(Amnion is a thin, tough, transparent membrane. It is about 10-15 micrometer thick.)

that was written in the literature and it means that it can be measured but may postpartum and I think with the recent development of investigatory tools it can be also measured intra uterine but i don't know the ideal tool for that.

Thats right Dr. Eloeity,

However it is not an issue to measure the thickness after the delivery and mention it. But I wish to know during pregnancy is it possible to measure. This could be a great help to carry out a hot topic for research.

I can ask my Obstetric colleagues and get back to you again...

Thanks Dr. Eloteify. This idea came to my mind after seeing many patients with leakage or some time with weak amniotic membrane etc. So, may be some thing can be done in this field.

Dear Paital,

I have been working on amnionic and chorial membranes for years for research after birth. Such membranes cand be easily collected and their cellular functions can be tested (my special interest deals with cytokines and prostanoids release in several experimental conditions). As far as I know, to neasure the thickness of fetal membranes during pregnancy by imaging technology is impossible at the moment.

Ultrasond examination has been adopted to measure the thickness of the lower uterine segment, but I do not trust such studies. During advanced pregnancy normal myometrial thickness is not more than 5 mm, while it becomes much less at the level of inferior segment during the last 15 days of pregnancy and even more during labor.. The resolution power of diagnostic ultrasound is 2 mm. This means that a distance below 2 mm cannot be detected bu ultrasound examination.

Fortunato Vesce

Head of the Operative Unit

Obstetrics and Gynecology

Arcispedale Sant'Anna

Ferrara University

Italy

Dear Prof. Vesce, 

Thanks a lot for sharing your experience. I also found such information from several research findings that it is not possible to measure the membrane thickness. I observed one common problem here in Odisha, India that many patients come with a problem of amniotic fluid leakage during pregnancy. Most of them miss carried the baby within few days of such leakage. However, about 2-3% of cases could able to hold the baby up to 6-7 months and gave birth the premature baby which are surviving. Since no allopathic approach is available for such treatment for leakage caused due to thinning of the membrane (for which leakage are supposed to happen other than microbial or mechanical damage at very early stages of pregnancy) , we took homeopathic approach to treat them but failed for their recovery. After that I have been thinking to initiate some work on the thickness of the membrane and to correlate it with the % of miss carriage at the condition of amniotic fluid loss/leakage etc.  You know so many issues exist at such stages. I wish to target certain apoptotic markers to correlate with the thickness of the membrane. Later I found that no methods are there to measure it and it is true that it is not possible to measure it through ultrasound and the reason you have already disclosed. No doubts cytokines and prostanoids have very specific role during this stages. Do you think it can be possible to draw a correlation among the above factors? 

Dear doctor,

rupture of the fetal membranes mainly depends on inflammatory changes, i.e. on the release of mediators of inflammation at the level of gestational tissues. Mechanical factors have less importance.The process does not need infection to be triggered: genetic polymorphism (either maternal or fetal) of the inflammatory type is enough.

There are rare cases with 4-5 cm dilatation of the cervix that procede towards the end of pregnancy, while most of them progress to labor, ending in abortion or premature delivery. Inflammation opens the door to infection (usually not the contrary!), but subsequently infection increases inflammation.

From an allopathic perspective anti-inflammatory drugs, both steroidal and non-steroidal, should help in preventing changes leading to premature rupture of the membranes, but one relevant matter is antibiotic therapy. Ampicillin, and to a lesser extent, cephalosporin, are able to directly decrease amniotic PG as well as IL-6 in vitro and in vivo, while macrolids not only lack such capacity, but also impair-abolish that of ampicillin, when administered together. Therefore, in preventing inflammatory-infectious complications such as premature delivery, Ampicillin is the first choice drug, while macrolides can be added only when the target becomes to treat bacterial rersistance. Low dose betamethasone throughout the entire gestation can be very helpful.

This is more or less what I understood during 42 years of teaching, research and clinical work at the University of Ferrara, Italy

With kind regards and best wishes

Fortunato Vesce

Dear Professor,

Yes you are correct. However, one of the important causes behind the leakage we observed here is the imbalance in thyroid problems. More than 50% of patients having leakage followed by miss carriage were found to be thyroid imbalance.  Yes, your opinion for the other causes are also true and widely accepted. Necessary treatments also have been found to remove the problems for acute leakage. However, the patients when came to our schedule research center (clinic), most of them were at critical condition and miss carried the baby. Microbial infection may be relieved with antibiotics but the patients those got miss carried at the clinic had found to have hormone disturbances. So, we thought there must be involvement of other biomolecules and especially the thinning of the membrane could be due to loss of cellular integrity and death. 

Thanks and regards

Biswaranjan