Term human fetal membranes have a weak zone overlying the lower uterine pole and cervix before onset of labor
Term human fetal membranes have a weak zone overlying the lower uterine pole and cervix before onset of labor
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DOI：
10.1095/biolreprod.104.033647
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发表时间：
2005-03-01
影响因子：
3.6
通讯作者：
Moore, JJ
中科院分区：
文献类型：
--
作者：
El Khwad, M;Stetzer, B;Moore, JJ
胎膜（FM）破裂的病因尚不清楚。有人提出了一种假设，即 FM 通过胶原蛋白重塑和细胞凋亡过程而减弱，从而促进破裂。据报道，人类 FM 表现出一个组织学改变的区域，推测为 FM 破裂部位，但尚未证明伴随的 FM 弱点。我们假设妊娠晚期在子宫颈上的 FM 中形成了一个离散的 FM 区域，具有明显的弱点、组织学变化以及重塑和细胞凋亡的证据。来自接受产前剖腹产的妇女的 FM 组织在围手术期进行标记，以识别覆盖子宫颈的 FM，使用有助于将 FM 碎片的断裂强度重新映射到三维模型上的先前位置和方向的程序进行切割，并测试强度。将以宫颈标记为中心的 10 厘米 FM 区域与其余 FM 进行比较。颈部区域内的平均破裂强度是剩余 FM 的 55%。颈部区域还表现出 MMP-9 蛋白增加、金属蛋白酶组织抑制剂 3 (TIMP-3) 蛋白减少以及 PARP 裂解增加，这与之前报道的组织学改变区域一致。覆盖宫颈的足月前 FM 中存在离散的薄弱区域，并且具有与组织重塑和细胞凋亡一致的生化特征。
The etiology of fetal membrane (FM) rupture is unknown. A hypothesis that the FM weakens by a process of collagen remodeling and apoptosis to facilitate rupture has been proposed. Human FMs reportedly exhibit a zone of altered histology, postulated to be the FM rupture site, but concomitant FM weakness has not been demonstrated. We hypothesized that a discrete zone of FM with marked weakness, histological change, and evidence of remodeling and apoptosis, develops in late gestation in the FM overlying the cervix. FM tissue from women undergoing prelabor cesarean delivery were perioperatively marked to identify the FM overlying the cervix, cut with a procedure that facilitates remapping the rupture strength of FM pieces to their former location and orientation on a three-dimensional model, and tested for strength. A 10-cm FM zone centered at the cervical mark was compared with the remaining FM. Mean rupture strength within the cervical zone was 55% of the remaining FM. The cervical zone also exhibited increased MMP-9 protein, decreased tissue inhibitor of metalloproteinases-3 (TIMP-3) protein, and increased PARP cleavage coincident with the previously reported zone of altered histology. A discrete zone of weakness is present in term prelabor FMs overlying the cervix and has biochemical characteristics consistent with tissue remodeling and apoptosis.