Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment

Jung, Eun-Jung; Romero, Roberto; Suksai, Manaphat; Gotsch, Francesca; Chaemsaithong, Piya; Erez, Offer; Gomez‐Lopez, Nardhy; Yoon, Bo Hyun

doi:10.1016/j.ajog.2023.02.002

Cited by 20 publications

(2 citation statements)

References 368 publications

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“…In our study, research nurses documented chorioamnionitis from the EMR. The EMR documentation of chorioamnionitis at each of the five enrollment sites may vary by the criteria used for diagnosing chorioamnionitis, ranging from suspicion due to maternal symptoms including maternal fever, or amniotic fluid that is not clear and/or purulent or foul-smelling [ 32 ]. The increased odds of having suspected chorioamnionitis may have led to EOS in the BPT infants rather than the increased odds of maternal diagnosis with Group B Streptococcus , as E. coli bacteria were more prevalent than Group B Streptococcus amongst the cases of EOS.…”

Section: Discussionmentioning

confidence: 99%

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Dail,

Everhart,

Iskersky

et al. 2024

TropicalMed

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Background: The birthrate of Black preterm (BPT) infants is 65% higher than White preterm (WPT) infants with a BPT mortality that is 2.3 times higher. The incidence of culture-positive late-onset sepsis is as high as 41% in very-preterm infants. The main purpose of this study was to examine thermal gradients and the heart rate in relation to the onset of infection. This report presents disparities in very-preterm infection incidence, bacteria, and mortality data amongst BPT and WPT infants. Methods: 367 preterms born at <32 weeks gestational age (GA) between 2019–2023 in five neonatal intensive care units (NICUs) were enrolled to study the onset of infections and dispositions; REDCap data were analyzed for descriptive statistics. Results: The 362 infants for analyses included 227 BPTs (63.7%) and 107 WPTs (29.6%), with 28 infants of other races/ethnicities (Hispanic, Asian, and other), 50.6% female, mean GA of 27.66 weeks, and 985.24 g birthweight. BPT infants averaged 968.56 g at birth (SD 257.50), and 27.68 (SD 2.07) weeks GA, compared to WPT infants with a mean birthweight of 1006.25 g (SD 257.77, p = 0.2313) and 27.67 (SD 2.00, p = 0.982) weeks GA. Of the 426 episodes of suspected infections evaluated across all the enrolled infants, the incidence of early-onset sepsis (EOS) was 1.9%, with BPT infants having 2.50 times higher odds of EOS than WPT infants (p = 0.4130, OR (odds ratio) = 2.50, p_or = 0.408). The overall incidence of late-onset sepsis (LOS) was 10.8%, with LOS in 11.9% of BPT infants versus 9.3% (p = 0.489, OR = 1.21, p_or = 0.637) of WPT infants. BPT infants made up 69.2% of the 39 infants with Gram-positive infections vs. 25.6% for WPT infants; 16 infants had Gram-negative culture-positive infections, with 81.2% being BPT infants versus 18.8% being WPT infants. Of the 27 urinary tract infections, 78% were in BPTs. The necrotizing enterocolitis incidence was 6.9%; the incidence in BPT infants was 7.5% vs. 6.5% in WPT infants. The overall mortality was 8.3%, with BPTs at 8.4% vs. WPT infants at 9.3%, (p = 0.6715). Conclusions: BPTs had a higher rate of positive cultures, double the Gram-negative infections, a much higher rate of urinary tract infections, and a higher rate of mortality than their WPT counterparts. This study emphasizes the higher risk of morbidity and mortality for BPTs.

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Section: Discussionmentioning

confidence: 99%

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Dail,

Everhart,

Iskersky

et al. 2024

TropicalMed

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“…Histological reports of those patients with hysterectomy or resection of the accrete area were reviewed for the degree of placental invasion (accreta, increta, percreta). Patients were excluded from this study when a caesarean section was performed due to chorioamnionitis [ 23 ], as this condition could urge the surgeon to perform the one-step approach thus leading to an allocation bias. In those patients with conservative management, laboratory results (i.e., leucocyte count and C-reactive protein (CRP)) measured between the two surgeries were also collected.…”

Section: Methodsmentioning

confidence: 99%

A Single-Centre Retrospective Analysis of Pregnancies with Placenta Accreta Spectrum (PAS): From One-Step Surgery towards Two-Step Surgical Approach

Weydandt,

Lia,

Schöne

et al. 2024

JCM

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Background: Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimise blood loss. Methods: We conducted a single-centre retrospective cohort study including all patients managed for PAS between 2007 and 2023. The number of units of red blood cells (RBCs) needed during surgery was the primary outcome used to compare these two approaches. Results: A total of 43 cases were included in this analysis. Twenty of these were managed with the delayed two-step surgical approach, whereas 23 received one-step surgery. The median estimated blood loss during surgery was 2000 mL and 2800 mL for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach, the median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBCs was 0.28 (95%-CI: 0.08–0.98, p = 0.043). A longer interval between the caesarean section and the second operation showed a trend toward lower blood loss (p = 0.065) and was associated with a significantly lower number of RBC units needed during surgery (p = 0.019). Conclusions: Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction in blood transfusion. Leaving the placenta in situ and delaying the final operation represents a possible alternative to traditional caesarean hysterectomy.

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Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever

Schreiber,

Cohen,

Zahavi

et al. 2024

Arch Gynecol Obstet

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Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment

Cited by 20 publications

References 368 publications

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

Prenatal and Postnatal Disparities in Very-Preterm Infants in a Study of Infections between 2018–2023 in Southeastern US

A Single-Centre Retrospective Analysis of Pregnancies with Placenta Accreta Spectrum (PAS): From One-Step Surgery towards Two-Step Surgical Approach

Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever

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