Preterm Prelabour Rupture of the Membranes (PPROM)

PPROM occurs in up to 40% of preterm births and is a major cause of fetal and neonatal complications. Often the fetal membranes rupture due to infection in which case preterm birth (<37 weeks) commonly occurs. However, the fetal membranes can rupture without infection being present, due to other causes such as vaginal bleeding. Iatrogenic PPROM and subsequent preterm birth occurs commonly after amniocentesis and fetoscopic surgery, interventional fetal therapies that are increasingly used in fetal medicine. Healing of the fetal membrane is poor. The image below shows a hole in the amniotic membrane 10 weeks after a patient underwent fetoscopy for twin complications. This hole did not heal. Attempts to seal the defect using collagen plugs or blood patches is often ineffective. The mechanisms which promote fetal membrane healing are poorly understood.

Research over the last decade in collaboration between Professor Anna David and Queen Mary University of London (Dr Tina Chowdhury) has demonstrated the importance of Cx43, a stretch-sensitive protein which influences inflammation and the healing response. Modulating Cx43 expression to alter healing of the amniotic membrane is being investigated as a potential therapy (Costa et al, 2021). We have found early signs of wound contraction similar to a healing response in term and preterm amniotic membrane (Costa et al 2023) so it may be possible to enhance this healing response. We are now investigating this further.