Amniotic Membrane in Health and Disease: An Obstetrical Perspective

Chapter

Abstract

Amnion, chorion and decidua form a complex unit, both anatomically and functionally. In normal pregnancy they constitute a border that simultaneously separates and relates the foetal and maternal environments. The balance between formation and degradation of membrane components is a physiological phenomenon that can be found throughout pregnancy. Moreover, during pregnancy there is an equilibrated balance between membrane degradation and formation; under some circumstances, an imbalance may ensue, resulting in membrane rupture. Immunological interactions between mother and foetus occur not only at the placental level, but also where the membranes (amnion and chorion) contact the deciduas. The amniotic membrane appears to be an immune privileged tissue and to contain some immunoregulatory factors. Therefore, a successful pregnancy seems to be the consequence of numerous interactions between the receptive uterus and the mature blastocyst, under immunohumoral control. Implantation and parturition are specifically characterized by mechanisms of local inflammatory activity. Sequential processes lead to a common pathway of parturition involving increased uterine contractility, cervical ripening and decidual/foetal membrane activation. In human amnion and decidua there is increased production of prostaglandins during parturition; in fact, labour may result from changes in prostaglandin availability within the uterus. Therefore, the process of giving birth may be abnormally initiated out of time by any interference, as membrane mechanical rupture or the action of infectious agents. Chorioamnionitis is the microbial invasion of the amniotic cavity through amnion, which induces a systemic inflammatory reaction. Foetal exposure to infection may lead to perinatal death, neonatal sepsis and other postnatal complications.

Keywords

Preterm birth Amniotic membrane Chorioamnionitis Fetal inflammatory response syndrome Reproductive immunology 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Pasquier J, Doret M (2008) Fetal membranes: embryological development, structure and the physiopathology of the preterm premature rupture of membranes. J Gynecol Obstet Biol Reprod (Paris) 37:579–588CrossRefGoogle Scholar
  2. 2.
    Cunningham FG, Leveno KJ, Bloom SL et al (2009) Implantation, embryogenesis and placental development. In: Cunningham FG, Leveno KJ, Bloom SL et al (eds) Williams Obstet, 23rd edn. McGraw-Hill Professional, Slock, London, p 1404Google Scholar
  3. 3.
    Chen S-J, Liu Y-L, Sytwu H-K (2012) Immunologic regulation in pregnancy: from mechanism to therapeutic strategy for immunomodulation. Clin Dev Immunol 258391:10Google Scholar
  4. 4.
    Bulmer J, Morrison L, Longfellow M et al (1991) Granulated lymphocytes in human endometrium: histochemical and immunohistochemical studies. Hum Reprod 6:791–798PubMedGoogle Scholar
  5. 5.
    Hanssens S, Salzet M, Vinatier D (2012) Immunological aspect of pregnancy. J Gynecol Obstet Biol Reprod (Paris) 41:595–611CrossRefGoogle Scholar
  6. 6.
    Von Rango U (2008) Fetal tolerance in human pregnancy – a crucial balance between acceptance and limitation of trophoblast invasion. Immunol Lett 115:21–32CrossRefGoogle Scholar
  7. 7.
    Mor G, Abrahams VM (2008) The immunology of pregnancy. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice, 8th edition Elsevier Health Sciences, Philadelphia, 87–99Google Scholar
  8. 8.
    Craven C, Morgan T, Ward K (1998) Decidual spiral artery remodelling begins before cellular interaction with cytotrophoblasts. Placenta 19:241–252PubMedCrossRefGoogle Scholar
  9. 9.
    Kammerer U, Kruse A, Barrientos G et al (2008) Role of dendritic cells in the regulation of maternal immune responses to the fetus during mammalian gestation. Immunol Invest 37:499–533PubMedCrossRefGoogle Scholar
  10. 10.
    Plaks V, Birnberg T, Berkutzki T et al (2008) Uterine DCs are crucial for decidua formation during embryo implantation in mice. J Clin Invest 118:3954–3965PubMedCentralPubMedGoogle Scholar
  11. 11.
    Ross MG (2011) Inflammatory mediators weaken the amniotic membrane barrier through disruption of tight junctions. J Physiol 589:5PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Gaudin P, Troame C, Monier F et al (1998) Protéolyse matricielle, protéolyse focalisée et inflammation. Ann Biol Clin (Paris) 56:661–669Google Scholar
  13. 13.
