Impact of subclinical chorioamnionitis on maternal and neonatal outcomes

Miyazaki, Ken; Furuhashi, Madoka; Matsuo, Keitaro; Minami, Kojiro; Yoshida, Kana; Kuno, Naohiko; Ishikawa, Kaoru

doi:10.1080/00016340601022793

Cited by 21 publications

(12 citation statements)

References 32 publications

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“…In the literature, there were many reports that support the importance of CRP levels in chorioamnionitis patients (11,19,25,26). However, we did not find any difference in the CRP levels and WBC counts between chorioamnionitis (+) and (−) cases in PPROM patients.…”

Section: Chorioamnionitis Chorioamnionitis (+)contrasting

confidence: 52%

“…Subclinical chorioamnionitis is a major problem for pregnant women with PPROM. Newborns with PPROM have a high risk of sepsis and many other newborn infections that makes the prognosis even worse in premature newborns with PPROM (11). Thus, early and definitive diagnosis of subclinical chorioamnionitis, particularly in cases with PPROM, has crucial importance to prevent both maternal and neonatal mortality and morbidity.…”

mentioning

confidence: 99%

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Diagnostic and Prognostic Value of Presepsin for Subclinical Chorioamnionitis in Pregnancies between 23-28 Week with Preterm Premature Rupture of the Membranes

Cakar¹,

Çakar²,

Ayvaci³

et al. 2016

Balkan Med J

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Background:Presepsin is an inflammatory marker released from monocytes and macrophages as an acute reaction to microbial infection. We hypothesized that it may be useful in pregnancies with preterm premature rupture of the membranes (PPROM) for early diagnosis of subclinical chorioamnionitis. Aims: To determine whether the plasma presepsin level has any diagnostic or prognostic value for subclinical chorioamnionitis in pregnancies complicated with PPROM. Study Design: Prospective cohort study. Methods: Fifty-three singleton pregnancies between 23 and 28 weeks of gestation diagnosed with PPROM were prospectively included in the study. Venous blood samples were collected at admission, at the 48 th hour of admission, and at the time of delivery to determine presepsin and C-reactive Protein (CRP) levels and white blood cell (WBC) counts. Chorioamnionitis was diagnosed by microscopic examination of the placenta and cords. Results: Of the 53 PPROM cases included in the study, 41 (77.4%) had histologically confirmed chorioamnionitis. Neonatal sepsis developed in 24 (45.3%) of the newborns. The median presepsin level at admission was 135.0 pg/mL for pregnancies with subclinical chorioamnionitis and 113.5pg/mL for pregnancies without chorioamnionitis (p=0.573). There was also no significant difference between subclinical chorioamnionitis (+) and (−) cases in terms presepsin levels at the 48 th hour and at delivery. However, chorioamnionitis (+) cases showed a significant decrease in both presepsin level and WBC count at the 48 th hour after the administration of antibiotics, which increased significantly at delivery (p<0.001 and p=0.011, respectively). Conclusion:The striking fluctuations in presepsin level after the diagnosis of PPROM can be used to predict subclinical chorioamnionitis and determine the optimal timing of delivery before the clinical signs of chorioamnionitis are established. However, presepsin level itself was neither diagnostic nor prognostic for neonatal sepsis. Keywords: Premature rupture of the membranes, preterm, chorioamnionitis, neonatal sepsis

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Section: Chorioamnionitis Chorioamnionitis (+)contrasting

confidence: 52%

mentioning

confidence: 99%

Diagnostic and Prognostic Value of Presepsin for Subclinical Chorioamnionitis in Pregnancies between 23-28 Week with Preterm Premature Rupture of the Membranes

Cakar¹,

Çakar²,

Ayvaci³

et al. 2016

Balkan Med J

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“…7,8,[19][20][21] For that reason, we sought to explore some of the factors associated with histological chorioamnionitis which may lead to the development of BPD. The importance of fully understanding the causes of BPD is highlighted by the association with poor neurodevelopmental outcome.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Specifically, chorioamnionitis, among other factors, has been associated with BPD in premature infants. [5][6][7][8] The role of inflammatory mediators including neutrophils and other white blood cells (WBCs) in the development of BPD has yet to be fully defined. Neutrophils have an important role in the host response to bacterial infection.…”

