The effect of very prolonged membrane rupture on fetal development

Nimrod, Carl; Varela-Gittings, Frances; Machin, Geoffrey A.; Campbell, Denise; Wesenberg, Richard L.

doi:10.1016/0002-9378(84)90743-9

Cited by 168 publications

(55 citation statements)

References 10 publications

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“…However, recent clinical evidence suggests that another threat should be considered when rupture of the membranes leads to oligohydramnios, i.e. fetal lung hypoplasia (22,23). Clinically we are particularly interested in what happens to lung growth with oligohydramnios during the canalicular to early terminal sac stages of lung development.…”

Section: Discussionmentioning

confidence: 99%

Oligohydramnios-Induced Lung Hypoplasia: The Influence of Timing and Duration in Gestation

et al. 1986

Pediatr Res

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MATERIALS AND METHODSplasia is also found as an isolated anomaly (3,4) or in association with minor deformities compatible with survival, i.e. oligohydramnios deformation sequence following prolonged rupture of the fetal membranes (5).Over 20 years ago, both Blanc et al. (6) and Bain et al. (7) demonstrated, using perinatal autopsy data, that prolonged oligohydramnios, irrespective of its cause, was associated with fetal lung hypoplasia. More recently, experimental evidence derived from work in various mammalian species confirmed this association (8-11). Two important questions remain unanswered: I) what is the mechanism by which lack of amniotic fluid interferes with fetal lung growth? 2) What are the influences of both gestational age at the onset of oligohydramnios, and its duration, on the degree of lung hypoplasia? This report focuses on the latter question using the guinea pig model of oligohydramnios. A preliminary account of these experiments has been published previously (12).Fetal lung growth proceeds in three consecutive stages, i.e. the pseudoglandular, canalicular, and terminal sac stages. Although this sequence is invariable, its timing in gestation varies among species. We induced oligohydramnios between days 40 and 55 of gestation in the guinea pig, a period roughly corresponding to 18 to 29 wk of gestation in the human. The five time-frames studied are illustrated in Figure I, along with the stages of fetal lung development involved. More specifically, the experiments were as follows: experiment A: drainage between days 40 and 45 (5 days); experiment B: drainage between 45 and 50 (5 days); experiment C: drainage between days 50 and 55 (5 days); experiment D: drainage between days 40 and 50 (10 days); experiment E: drainage between days 45 and 55 (10 days).All fetuses were sacrificed at the end of the 5-or 10-days study period to assess fetal and lung growth. In order to overcome the effects of variation between litters, we used untouched littermate fetuses as controls. Whenever possible, untouched littermate fetuses located at the same level in the opposite uterine horn were chosen as paired controls in order to control for the naturally occurring intralitter variation in fetal size.Pregnant guinea pigs (Cavia porcellus, Camm-Hartley strain) were obtained 30 days after mating from the Camm Research Laboratory, Wayne, NJ. Pregnant animals were caged individually and provided with guinea pig chow no. 5025 (Ralston Purina Co.) and tap water ad libitum. Following an overnight fast, the animals were anesthetized with intramuscular injections of ketamine hydrochloride (40 mg/kg) (Ketaset, Bristol Lab.) and acepromazine maleate (3 mg/kg) (Tech America Group, Inc.). After local anesthesia with lidocaine, a midline laparotomy was performed. Both uterine horns were exteriorized and the position of each fetus was recorded. Half the litter was randomly assigned to the experimental group and the other half served as 951 ABSTRACf. We drained amniotic fluid for periods of 5 and 10 days at various times in g...

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Section: Discussionmentioning

confidence: 99%

Oligohydramnios-Induced Lung Hypoplasia: The Influence of Timing and Duration in Gestation

et al. 1986

Pediatr Res

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“…Our results show that clinical suspicion of chorioamnionitis is related with a higher incidence of neonatal infection but not with higher neonatal death rate. Hypoplastic lungs after prolonged PROM is well described [26,37]. For some authors, PROM does not affect the growth process [3,18] but for others, PROM slows the growth [5,35].…”

Section: Discussionmentioning

confidence: 99%

“…Statistical analysis consisted of Chi-square tests of independence performed on groups separated by the procedure CROSSTAB of the statistical package SPSS [26]. When pregnancy is terminated because of the suspicion of chorioamnionitis, the neonatal outcome is compromised; the incidence of neonatal infection is significantly (P < 0.001) related to the suspicion of chorioamnionitis (table III).…”

Section: Methodsmentioning

confidence: 99%

Preterm premature rupture of the membranes: neonatal outcome in 215 cases of an active conservative management

