Banerjee S, Sanyal S, Banerjee U, Sanyal M K, Dasgupta J
Department of Pathology, Eden Hospital, Medical College, Calcutta.
J Indian Med Assoc. 1997 Sep;95(9):500-4.
One hundred two (102) cases of pre-labour rupture of membrane (PROM) were studied and special attention was given to the histological study of the amniotic membrane as well as to the bacteriological study of high vaginal flora, cervical flora and flora of amniotic fluid, in search of probable causes or factors leading to PROM. The incidence was found to be 3.16% in the age group of 20-25 years without any relation to parity; and the duration of gestation was 38 to 40 weeks in most of the cases. The histological study revealed: (a) Focally denuded amniotic epithelium, focally separated amniotic epithelium from chorion layer, lesser density of focal squamoid change of the epithelium and thicker chorion layer probably indicating focal immaturity of the chorio-amnion, (b) lesser thickness of collagen layer, focal hydropic degeneration and mild cellular infiltrate, (c) presence of focal hyaline degeneration and focal calcification of chorio-amnion. Microbial culture revealed: (a) Higher rate of positive culture in high vaginal swab, cervical swab and amniotic fluid showing presence predominantly of Esch coli, Strept haemolyticus, klebseilla species, Staph aureus, Strept non-haemolyticus, proteus species and pseudomonas species against that of positive cultures in the control cases, (b) no anaerobic bacteria from high vaginal swab, cervical swab or from amniotic fluid. It was presumed that focal immaturity of chorio-amnion or focal irregularity in the chorio-amnion at the microscopical level, focal degeneration of collagen superadded with bacterial infection, however mild, could be the factors leading to weakness in the tensile strength of chorio-amnion, again leading to PROM, in the face of stress factors of foetal origin.
对102例胎膜早破（PROM）病例进行了研究，并特别关注了羊膜的组织学研究以及高阴道菌群、宫颈菌群和羊水菌群的细菌学研究，以寻找导致胎膜早破的可能原因或因素。发现20 - 25岁年龄组的发病率为3.16%，与产次无关；大多数病例的孕周为38至40周。组织学研究显示：（a）羊膜上皮局部剥脱，羊膜上皮与绒毛膜层局部分离，上皮局部鳞状化生密度较低，绒毛膜层较厚，可能提示绒毛膜羊膜局部不成熟；（b）胶原层厚度较薄，局部水样变性和轻度细胞浸润；（c）绒毛膜羊膜存在局部透明变性和局部钙化。微生物培养显示：（a）高阴道拭子、宫颈拭子和羊水的阳性培养率较高，主要表现为大肠杆菌、溶血性链球菌、克雷伯菌属、金黄色葡萄球菌、非溶血性链球菌、变形杆菌属和假单胞菌属，而对照病例的阳性培养率较低；（b）高阴道拭子、宫颈拭子或羊水均未检出厌氧菌。据推测，绒毛膜羊膜在显微镜下的局部不成熟或局部不规则，胶原的局部变性加上细菌感染（无论多么轻微），可能是导致绒毛膜羊膜抗张强度减弱的因素，进而在胎儿源性应激因素作用下导致胎膜早破。
