Between 1974 and 1989, 15 neonates were found, at autopsy, to have subcapsular hematoma of the liver in a retrospective clinicopathologic study of 644 neonates. The majority (75%) of the neonates were less than 28 weeks gestation, male gender, and were delivered by the vaginal route following a complicated pregnancy and labor including malpresentation. The clinical course included resuscitation at birth, ventilatory support and hypovolemic shock with death occurring within 24 hours in 11 neonates. Other clinical events included air leak (n = 4 infants) and infection (n = 4). Intracranial hemorrhage was suspected in all but was found at autopsy in 8 neonates. The subcapsular hematoma was intact in 7 and ruptured in 8 neonates. Hence, subcapsular hemorrhage of the liver should be considered in the differential diagnosis of hypovolemic shock in very low birthweight infants.

Several reports have shown strong correlation of significant villous edema to most perinatal and neonatal morbidity and mortality related to clinical chorioamnionitis.1~2 Presumably, the fetal and neonatal insults result from the compression of the blood vessels and capillary networks in the villous spaces by the edema, creating an effective barrier to gas exchange and nutrient movements.2 This present study was undertaken to determine the degree and the nature of bacteria-related chorioamnionitis as it relates to placental villous edema and to investigate its perinatal and neonatal consequences.

In a study of 82 cases of clinical chorioamnionitis in which no antibiotics were administered antenatally, significant villous edema was observed in 51 placentas (62%). Polymorphonuclear leukocyte invasion of the placental plate was found in 53 placentas (65%). The presence of SVE was significantly associated with placental bacterial recovery, occurrence of prolonged rupture of membranes, lower one minute Apgar score, the need for resuscitation and significant neonatal respiratory problems. Findings suggest that bacteria-related placental villous edema can lead to significant perinatal and neonatal morbidities.