STRUCTURAL CHARACTERISTICS OF TERM HUMAN FETAL MEMBRANES - A NOVEL ZONE OF EXTREME MORPHOLOGICAL ALTERATION WITHIN THE RUPTURE SITE
STRUCTURAL CHARACTERISTICS OF TERM HUMAN FETAL MEMBRANES - A NOVEL ZONE OF EXTREME MORPHOLOGICAL ALTERATION WITHIN THE RUPTURE SITE
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DOI：
10.1111/j.1471-0528.1994.tb11908.x
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发表时间：
1994-05-01
期刊：
影响因子：
--
通讯作者：
BELL, SC
中科院分区：
文献类型：
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作者：
MALAK, TM;BELL, SC
目的探讨分娩后足月胎膜（羊膜和蜕膜）自发破裂部位的结构特点。设计14个足月胎儿在分娩后立即在光学显微镜下检查胎膜。沿着整个破裂部位和该部位与胎盘边缘之间的轴取多个样本。对胎膜组成层的厚度进行形态计量学分析。设置莱斯特皇家医院妇产医院。结果在所有患者的破裂部位都发现了一个极端形态学改变的限制区，其特征是结缔组织明显肿胀和破坏，滋养层变薄，蜕膜变薄或没有。膜层厚度的形态计量学分析表明，这些变化以及结缔组织层厚度与滋养层和蜕膜层厚度之比（称为胎膜形态计量指数）在形态极端改变区与其他膜区之间具有显著性。结论形态学极端改变带的形态特征表明它代表了细胞膜结构薄弱的区域。由于该区域不包括破裂部位的整个长度，因此它很可能在膜破裂之前就存在，并在怀孕期间产生。我们假设极端改变形态的区域代表了最初破裂的部位，之后撕裂通过膜传播产生破裂部位。如果这些变化变得更加极端，则可能发生产前膜破裂。进一步表征该区域可能有助于了解其发生机制及其在胎膜破裂易感性中的作用。
Objective To determine the structural characteristics of the rupture site of term fetal membranes (amniochorion and decidua) that rupture spontaneously after the onset of labour.Design Fourteen term fetal membranes were examined immediately after delivery at the light microscope level. Multiple samples were taken along the whole rupture site and along an axis between this site and placental edge. Morphometric analysis of the thickness of the constituent layers of the fetal membranes was performed.Setting Leicester Royal Infirmary Maternity Hospital.Results A restricted zone of extreme altered morphology, characterised by marked swelling and disruption of the connective tissue, thinning of the trophoblast layer and thinning or absence of decidua, was identified in the rupture site of all patients. Morphometric analysis of the thickness of membrane layers showed that these changes and the ratio between the thickness of the connective tissue layers and that of the trophoblast and decidua (termed fetal membrane morphometric index) were significant between the zone of extreme altered morphology and the rest of the membranes.Conclusions The morphological features of the zone of extreme altered morphology suggests that it represents an area of structural weakness of the membranes. Since this zone did not include the whole length of the rupture site, it is likely that it was present before membrane rupture and was generated during pregnancy. We hypothesise that the zone of extreme altered morphology represents the site of initial rupture after which the tear is transmitted through the membranes to produce the rupture site. It is possible that if these changes become more extreme, then prelabour membrane rupture may occur. Further characterisation of this zone may help to understand the mechanism of its genesis and its role in predisposing the fetal membranes to rupture.