Perinatal and Neonatal Significance of Bacteria-Related Placental Villous Edema

Abstract

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.

Effect of Clinical and Histological Chorioamnionitis on the Outcome of Preterm Infants

“…Although invading pathogens and their endotoxic products are suggested as a possible cause for fetal injury in chorioamnionitis, 20 the fetal inflammatory response has currently been receiving greater consideration as a cause of fetal injury. 3 As a result of this inflammatory response, cytokines (interleukins-1 and -6; tumor necrosis factor-α) are increased in the fetal blood, potentially initiating necrosis of white matter in the fetal brain and leading to long-term neurological sequelae, including CP.…”

“…18,19 Suggested theories to explain the association between maternal chorioamnionitis and neonatal morbidities include the primary endotoxic effect of the invading pathogens, placental abruption, fetal vascular inflammation, fetal cardiac dysfunction, increased fetal oxygen consumption related to maternal fever, and fetal inflammatory response syndrome. [20][21][22][23][24] Various measures have been made to screen for and prevent intra-amniotic infection during pregnancy aiming to minimize chorioamnionitis and associated maternal and neonatal morbidities. These measures include screening and management of urinary tract infection throughout the pregnancy, 25,26 the use of antibiotics in patients with PROM who are being managed expectantly, 27,28 development of and adherence to chemoprophylaxis guidelines for group B streptococcal (GBS) colonization, 29,30 and intrapartum antibiotics for clinical chorioamnionitis.…”