title: Function and failure of the fetal membrane: Modelling the mechanics of the chorion and amnion.
abstract: The fetal membrane surrounds the fetus during pregnancy and is a thin tissue composed of two layers, the chorion and the amnion. While rupture of this membrane normally occurs at term, preterm rupture can result in increased risk of fetal mortality and morbidity, as well as danger of infection in the mother. Although structural changes have been observed in the membrane in such cases, the mechanical behaviour of the human fetal membrane in vivo remains poorly understood and is challenging to investigate experimentally. Therefore, the objective of this study was to develop simplified finite element models to investigate the mechanical behaviour and rupture of the fetal membrane, particularly its constituent layers, under various physiological conditions. It was found that modelling the chorion and amnion as a single layer predicts remarkably different behaviour compared with a more anatomically-accurate bilayer, significantly underestimating stress in the amnion and under-predicting the risk of membrane rupture. Additionally, reductions in chorion-amnion interface lubrication and chorion thickness (reported in cases of preterm rupture) both resulted in increased membrane stress. Interestingly, the inclusion of a weak zone in the fetal membrane that has been observed to develop overlying the cervix would likely cause it to fail at term, during labour. Finally, these findings support the theory that the amnion is the dominant structural component of the fetal membrane and is required to maintain its integrity. The results provide a novel insight into the mechanical effect of structural changes in the chorion and amnion, in cases of both normal and preterm rupture.
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Stefaan W
authors.identifier: http://orcid.org/0000-0002-2321-1367
authors.initials: SW
authors.lastname: Verbruggen
authors.affiliation: Engineering Department, University of Cambridge, Trumpington Street, Cambridge, United Kingdom.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Oyen
authors.affiliation: Structural Biomechanics, Department of Civil and Environmental Engineering, Imperial College London, London, United Kingdom.
authors.forename: Andrew T M
authors.initials: AT
authors.lastname: Phillips
authors.affiliation: Department of Bioengineering, Imperial College London, London, United Kingdom.
authors.forename: Niamh C
authors.initials: NC
authors.lastname: Nowlan
mesh_terms: D000465:Algorithms; D000650:Amnion / Q000502:physiology* / Q000503:physiopathology; D002584:Cervix Uteri / Q000502:physiology* / Q000503:physiopathology; D002823:Chorion / Q000502:physiology* / Q000503:physiopathology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000503:physiopathology; D020342:Finite Element Analysis; D005865:Gestational Age; D006801:Humans; D007743:Labor, Obstetric; D011247:Pregnancy; D013314:Stress, Mechanical; D047929:Term Birth; D014599:Uterus / Q000502:physiology* / Q000503:physiopathology