Lack of evidence for microorganisms in most women with clinical chorioamnionitis: A need to revisit the clinical and microbiologic criteria for one of the most important obstetrical complications

Seong, Hyo Suk; Kang, Young Hwa; Lee, S.I. Eun; Shim, So Yeon; Romero, Roberto; Yoon, Bo Hyun

doi:10.1016/j.ajog.2006.10.232

Cited by 4 publications

(2 citation statements)

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“…Fetal inflammatory response syndrome, a condition associated with elevated levels of cytokines in the fetal circulation, is a risk factor for development of cerebral palsy and white matter damage (10). In a significant proportion of preterm deliveries complicated by histologic chorioamnionitis, amniotic fluid is sterile (11)(12)(13), and although there is no evidence of fetal infection, elevated concentrations of cytokines in amniotic fluid (9) and fetal plasma (14) have been reported. Under these circumstances, it is likely that detrimental fetal responses occur primarily in response to exposure to elevated cytokine concentrations, rather than to direct exposure to the pathogen (14,15).…”

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confidence: 99%

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

Keelan

Khan²,

Yosaatmadja³

et al. 2009

The Journal of Immunology

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Intrauterine inflammation plays a major role in the etiology of preterm labor and birth. We established an ex vivo model employing perfused full-thickness term gestational membranes to study membrane transport, function, and inflammatory responses. Exposure of the maternal (decidual) face of the membranes to LPS (5 μg/ml) resulted in increased accumulation of proinflammatory cytokines in the maternal compartment within 4 h, followed by a response in the fetal (amniotic) compartment. Using cytokine arrays, exposure to LPS was found to result in increased secretion of a large number of cytokines and chemokines in both compartments, most notably IL-5, IL-6, IL-7, MDC (macrophage-derived chemokine), MIG (monokine induced by IFN-γ), TARC (thymus and activation-regulated chemokine), TGF-β, and TNF-α. PGE2 accumulation also increased in response to LPS, particularly in the fetal compartment. Cotreatment with sulfasalazine, which inhibited nuclear translocation of NF-κB p65, had a rapid and marked inhibitory effect on the rate of cytokine accumulation in the maternal compartment, with lesser but significant effects observed in the fetal compartment. While membrane integrity was not discernibly impaired with LPS or sulfasalazine exposure, rates of chorionic apoptosis after 20 h were doubled in sulfasalazine-treated tissues. We conclude that the system described provides a means of accurately modeling human gestational membrane functions and inflammatory activation ex vivo. Decidual LPS exposure was shown to elicit a robust inflammatory response in both the maternal and fetal compartments. Sulfasalazine was an effective antiinflammatory agent in this model, but also exerted proapoptotic effects that raise concerns regarding its placental effects when administered in pregnancy.

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confidence: 99%

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

Keelan

Khan²,

Yosaatmadja³

et al. 2009

The Journal of Immunology

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“…Studies have shown that intra-amniotic inflammation is only present in around 70% of patients with CCA and should, therefore not be used in scientific publications due to this high false-positive rate. 76 77 Furthermore, recommendations have been proposed to restrict the term CA to pathologic diagnosis, since substantial heterogeneity occurs in the criteria for CCA, and to introduce positive Gram stain, positive amniotic fluid culture and placental histology to the criteria of CA besides isolated maternal fever. 7 Excluding CCA cases provides stronger evidence and may explain the significantly higher odds of ROP in neonates with HCA found in our study.…”

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confidence: 99%

Histological Chorioamnionitis and Funisitis as New Risk Factors for Retinopathy of Prematurity: A Meta-analysis

El Emrani,

Jansen,

Goeman

et al. 2023

Am J Perinatol

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Objective The role of placental inflammation in neonatal morbidities is underestimated due to lack of placental examination. This meta-analysis aims to assess the association between histological chorioamnionitis (HCA) with and without funisitis (FUN) and risk of retinopathy of prematurity (ROP). Study Design Forty-five studies reporting (unadjusted) data on HCA without FUN and HCA with FUN in neonates with ROP were included. Primary outcomes were any stage ROP and severe ROP. Potential confounders explored were gestational age (GA) at birth, birthweight, maternal steroid use, necrotizing enterocolitis, sepsis (suspected/proven) and mechanical ventilation duration. Results Neonates with HCA had increased risk for any stage ROP (odds ratio [OR] 1.8; 95% confidence interval [CI] 1.3–2.4) and severe ROP (OR 1.5; 95% CI 1.2–1.8) compared with neonates without HCA. The rates of any stage ROP (OR 1.8; 95% CI 1.4–2.2) and severe ROP (OR 1.4; 95% CI 1.1–1.6) were higher in neonates with FUN compared with neonates without FUN. Multivariate meta-regression analysis suggests that lower GA increases the effect size between FUN and severe ROP. Conclusion This meta-analysis confirms that presence of HCA and FUN are risk factors for any stage ROP and severe ROP. Structured histological placental examination of HCA and FUN may be a tool to further refine the ROP risk profile. Key Points

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Pharmacological inhibition of inflammatory pathways for the prevention of preterm birth

Keelan

2011

Journal of Reproductive Immunology

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Lack of evidence for microorganisms in most women with clinical chorioamnionitis: A need to revisit the clinical and microbiologic criteria for one of the most important obstetrical complications

Cited by 4 publications

References 0 publications

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

Prevention of Inflammatory Activation of Human Gestational Membranes in an Ex Vivo Model Using a Pharmacological NF-κB Inhibitor

Histological Chorioamnionitis and Funisitis as New Risk Factors for Retinopathy of Prematurity: A Meta-analysis

Pharmacological inhibition of inflammatory pathways for the prevention of preterm birth

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