title: Fetal membranes from term vaginal deliveries have a zone of weakness exhibiting characteristics of apoptosis and remodeling.
abstract: BACKGROUND
  Recently we identified a weak zone in term, pre-labor (repeat Cesarean section) human fetal membranes (FM) overlying the cervix with biochemical characteristics suggestive of apoptosis and collagen remodeling. We suggested that this weak zone is the FM rupture initiation site. Vaginally delivered patients have a weak zone in their FM overlying the cervix; a comparable weak zone lies adjacent to the tear line in FM after spontaneous rupture (SROM).
  
  
  METHODS
  FM from vaginally delivered patients with artificial rupture (AROM) and SROM were collected. FM of AROM patients were marked per vagina to identify the FM zone overlying the cervix. Postpartum FM were cut, strength tested, and piece strengths were remapped to their former location on a three-dimensional model. A 10-cm diameter zone centered on the marked area (AROM), or defined weak zone (SROM) was compared with the remaining FM.
  
  
  RESULTS
  AROM FM exhibit a para-cervical weak zone. SROM FM exhibit a comparable zone on the tear line. The mean rupture strength within weak zones was 60% of the remaining membranes (P <.001). AROM and SROM FM weak zones both exhibit increased matrix metalloproteinase 9, increased poly (ADP-ribose) polymerase I cleavage, decreased tissue inhibitor of metalloproteinase 3 protein, and histology consistent with remodeling and apoptosis.
  
  
  CONCLUSIONS
  Vaginally delivered AROM FM contain a weak zone overlying the cervix. Vaginally delivered SROM FM contain a weak zone adjacent to the tear line that exhibits biochemical and mechanical characteristics suggestive of collagen remodeling and apoptosis comparable to those of the AR FM weak zone.
authors.affiliation: Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Mohammed
authors.initials: M
authors.lastname: El Khwad
authors.forename: Vishal
authors.initials: V
authors.lastname: Pandey
authors.forename: Bradley
authors.initials: B
authors.lastname: Stetzer
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.forename: Robert M
authors.initials: RM
authors.lastname: Moore
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fox
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Redline
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Mansour
authors.forename: John J
authors.initials: JJ
authors.lastname: Moore
mesh_terms: D017209:Apoptosis; D001696:Biomechanical Phenomena; D015153:Blotting, Western; D002584:Cervix Uteri; D003094:Collagen / Q000378:metabolism*; D036861:Delivery, Obstetric; D004591:Electrophoresis, Polyacrylamide Gel; D005321:Extraembryonic Membranes / Q000166:cytology* / Q000378:metabolism*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology; D006801:Humans; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D000071137:Poly (ADP-Ribose) Polymerase-1; D011065:Poly(ADP-ribose) Polymerases / Q000378:metabolism; D011247:Pregnancy; D019717:Tissue Inhibitor of Metalloproteinase-3 / Q000378:metabolism
chemical_list: C088390:TIMP3 protein, human; D019717:Tissue Inhibitor of Metalloproteinase-3; D003094:Collagen; C499320:PARP1 protein, human; D000071137:Poly (ADP-Ribose) Polymerase-1; D011065:Poly(ADP-ribose) Polymerases; D020780:Matrix Metalloproteinase 9