    Menon R, Fortunato SJ (2004) The role of matrix degrading enzymes and apoptosis in repture of membranes. J Soc Gynecol Investig 11:427–437PubMedCrossRefGoogle Scholar
  14. 14.
    Vinatier D, Dufour P, Subtil D (1996) Apoptosis: a programmed cell death involved in ovarian and uterine physiology. Eur J Obstet Gynecol Reprod Biol 67:85–102PubMedCrossRefGoogle Scholar
  15. 15.
    Bryant-greenwood GD, Millar LK (2000) Human fetal membranes: their preterm premature rupture. Biol Reprod 63:1575–1579PubMedCrossRefGoogle Scholar
  16. 16.
    Mercer BM, Goldenberg RL, Das AF et al (2003) What we have learned regarding antibiotic therapy for the reduction of infant morbidity after preterm premature rupture of the membranes. Semin Perinatol 27:217–230PubMedCrossRefGoogle Scholar
  17. 17.
    Newton ER (2005) Preterm labor, preterm premature rupture of membranes and chorioamnionitis. Clin Perinatol 32:571–600PubMedCrossRefGoogle Scholar
  18. 18.
    Goldenberg RL, Hauth JC, Andrews WW (2000) Intrauterine infection and preterm delivery. N Engl J Med 342:1500–1507PubMedCrossRefGoogle Scholar
  19. 19.
    Chibbar R, Wong S, Miller F, Mitchell B (1995) Estrogen stimulates oxytocin gene expression in human chorio-decidua. J Clin Endocrinol Metab 80:567–572PubMedGoogle Scholar
  20. 20.
    Oh S-Y, Kim CJ, Park I et al (2005) Progesterone receptor isoform (A/B) ratio of human fetal membranes increases during term parturition. Am J Obstet Gynecol 193:1156–1160PubMedCrossRefGoogle Scholar
  21. 21.
    Weiss G, Goldsmith LT (2005) Mechanisms of relaxin-mediated premature birth. Ann N Y Acad Sci 1041:345–350PubMedCrossRefGoogle Scholar
  22. 22.
    Petersen L, Skajaa K, Uldbjerg N (1992) Serum relaxin as a potential marker for preterm labour. Br J Obstet Gynaecol 99:292–295PubMedCrossRefGoogle Scholar
  23. 23.
    Vogel I, Goepfert AR, Møller HJ et al (2006) Early mid-trimester serum relaxin, soluble CD163 and cervical length in women at high risk for preterm delivery. Am J Obstet Gynecol 195:208–214PubMedCrossRefGoogle Scholar
  24. 24.
    Lowndes K, Amano A, Yamamoto S, Bryant-Greenwood G (2006) The human relaxin receptor (LGR7): expression in the fetal membranes and placenta. Placenta 27:610–618PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Rocha FG, Slavin TP, Li D et al (2013) Genetic associations of relaxin: preterm birth and premature rupture of fetal membranes. Am J Obstet Gynecol 209:258.e1–258.e8CrossRefGoogle Scholar
  26. 26.
    Ulm B, Ulm M, Bernaschek G (1999) Unfused amnion and chorion after 14 weeks of gestation: associated fetal structural and chromosomal abnormalities. Ultrasound Obstet Gynecol 13:392–395PubMedCrossRefGoogle Scholar
  27. 27.
    Woods JR, Plessinger MA, Miller RK (2001) Vitamins C and E: missing links in preventing preterm premature rupture of membranes? Am J Obstet Gynecol 185:5–10PubMedCrossRefGoogle Scholar
  28. 28.
    Moore R, Mansour J, Redline R et al (2006) The physiology of fetal membrane rupture: insight gained from the determination of physical properties. Placenta 27:1037–1051PubMedCrossRefGoogle Scholar
  29. 29.
    Iams J, Stilson R, Johnson F et al (1990) Symptoms that precede preterm labor and preterm premature rupture of the membranes. Am J Obstet Gynecol 162:486–490PubMedCrossRefGoogle Scholar
  30. 30.
    Arikat S, Novince RW, Mercer BM et al (2006) Separation of amnion from choriodecidua is an integral event to the rupture of normal term fetal membranes and constitutes a significant component of the work required. Am J Obstet Gynecol 194:211–217PubMedCrossRefGoogle Scholar
  31. 31.
