Bacteria localization and chorion thinning among preterm premature rupture of membranes.

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2014

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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.

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10.1371/journal.pone.0083338

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Murtha, AP, KB Fortner, CA Grotegut, CE Ransom, RC Bentley, L Feng, L Lan, RP Heine, et al. (2014). Bacteria localization and chorion thinning among preterm premature rupture of membranes. PLoS One, 9(1). p. e83338. 10.1371/journal.pone.0083338 Retrieved from https://hdl.handle.net/10161/8299.

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Scholars@Duke

Bentley

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 molecular and genetic alterations in neoplasms.

Improving accuracy of radiographic screening for breast cancer, by careful patho-radiographic correlation and study of improved imaging techniques (especially ultrasound).

Use of electron microscopy as a diagnostic and research technique.

Objective measures of pathology resident performance.

Feng

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, as well as participates in clinical studies. Her laboratory has focused on understanding the mechanisms of placenta-originated pregnancy complications such as preeclampsia and still birth, which are important causes of perinatal and neonates’ mortality and morbidity. Currently, she has three lines of investigation focused on the roles of inflammation/infection, cell aging, and environmental exposure in placental development and subsequent pregnancy complications.

In addition, Dr. Feng has established an international collaboration in Global Women’s Health. She has affiliated with the Duke Global Health Institute (DGHI) and participates in a DGHI research. She has an interest in DGHI education, and service or policy initiatives, including mentoring and teaching graduate and professional students on fieldwork and research.


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