (PTNL = 8), term labor (TL = 10), and term
no labor (TNL = 8), subjects. Sections were probed with cytokeratin to identify fetal
trophoblast layer of the chorion using immunohistochemistry. Fluorescence in situ
hybridization was performed using broad range 16 s ribosomal RNA probe. Images were
evaluated, chorion 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 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.
Type
Journal articleSubject
AdultAmnion
Bacteria
Chorion
Colony Count, Microbial
Fetal Membranes, Premature Rupture
Gestational Age
Humans
Immunohistochemistry
In Situ Hybridization, Fluorescence
Least-Squares Analysis
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https://hdl.handle.net/10161/8299Published Version (Please cite this version)
10.1371/journal.pone.0083338Publication Info
Murtha, AP; Fortner, KB; Grotegut, CA; Ransom, CE; Bentley, RC; Feng, L; ... Seed,
PC (2014). Bacteria localization and chorion thinning among preterm premature rupture of membranes.
PLoS One, 9(1). pp. e83338. 10.1371/journal.pone.0083338. Retrieved from https://hdl.handle.net/10161/8299.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Rex Colle Bentley
Professor of Pathology
Outcome-based research on pathology of endometrial carcinoma, including prognostic
significance of histologic features of endometrial carcinoma, variants of endometrial
carcinoma, definitions of atypia and well-differentiated carcinoma, and collaborative
studies of oncogenes and tumor suppressor genes in endometrial carcinoma. Endometrial
pathology, especially as it relates to molecular/genetic alterations in neoplasms.
Ovarian pathology, especially as it relates to
Liping Feng
Associate Professor of Obstetrics and Gynecology
Liping Feng, MD's research has focused on understanding the mechanisms of pregnancy
complications associated with placental development. These works are translated then
to the clinical care of women through studies dedicated to identify risk factors and
novel biomarkers for early prediction and prevention of adverse birth outcomes.
Dr. Feng devotes her entire career to improving pregnancy outcomes through innovative
research. Dr. Feng conducts both basic science/laboratory research, a
Chad Aaron Grotegut
Associate Professor of Obstetrics and Gynecology
I am a specialist in maternal-fetal medicine, which is a subspecialty of OB/GYN that
focuses on the care of women with high-risk pregnancies. I serve as the Medical Director
of the Labor and Delivery Unit at Duke University Hospital. In that role, and together
with our outstanding unit team members, we have the opportunity to help women and
their families ensure that they have the safest and best labor and delivery experience
possible. My specific clinical int
Robert Phillips Heine
Professor of Obstetrics and Gynecology
Amy Patricia Murtha
Professor of Obstetrics and Gynecology
Dr. Amy Murtha is a Professor in the Department of Obstetrics and Gynecology and Department
of Pediatrics, and past Vice Chair for Research in Obstetrics and Gynecology. After
graduating from the Medical College of Pennsylvania in 1992 she completed her residency
in OB-GYN and fellowship in Maternal Fetal Medicine (MFM) at Duke University then
joined the faculty at Duke in 1998.
Dr. Murtha served as interim Chair for the Department of OB-GYN and Fellowship Director
for the mater
Patrick Casey Seed
Associate Professor of Pediatrics
We are studying human microbial ecology and the molecular basis for different bacterial
infections that are of relevance to both children and adults. Summaries of the research
areas are described below: 1. THE MOLECULAR BASIS FOR VIRULENCE OF UROPATHOGENIC
ESCHERICHIA COLI AND URINARY TRACT INFECTIONS. Uropathogenic Escherichia coli (UPEC)
is the leading cause of community-acquired urinary tract infections (UTIs). Over
100 million UTIs occur annually throughout the world inclu
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