Section: Introductionmentioning

confidence: 99%

Reduced mortality and increased BPD with histological chorioamnionitis and leukocytosis in very-low-birth-weight infants

et al. 2009

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Objective: To investigate the association between leukocytosis, mortality and bronchopulmonary dysplasia (BPD) in very-low-birth-weight infants (VLBW) born to mothers with histological chorioamnionitis.Study Design: A retrospective cohort study from a single level 3 neonatal intensive care unit. The study sample included infants born to mothers with histological chorioamnionitis (n ¼ 252). Total white blood cells (WBCs) after birth were measured. Leukocytosis was defined as a total WBC count >30 000 per mm 3 in the first 2 days of life. Outcomes investigated included BPD and death. Both unadjusted and multivariable analyses were carried out.Result: After controlling for potential confounding variables, infants who developed a leukocytosis after birth had increased odds of BPD (4.6, 95% confidence interval (95% CI): 2.0 to 10.3), but decreased odds of death (0.3, 95% CI: 0.1 to 0.90). Conclusion:In our population of VLBW infants born to mothers with histological chorioamnionitis, leukocytosis after birth is associated with a decrease in mortality but an increase in BPD.

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“…Chorioamnionitis (ChA), also referred to as inflammation of the fetal membranes (amnion and chorion), is a common complication of pregnancy associated with significant maternal, perinatal and long-term adverse outcomes [29,30]. ChA is caused by a breach in the normal defenses of the uterine interior by bacteria, typically ascending from lower in the vagina.…”

Section: Introductionmentioning

confidence: 99%

Chorioamnionitis (ChA) modifies CX3CL1 (fractalkine) production by human amniotic epithelial cells (HAEC) under normoxic and hypoxic conditions

Szukiewicz

Kochanowski

Mittal

et al. 2014

Journal of Inflammation

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BackgroundChemokine CX3CL1 possesses unique properties, including combined adhesive and chemotactic functions. Human amniotic epithelial cells (HAEC) show expression of CX3CL1 receptor (CX3CR1) and produce CX3CL1 in response to both physiologic and pathologic stimuli. Chorioamnionitis (ChA) is a common complication of pregnancy and labour. ChA is often accompanied by local hypoxia because of the high oxygen consumption at the site of inflammation. We examined comparatively (ChA-complicated vs. normal pregnancy) CX3CR1 expression and the effects of hypoxia, lipopolysaccharide (LPS), and CX3CR1 blockade on CX3CL1 production in HAEC cultured in vitro.MethodsHAEC have been isolated using trypsinization, and cultured under normoxia (20% O2) vs. hypoxia (5% O2). According to the experimental design, LPS (1 μg/ml) and neutralizing anti-CX3CR1 antibodies were added at respective time points. Mean CX3CL1 concentration in the supernatant samples were determined by ELISA. Expression of immunostained CX3CR1 was analyzed using quantitative morphometry.ResultsWe have found that the mean levels of CX3CL1 and CX3CR1 expression were remarkably (p < 0.05) higher in ChA, compared to normal pregnancy. Significantly increased expression of CX3CR1 was observed in ChA during both normoxia and hypoxia. Hypoxia exposure produced decrease in the mean concentration of CX3CL1 in both groups, however this reduction was stronger in normal pregnancy. In normoxia, LPS-evoked rise in the mean concentration of CX3CL1 was higher (p < 0.05) in normal pregnancy. This response was positively correlated with CX3CR1 expression. Blockade of CX3CR1 canceled the secretory response to LPS in all groups.ConclusionsChA-complicated pregnancy up-regulates CX3CR1 in HAEC cultured in vitro with simultaneous increase in CX3CL1 production. Hypoxia-resistant production of CX3CL1 may be responsible for ChA-related complications of pregnancy and labor.

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Impact of subclinical chorioamnionitis on maternal and neonatal outcomes

Abstract: Chorioamnionitis could be controlled but is hard to cure. Higher levels of amniotic fluid neutrophil elastase are associated with a shorter interval from admission to delivery in women with subclinical chorioamnionitis.

Cited by 21 publications

References 32 publications

Diagnostic and Prognostic Value of Presepsin for Subclinical Chorioamnionitis in Pregnancies between 23-28 Week with Preterm Premature Rupture of the Membranes

Diagnostic and Prognostic Value of Presepsin for Subclinical Chorioamnionitis in Pregnancies between 23-28 Week with Preterm Premature Rupture of the Membranes

Reduced mortality and increased BPD with histological chorioamnionitis and leukocytosis in very-low-birth-weight infants

Chorioamnionitis (ChA) modifies CX3CL1 (fractalkine) production by human amniotic epithelial cells (HAEC) under normoxic and hypoxic conditions

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