title: Fetal membrane imaging and the prediction of preterm birth: a systematic review, current issues, and future directions.
abstract: Preterm premature rupture of membranes (PPROM) is the largest identifiable cause of preterm birth. There is currently no good screening test for PPROM in low-risk asymptomatic patients. Our goal was to identify how imaging methods can be utilized for examining the risks for PPROM in asymptomatic patients.
  
  
  
  This paper is a systematic review of the literature on fetal membrane thickness and its use for the prediction of PPROM. Four key studies are identified and reviewed; two in vitro studies and two in vivo ultrasound studies each using differing methodologies. Additionally reviewed is a study using Optical Coherence Tomography, an emerging technique using near-infrared technology to produce high-resolution images.
  
  
  
  There is currently insufficient data to determine the association between fetal membrane thickness and PPROM by ultrasound.
  
  
  
  Fetal membrane thickness could have relevant clinical ramifications for the prediction of PPROM. Suggested improvements in study methodology and design will lead to progress in this area of research, as well as the use of newer technologies. Larger sample sizes, histological comparison, uniform methodologies for data collection, longitudinal study design and expanding data analysis beyond fetal membrane thickness to other properties would expand our knowledge in this field. In addition, transvaginal ultrasound should be utilized to improve resolution, as well as emerging methodologies such as MRI fusion imaging using ultrasound and Shear Wave Elastography.
authors.affiliation: Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Nunes
authors.affiliation: Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cross
authors.affiliation: Department of Mechanical and Nuclear Engineering, School of Engineering, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: John E
authors.initials: JE
authors.lastname: Speich
authors.affiliation: Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Danielle R
authors.initials: DR
authors.lastname: Morgan
authors.affiliation: Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Jerome F
authors.initials: JF
authors.lastname: Strauss
authors.affiliation: Department of Obstetrics & Gynecology, Virginia Commonwealth University, Richmond, VA, USA. ronald.ramus@vcuhealth.org.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Ramus
mesh_terms: D054459:Elasticity Imaging Techniques; D005321:Extraembryonic Membranes / Q000000981:diagnostic imaging*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D018570:Risk Assessment; D041623:Tomography, Optical Coherence; D016216:Ultrasonography, Prenatal
keywords: Amnion; Chorion; Fetal membrane; PROM; Premature rupture of membranes; Preterm birth; Preterm premature rupture of membranes; Ultrasound