Theunissen¹,

Vanlierde²

1989

Jpme

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“…Prolonged duration of oligohydramnios is associated with both greater incidence (22) and severity of pulmonary growth reduction (3) but lung hypoplasia has been diagnosed following oligohydramnios lasting less than 3 wk (i.e. less than 7.5% of gestation (3,22). Morphometric studies of lungs that are hypoplastic because of amniotic fluid leak have not been reported; in cases of renal agenesis and oligohydramnios, bronchi are reduced in number and alveoli are reduced in number and size (9).…”

mentioning

confidence: 99%

“…The time of onset and the duration of oligohydramnios both influence lung growth. The incidence of fetal lung hypoplasia is greater following rupture of membranes early (prior to 26 wk) compared to late in gestation (22). Prolonged duration of oligohydramnios is associated with both greater incidence (22) and severity of pulmonary growth reduction (3) but lung hypoplasia has been diagnosed following oligohydramnios lasting less than 3 wk (i.e.…”

mentioning

confidence: 99%

Morphometry of Hypoplastic Fetal Guinea Pig Lungs following Amniotic Fluid Leak

et al. 1986

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ABSTRACf. Deficient quantity of amniotic fluid causes fetal guinea pig lung hypoplasia. Oligohydramnios that lasts only 5 days in early gestation is sufficient to reduce fetal lung growth significantly. We quantitated lung structural alterations at 50 days gestation (term is 67 days) of fetal guinea pigs whose amniotic fluid was drained on day 45 gestation. The study period spans the late canalicularearly saccular phases of guinea pig lung growth. Compared to littermate controls (n = 4), experimental fetuses (n = 5) have reduced lung:body weight ratio (2.81 ± 0.16 versus 3.21 ± 0.20 x 10-2 , P < 0.01), indicating lung hypoplasia. Lung hypoplasia is a disorder of pulmonary growth resulting in lungs that are disproportionately small relative to body size. This condition is currently recognized in one of seven perinatal autopsies (I) and may be increasing in incidence (2).The clinical manifestations are likely to be determined by the degree of compromised pulmonary growth and range from tachypnea to irreversible pulmonary failure (3). Postmortem, hypoplasia is defined as reduced ratio of lung weight to body weight (4) and decreased lung DNA content (5). Radial alveolar count is a morphometric measurement of acinar complexity; in hypoplastic lungs counts are either reduced (4) or within normal range (6-9).There are multiple etiologies of lung hypoplasia and they can be categorized into disorders of amniotic fluid volume (10-12), disorders that compromise thoracic space (13-17), and disorders of the neuromuscular system (6, 18-21).Premature and prolonged rupture of fetal membranes with continuous leakage of amniotic fluid causes oligohydramnios and lung hypoplasia. The time of onset and the duration of oligohydramnios both influence lung growth. The incidence of fetal lung hypoplasia is greater following rupture of membranes early (prior to 26 wk) compared to late in gestation (22). Prolonged duration of oligohydramnios is associated with both greater incidence (22) and severity of pulmonary growth reduction (3) but lung hypoplasia has been diagnosed following oligohydramnios lasting less than 3 wk (i.e. less than 7.5% of gestation (3,22). Morphometric studies of lungs that are hypoplastic because of amniotic fluid leak have not been reported; in cases of renal agenesis and oligohydramnios, bronchi are reduced in number and alveoli are reduced in number and size (9).Over the last several years, we have developed a guinea pig model of fetal lung hypoplasia associated with oligohydramnios due to ruptured membranes (23). Our data show that in the guinea pig, as in the human, both early onset and prolonged duration influence the incidence and severity of fetal lung hypoplasia (24). Recently, Hislop et al. (25) reported the adverse effects of amniocentesis on fetal lung development in Macaca fascicularis; amniotic fluid, varying in amount from none to total volume, was withdrawn and the pulmonary sequelae were analyzed at term, 2 or more months following amniocentesis. Our study differs because we have induced complete o...

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The effect of very prolonged membrane rupture on fetal development

Cited by 168 publications

References 10 publications

Oligohydramnios-Induced Lung Hypoplasia: The Influence of Timing and Duration in Gestation

Oligohydramnios-Induced Lung Hypoplasia: The Influence of Timing and Duration in Gestation

Preterm premature rupture of the membranes: neonatal outcome in 215 cases of an active conservative management

Morphometry of Hypoplastic Fetal Guinea Pig Lungs following Amniotic Fluid Leak

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