Current Management and Long-term Outcomes Following Chorioamnionitis

Johnson, Clark T.; Farzin, Azadeh; Burd, Irina

doi:10.1016/j.ogc.2014.08.007

Cited by 50 publications

(37 citation statements)

References 70 publications

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“…Currently, the diagnosis of clinical chorioamnionitis is based on maternal clinical signs that have only about a 50% accuracy for the identification of proven intra-amniotic infection (8). The management of mothers with suspected clinical chorioamnionitis includes treatment with antimicrobial agents (47, 71, 104-106) and labor augmentation (4, 6, 73, 107). Neonatologists often perform a laboratory work-up for sepsis and initiate antibiotic treatment (108-114).…”

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation

Chaiyasit

Romero

Chaemsaithong

et al. 2017

Journal of Perinatal Medicine

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Objective Clinical chorioamnionitis is the most common infection/inflammatory process diagnosed in labor and delivery units worldwide. The condition is a syndrome that can be caused by: 1) intra-amniotic infection; 2) intra-amniotic inflammation without demonstrable microorganisms (i.e., sterile intra-amniotic inflammation); and 3) maternal systemic inflammation that is not associated with intra-amniotic inflammation. The presence of intraamniotic inflammation is a risk factor for adverse maternal and neonatal outcomes in a broad range of obstetrical syndromes that includes clinical chorioamnionitis at term. Although the diagnosis of intra-amniotic infection has relied on culture results, such information is not immediately available for patient management. Therefore, the diagnosis of intra-amniotic inflammation could be helpful as a proxy for intra-amniotic infection, while results of microbiologic studies are pending. A rapid test is now available for the diagnosis of intraamniotic inflammation, based on the determination of neutrophil collagenase or matrix metalloproteinase-8 (MMP-8). The objectives of this study were to 1) evaluate the diagnostic indices of a rapid MMP-8 test for the identification of intra-amniotic inflammation/infection in patients with the diagnosis of clinical chorioamnionitis at term; and 2) compare the diagnostic performance of a rapid MMP-8 test to that of a conventional enzyme-linked immunosorbent assay (ELISA) interleukin (IL)-6 test for patients with clinical chorioamnionitis at term. Materials and Methods A retrospective cohort study was conducted. A transabdominal amniocentesis was performed in patients with clinical chorioamnionitis at term (n=44). Amniotic fluid was analyzed using cultivation techniques (for aerobic and anaerobic bacteria as well as genital Mycoplasmas) and broad-range polymerase chain reaction (PCR) coupled with electrospray ionization mass spectrometry (PCR/ESI-MS). Amniotic fluid IL-6 concentrations were determined by ELISA, and rapid MMP-8 results were determined by Yoon's MMP-8 Check®. Intra-amniotic inflammation was defined as an elevated amniotic fluid IL-6 concentration ≥2.6 ng/mL, and intra-amniotic infection was diagnosed by the presence of microorganisms in the amniotic fluid accompanied by intra-amniotic inflammation. The diagnostic indices of Yoon's MMP-8 Check® for the identification of intra-amniotic inflammation were calculated. In order to objectively compare Yoon's MMP-8 Check® to the ELISA IL-6 test for the identification of intra-amniotic inflammation, we used an amniotic fluid white blood cell (WBC) count ≥50 cells/mm3 to define intra-amniotic inflammation. Results 1) A positive rapid MMP-8 test had a sensitivity of 82.4% (28/34), specificity of 90% (9/10), positive predictive value of 96.6% (28/29), negative predictive value of 60% (9/15), positive likelihood ratio 8.2 (95% CI 1.3-53.2), and negative likelihood ratio 0.2 (95% CI 0.1-0.4) for the identification of intra-amniotic inflammation (prevalence 77.3%); 2) a positive rapid MMP-...

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Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation

Chaiyasit

Romero

Chaemsaithong

et al. 2017

Journal of Perinatal Medicine

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“…IUGR fetuses do not reach their genetically determined growth potential as a consequence of the placental dysfunction and have a higher morbidity and mortality, whereas SGA fetuses include the large group of genetically small fetuses without pathology ( 15 ). Clinical chorioamnionitis is a syndrome of the mother, which is diagnosed if one or more of the following signs and symptoms are present: maternal fever (intrapartum temperature >37.8°C), maternal tachycardia (>120 beats/min) or fetal tachycardia (>160–180 beats/min), purulent or foul-smelling amniotic fluid or vaginal discharge, uterine tenderness, maternal leukocytosis (total blood leukocyte count >15,000–18,000 cells/μL) ( 16 ).…”

Section: Methodsmentioning

confidence: 99%

Neonatal Outcome After Preeclampsia and HELLP Syndrome: A Population-Based Cohort Study in Germany

et al. 2020

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Aim: To analyze short term outcomes of very low birth weight infants (VLBWI) born preterm after maternal preeclampsia and HELLP syndrome within the German Neonatal Network. Methods: The German Neonatal Network is a large population-based cohort study enrolling VLBWI since 2009. Two thousand six hundred and fifty two infants below 32 weeks of gestation born after maternal preeclampsia or HELLP syndrome and 13,383 infants born prematurely for other causes between 2009 and 2018 were included in our analysis. Descriptive statistics and multinomial regression models including preeclampsia and HELLP syndrome were performed for short-term outcome measures such as intracerebral hemorrhage, necrotizing enterocolitis requiring surgery, bronchopulmonary dysplasia, retinopathy of prematurity, periventricular leukomalacia, persistent ductus arteriosus requiring surgery, blood culture positive sepsis and death. Results: After adjustment for confounding variables, preterm birth due to preeclampsia or HELLP syndrome was associated with a reduced risk for intracerebral hemorrhage (OR 0.73, 95% CI 0.60–0.89), necrotizing enterocolitis requiring surgery (OR 0.35 95% CI 0.15–0.82), periventricular leukomalacia (OR 0.61 95% CI 0.40–0.92), and death (OR 0.72 95% CI 0.55–0.96) as compared to other causes of preterm birth. Conclusions: The indication for preterm birth has an impact on neonatal outcome in preterm infants born below 32 weeks. This notion should be included when counseling the families.

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“…Amniotic fluid sampling and culture can be used in the diagnosis of chorioamnionitis, however, diagnosis of chorioamnionitis is often made clinically due to challenges in accessing uncontaminated amniotic fluid or placenta for culture 113 , 114 . Culture of the fluid may be conducted, but may have limited clinical utility due to the potential colonization of the amniotic fluid and the time it takes to obtain results 114 . In addition, the infectious etiology is often polymicrobial 115 .…”

Section: Diagnosis and Treatment Of Gbs Diseasementioning

confidence: 99%

Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries

et al. 2016

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Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations.

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Current Management and Long-term Outcomes Following Chorioamnionitis

Cited by 50 publications

References 70 publications

Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation

Clinical chorioamnionitis at term VIII: a rapid MMP-8 test for the identification of intra-amniotic inflammation

Neonatal Outcome After Preeclampsia and HELLP Syndrome: A Population-Based Cohort Study in Germany

Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries

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