Examination of biochemical changes in maternal blood as well as histological changes in the placenta and amniotic membrane of pregnant women diagnosed with premature rupture of membrane

Aim: This study aimed to investigate the biochemical and histological relationship between maternal serum, amniotic membrane, and placental syndecan levels and preterm premature rupture of membranes (PPROM). It is further anticipated that the findings may provide a foundation for future research focused on preventing PPROM and its related complications. Materials and Methods: The study was conducted at the Department of Obstetrics and Gynecology, Manisa Celal Bayar University, between 2023 and 2024, after obtaining ethics committee approval and informed consent from all participants. Fourteen pregnant women diagnosed with PPROM without additional obstetric pathology and twenty-two healthy pregnant women with similar demographic characteristics were included. Venous blood samples were collected, and serum levels of syndecan 1, 2, 3 and 4 were analyzed using the ELISA method. Placental and amniotic membrane tissue samples were also obtained, and the immunohistochemical expression of the same biomarkers was evaluated. Data were statistically compared between groups. Results: The PPROM group had significantly lower mean maternal age, BMI, parity, gestational age, and neonatal birth weight compared with the control group (all p < 0.01). WBC and CRP levels were significantly higher in the PPROM group (p = 0.003 and p = 0.022), whereas hemoglobin level, platelet count, and smoking status showed no significant differences (p > 0.05). Immunohistochemical analysis demonstrated weaker expression syndecan 1, 2, 3 and 4 in the placental and amniotic tissues of the PPROM group. Similarly, maternal serum levels of all syndecan isoforms were markedly reduced compared to controls (p < 0.001). Conclusion:The decreased expression of syndecan family proteoglycans in PPROM may weaken extracellular matrix integrity and epithelial barrier function, thereby contributing to premature rupture of fetal membranes. Keywords: Amniotic membrane; Placenta; Preterm Prelabor Rupture of Membranes; Proteoglycan; Syndecan