    Medawar P (1953) Some immunological and endocrinological problems raised by the evolution of viviparity in vertebrate. Symp Soc Exp Biol 7:320–338Google Scholar
  32. 32.
    van Nieuwenhoven AV, Heineman M, Faas M (2003) The immunology of successful pregnancy. Hum Reprod Update 9:347–357CrossRefGoogle Scholar
  33. 33.
    Kubo M, Sonoda Y, Muramatsu R, Usui M (2001) Immunogenicity of human amniotic membrane in experimental xenotransplantation. Invest Ophthalmol Vis Sci 42:1539–1546PubMedGoogle Scholar
  34. 34.
    Mor G (2011) Clinical aspect of reproductive immunology. Am J Reprod Immunol 66:451PubMedCrossRefGoogle Scholar
  35. 35.
    Saito S, Nakashima A, Shima T, Ito M (2010) Th1/Th2/Th17 and regulatory T-cell paradigm in pregnancy. Am J Reprod Immunol 63:601–610PubMedCrossRefGoogle Scholar
  36. 36.
    Challis JR, Lockwood CJ, Myatt L et al (2009) Inflammation and pregnancy. Reprod Sci 16:206–215PubMedCrossRefGoogle Scholar
  37. 37.
    Thaxton JE, Nevers TA, Sharma S (2010) TLR-mediated preterm birth in response to pathogenic agents. Infect Dis Obstet Gynecol 378472:1–8CrossRefGoogle Scholar
  38. 38.
    Van Mourik MS, Macklon NS, Heijnen CJ (2009) Embryonic implantation: cytokines, adhesion molecules and immune cells in establishing an implantation environment. J Leukoc Biol 85:4–19PubMedCrossRefGoogle Scholar
  39. 39.
    Norman JE, Bollapragada S, Yuan M, Nelson SM (2007) Inflammatory pathways in the mechanism of parturition. BMC Pregnancy Childbirth 7:1–4CrossRefGoogle Scholar
  40. 40.
    Mendelson CR (2009) Minireview: fetal-maternal hormonal signaling in pregnancy and labor. Mol Endocrinol 23:947–954PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Kelly RW, King AE, Critchley HO (2001) Cytokine control in human endometrium. Reproduction 121:3–19PubMedCrossRefGoogle Scholar
  42. 42.
    Creasy RK, Resnik R, Iams JD et al (2008) Creasy and Resnik’s maternal-fetal medicine: principles and practice, 7th edn. Elsevier Health Sciences, PhiladelphiaGoogle Scholar
  43. 43.
    Behrman RE, Butler AS (2007) Biological pathways leading to preterm birth. In: Behrman RE, Butler AS (eds) Preterm birth causes, consequences prev. The National Academies Press, Washington, p 790Google Scholar
  44. 44.
    Protonotariou E, Chrelias C, Kassanos D et al (2010) Immune response parameters during labor and early neonatal life. In Vivo (Brooklyn) 24:117–124Google Scholar
  45. 45.
    Romero R, Brody DT, Oyarzun E et al (1989) Infection and labor. III. Interleukin-1: a signal for the onset of parturition. Am J Obstet Gynecol 160:1117–1123PubMedCrossRefGoogle Scholar
  46. 46.
    Lindström TM, Bennett PR (2005) The role of nuclear factor kappa B in human labour. Reproduction 130:569–581PubMedCrossRefGoogle Scholar
  47. 47.
    Gibb W (1998) The role of prostaglandins in human parturition. Ann Med 30:235–241PubMedCrossRefGoogle Scholar
  48. 48.
    Gantert M, Been J, Gavilanes A et al (2010) Chorioamnionitis: a multiorgan disease of the fetus? J Perinatol 30:S21–S30PubMedCrossRefGoogle Scholar
  49. 49.
    Choi SJ, Jung S-H, Eom M et al (2012) Immunohistochemical distribution of toll-like receptor 4 in preterm human fetal membrane. J Obstet Gynaecol Res 38:108–112PubMedCrossRefGoogle Scholar
  50. 50.
    Holst D, Garnier Y (2008) Preterm birth and inflammation: the role of genetic polymorphisms. Eur J Obstet Gynecol Reprod Biol 141:3–9PubMedCrossRefGoogle Scholar
  51. 51.
