Potential mechanisms for chorioamniotic membrane rupture after subchorionic hematoma - 25/07/25
Abstract |
Background |
Subchorionic hematoma is a risk factor for preterm prelabor rupture of membranes and preterm birth. A small proportion of persistent subchorionic hematoma leads to a chronic abruption–oligohydramnios sequence.
Objective |
To determine the mechanism by which subchorionic hematomas may damage chorioamniotic membranes.
Study Design |
1) The number and subtype of macrophages were determined by immunohistochemistry in chorioamniotic membranes from 8 subchorionic hematoma patients who delivered preterm (25.5 (24–32) weeks of gestation (median and range)) and 6 gestational age-matched control patients (25.5 (25–28) weeks of gestation (median and range)). Further, the thickness and fibrosis of the membranes were quantified. 2) We also developed an intrauterine hematoma model in pregnant mice, and the effects of hematoma on the amnion were analyzed by histology and immunofluorescence. 3) In vitro, primary human amnion mesenchymal cells were cocultured with M2-differentiated macrophages, and changes in mesenchymal cells were analyzed.
Results |
1) Subchorionic hematoma increased the number of iron-laden macrophages in the human amnion. These macrophages were CD206 + , a marker of macrophages required for the maintenance of homeostasis, tissue remodeling, and metabolic adaptations. The collagen layer of the amnion tended to be thickened in patients with subchorionic hematoma. Interestingly, α-smooth muscle actin + myofibroblasts were increased in the amnion mesenchymal layer in patients with subchorionic hematoma. Vimentin, a mesenchymal marker, was expressed in the epithelial layer of the hematoma amnion. Together, these findings indicate epithelial-mesenchymal transition in the amnion of membranes from pregnancies with subchorionic hematomas. 2) These findings in human amnion were confirmed in a mouse model of intrauterine hematoma. 3) Further, in vitro, coculture of human amnion mesenchymal cells with M2-differentiated human macrophages resulted in transformation of these cells into α-smooth muscle actin-expressing myofibroblasts via the TGF-β‒Smad3 pathway.
Conclusion |
Subchorionic hematoma induces migration of macrophages to chorioamniotic membranes which activate the transition of amnion mesenchymal cells to myofibroblasts. These myofibroblasts may contribute to fibrosis of the amnion and damage chorioamniotic membranes.
Le texte complet de cet article est disponible en PDF.Video |
(13.2 Mo)
Key words : amnion, epithelial-mesenchymal transition, intrauterine bleeding, macrophages, mouse model, myofibroblasts, pregnancy, preterm birth, preterm prelabor rupture of membranes, Smad3, subchorionic hematoma, TGF-β
Plan
| This work was supported by the Japan Society for the Promotion of Science KAKENHI (Grant Nos. 19K22686 , 21K09540 , and 24K02587 ) and the Kyoto University 125th Anniversary Fund Kusunoki 125. The authors report no conflicts of interest. |
|
| Cite this article as: Yasuda E, Kawamura Y, Ueda Y, et al. Potential mechanisms for chorioamniotic membrane rupture after subchorionic hematoma. Am J Obstet Gynecol 2025;233:125.e1-18. |
Vol 233 - N° 2
P. 125.e1-125.e18 - août 2025 Retour au numéro
Article précédent
- Episiotomy to prevent obstetric anal sphincter injuries during instrumental delivery in nulliparous women: a national prospective comparative cohort study
- Bertrand Gachon, Lisa Durocher, Charles Garabedian, Paul Guerby, Celine Chauleur, Charline Bertholdt, Thomas Desplanches, Loïc Sentilhes, Jeanne Sibiude, Nicolas Mottet, Camille Le Ray, Marie Laure Estzo, Linda Lassel, Sandra Bel, Pauline Devouge, Vincent Dochez, Didier Riethmuller, Thomas Schmitz, Aurelie Vincent-Rohfritsch, Thierry Harvey, Florian Delaunay, Guillaume Ducarme, Catherine Checchi-Guichard, Yohann Foucher, Renaud de Tayrac, Anne Cécile Pizzoferrato, Fabrice Pierre, Paul Berveiller, Xavier Fritel, INSTRUMODA Study Group, GROG (Groupe de Recherche en Obstétrique et Gynécologie), Fabrice Pierre, France Artzner, Anne Morlot, Emmanuel Decroisette, Suzanne Braig, Stephane Miot, Eric Bourdier, Richard Kutnahorsky, Michele Lehman, Caroline Bohec, Lionel Bourdarias, Pascal Ko Kivok Yun, Denis Gallot, Fanny Desvignes, Claire Bonnefoy, Michel Dreyfus, Anne Villot, Solene Renouf, Patrick Dellinger, Thierry Miras, Myriam Nadi, Zacharie Akalogoun, Flavie Toret Labeeuw, Sebastien Seconda, Corinne Cudeville, Cécile Tardif, Franck Perrotin, Anna Ramos, Cyrille Faraguet, Etienne Roussel, René Gabriel, Emile Mereb, Emma Rufenacht, Margaux Canaguier, Barbara Monnard, Anne Gael Cordier, Edouard Lecarpentier, Jeremy Sroussi, Anne Cécile Laurent, Imane Ben M'Barek, Marine Driessen, Amelie Benbara, Marie Victoire Senat, Marc Siffert, Christophe Poncelet, Stephanie Valery, Martha Duares, Anne Cogan, Joelle Leonard, Melanie Cayrac, Nathalie Clainquart, Eric Orvain, Fannette Galtier, Agathe Houze de l’Aulnoit, Edwige Wery, Aurore Marx, Elodie Clouqueur, Elisabeth Guinard, Sophie Deltombe, Guillaume Legendre, Chloe Reau Giusti, Anne Paumier, Melanie Randet, Michel Lemine, Emilie Picouleau, Yves Aubard, Caroline Carlier Guerin, Melie Sarreau, Martin Merouze, Yannick Thirouard, Audrey Guesdon, Julie Blanc, Helene Heckenroth, Julien Antomarchi, Melinda Petrovic, Daniel Cohen, Laurence Debono, Candice Ronin, Deborah Gavanier, Fanny Roumieu, Maud Salzmann, Claire Mossan, Fabienne Comte, Eric Verspyck, Elise Machevin, Helene Muszynski, Solene Quibel, Sylvie Pauthier, Aurelie Vallee
- At mid-gestation, markers of placental function rather than maternal cardiac function are stronger determinants of birthweight
- Ioannis Papastefanou, Vita Mesaric, Renata Gomes Castello, Kypros H. Nicolaides, Marietta Charakida
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?