Bacteria Localization and Chorion Thinning among Preterm Premature Rupture of MembranesReport as inadecuate

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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.


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 PPROM114.9 vs. PTL246.0 vs. PTNL200.8 vs. TL217.9 vs. TNL246.5. Bacteria counts were highest among PPROM subjects compared to all other groups regardless of site sampled or histologic infection PPROM31 vs. PTL9 vs. PTNL7 vs. TL7 vs. TNL6. 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.


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.

Author: Kimberly B. Fortner, Chad A. Grotegut, Carla E. Ransom, Rex C. Bentley, Liping Feng, Lan Lan, R. Phillips Heine, Patrick C. Seed,



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