    Parry S, Holder J, Strauss JF III (1997) Mechanisms of trophohlast-virus interaction. J Reprod Immunol 37:25–34PubMedCrossRefGoogle Scholar
  52. 52.
    Arechavaleta-Velasco F, Koi H, Strauss JF, Parry S (2002) Viral infection of the trophoblast: time to take a serious look at its role in abnormal implantation and placentation? J Reprod Immunol 55:113–121PubMedCrossRefGoogle Scholar
  53. 53.
    Gomez R, Ghezzi F, Romero R et al (1995) Premature labor and intra-amniotic infection. Clinical aspects and role of the cytokines in diagnosis and pathophysiology. Clin Perinatol 22:281–342PubMedGoogle Scholar
  54. 54.
    Romero R, Sirtori M, Oyarzun E et al (1989) Infection and labor. V. Prevalence, microbiology and clinical significance of intraamniotic infection in women with preterm labor and intact membranes. Am J Obstet Gynecol 161:817–824PubMedCrossRefGoogle Scholar
  55. 55.
    Romero R, Mazor M, Brandt F et al (1992) Interleukin-1 alpha and interleukin-1 beta in preterm and term human parturition. Am J Reprod Immunol 27:117–123PubMedCrossRefGoogle Scholar
  56. 56.
    Romero R, Mazor M, Sepulveda W et al (1992) Tumor necrosis factor in preterm and term labor. Am J Obstet Gynecol 166:1576–1587PubMedCrossRefGoogle Scholar
  57. 57.
    Romero R, Mazor M (1988) Infection and preterm labor. Clin Obstet Gynecol 31:553–584PubMedCrossRefGoogle Scholar
  58. 58.
    Tita AT, Andrews WW (2010) Diagnosis and management of clinical chorioamnionitis. Clin Perinatol 37:339–354PubMedCentralPubMedCrossRefGoogle Scholar
  59. 59.
    Park C-W, Moon KC, Park JS et al (2009) The involvement of human amnion in histologic chorioamnionitis is an indicator that a fetal and an intra-amniotic inflammatory response is more likely and severe: clinical implications. Placenta 30:56–61PubMedCentralPubMedCrossRefGoogle Scholar
  60. 60.
    Yoon BH, Romero R, Bin MJ et al (2001) Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol 185:1130–1136PubMedCrossRefGoogle Scholar
  61. 61.
    Seong H, Lee S, Kang J et al (2008) The frequency of microbial invasion of the amniotic cavity and histologic chorioamnionitis in women at term with intact membranes in the presence or absence of labor. Am J Obstet Gynecol 199:1–9CrossRefGoogle Scholar
  62. 62.
    Lockwood C (1994) Recent advances in elucidating the pathogenesis of preterm delivery, the detection of patients at risk, and preventative therapies. Curr Opin Obstet Gynecol 6:7–18PubMedCrossRefGoogle Scholar
  63. 63.
    Rechberger T, Woessner JJ (1993) Collagenase, its inhibitors, and decorin in the lower uterine segment in pregnant women. Am J Obstet Gynecol 168:1598–1603PubMedCrossRefGoogle Scholar
  64. 64.
    Lahra M, Beeby P, Jeffery H (2009) Maternal versus fetal inflammation and respiratory distress syndrome: a 10-year hospital cohort study. Arch Dis Child Fetal Neonatal Ed 94:13–16CrossRefGoogle Scholar
  65. 65.
    Gotsch F, Romero R, Kusanovic J et al (2007) The fetal inflammatory response syndrome. Clin Obstet Gynecol 50:652–683PubMedCrossRefGoogle Scholar
  66. 66.
    Ross MG, Beall MH (2008) Amniotic fluid dynamics. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice, 8th edition Elsevier Health Sciences, Philadelphia, 47–54Google Scholar
  67. 67.
    Calvo RM, Jauniaux E, Gulbis B et al (2002) Fetal tissues are exposed to biologically relevant free thyroxine concentrations during early phases of development. J Clin Endocrinol Metab 87:1768–1777PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Faculty of MedicineUniversity of CoimbraCoimbraPortugal
  2. 2.Obstetric Unit ACoimbra Hospital and Universitary CenterCoimbraPortugal

Personalised recommendations