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Biomechanics of the fetal membrane prior to mechanical failure: review and implications
Erinn M Joyce1, John J Moore, Michael S Sacks
1The Swanson School of Engineering, Department of Bioengineering, and the McGowan Institute, University of Pittsburgh, Pittsburgh, PA 15219, USA.
Insights
Premature rupture of fetal membranes (FM) is a leading cause of preterm birth. Understanding FM biomechanical properties and degradation is crucial for preventing this catastrophic event.
Area of Science:
- Reproductive biology
- Biomedical engineering
- Maternal-fetal medicine
Background:
- Premature birth is a significant public health issue, with 40% of cases initiated by preterm premature rupture of the membranes (pPROM).
- Fetal membrane (FM) rupture is a unique physiological failure, distinct from pathological tissue failures.
- Current understanding of the mechanisms causing FM failure and rupture is limited.
Purpose of the Study:
- To fully characterize the structural and biomechanical behavior of FMs.
- To investigate FM failure under sub-failure and failure conditions near term.
- To elucidate biological factors modulating FM failure and link biomechanical degradation to premature rupture.
Main Methods:
- Characterization of structural and biomechanical properties of FMs.
- Analysis of FM behavior under varying load conditions.
- Investigation of enzymatic degradation and its modulation by biomechanical load.
Main Results:
- FM rupture is a catastrophic failure with poorly understood mechanisms.
- Biomechanical loading may enhance enzymatic degradation of FMs.
- This degradation could link to premature mechanical failure.
Conclusions:
- Integrated biomechanical and biological analysis is needed to understand FM failure.
- Understanding these mechanisms can lead to interventions to prevent preterm birth.
- Further research can provide insights into anticipating and preventing preterm FM rupture.
Abstract:
Annually, premature birth is a major public health problem accounting for over 13,000 deaths and 30,000 surviving infants with life-long morbidity. Preterm premature rupture of the membranes is the initiating event leading to preterm birth of 40% of these premature infants. Fetal membrane (FM) rupture is a catastrophic tissue failure, a unique event in normal physiology; other tissue failures (bone breaks, aneurism ruptures) are pathological processes. The mechanisms which cause FM failure and thereby rupture are not understood. A full understanding of FM failure process requires a complete characterization of structural and biomechanical behavior at near/full term under sub-failure (forces well below that which induce rupture) and failure conditions as well as elucidating the biological factors which modulate its failure. The relatively, highly loaded state of the FM in vivo may also facilitate its susceptibility to enzymatic degradation, which was shown to be augmented with increased load in collagenous tissues. Indeed, this last observation may help to provide the link between biomechanical degradation and premature mechanical failure in the FM. This integrated approach will further the understanding of this unique physiological event and thereby provide insight into how to anticipate and when appropriate, intervene to prevent preterm FM rupture.
