The frequency and risk factors of funisitis and histologic chorioamnionitis in pregnant women at term who delivered after the spontaneous onset of labor

Lee, Seung Mi; Romero, Roberto; Lee, Kyung A.; Yang, Hye Jin; Oh, Kyung Joon; Park, Chan Wook; Yoon, Bo Hyun

doi:10.3109/14767058.2010.482622

Cited by 68 publications

(33 citation statements)

References 35 publications

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“…In term gestations, acute histologic chorioamnionitis is more common in patients who undergo spontaneous labor than in those who deliver by cesarean section without labor [160, 235]. Moreover, the more advanced the cervical dilatation is at the time of a cesarean delivery, the greater the risk of acute histologic chorioamnionitis and microbial invasion of the amniotic cavity [236, 237]. Other studies have documented that acute histologic chorioamnionitis is associated with the presence of bacteria in the chorioamniotic space [150, 151, 238], although the strength of this association varies between term and preterm gestations [172, 173].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have documented that acute histologic chorioamnionitis is associated with the presence of bacteria in the chorioamniotic space [150, 151, 238], although the strength of this association varies between term and preterm gestations [172, 173]. For example, in preterm birth, the frequency of funisitis ranges from 17% to 44.8% [98, 154, 218, 239–241], while at term, funisitis is present in only 6.1% to 7.2% and in 1.1% to 4% of cases with and without labor, respectively [157, 160, 235, 237], and its frequency is higher in patients who have rupture of the membranes [157]. …”

Section: Discussionmentioning

confidence: 99%

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Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Romero¹,

Chaemsaithong²,

Docheva³

et al. 2015

Journal of Perinatal Medicine

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Objective Neonates born to mothers with clinical chorioamnionitis at term are at an increased risk of infection. Acute subchorionitis, chorioamnionitis, and funisitis are considered placental histologic features consistent with acute inflammation according to the Society for Pediatric Pathology. The objectives of this study were to examine the performance of placental histologic features in the identification of: 1) microbial-associated intra-amniotic inflammation (intra-amniotic infection); and 2) a fetal inflammatory response syndrome (FIRS). Methods and Materials This retrospective cohort study included women with the diagnosis of clinical chorioamnionitis at term (n=45), who underwent an amniocentesis to determine: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad range primers]; and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay (ELISA). The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of placental histologic features consistent with acute inflammation was determined for the identification of microbial-associated intra-amniotic inflammation and FIRS. Results 1) The presence of acute histologic chorioamnionitis and funisitis was associated with the presence of proven intra-amniotic infection assessed by amniotic fluid analysis; 2) funisitis was also associated with the presence of FIRS; 3) the negative predictive value of acute funisitis ≥ stage 2 for the identification of neonates born to mothers with intra-amniotic infection was less than 50%, and therefore, suboptimal to exclude fetal exposure to bacteria in the amniotic cavity; and 4) acute funisitis ≥ stage 2 had a negative predictive value of 86.8% for the identification of FIRS in a population with a prevalence of 20%. Conclusion Acute histologic chorioamnionitis and funisitis are associated with intra-amniotic infection and the presence of FIRS. However, current pathologic methods have limitations in the identification of the fetus exposed to microorganisms present in the amniotic cavity. Further studies are required to determine whether molecular markers can enhance the performance of placental pathology in the identification of neonates at risk for neonatal sepsis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Romero¹,

Chaemsaithong²,

Docheva³

et al. 2015

Journal of Perinatal Medicine

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“…Accumulating evidence demonstrated that term parturition is associated with intra-amniotic infection and/or inflammation [175–188]. Patients with acute atherosis were less likely to have placental lesions consistent with amniotic fluid infection.…”

Section: Discussionmentioning

confidence: 99%

Placental lesions associated with acute atherosis

Kim

Chaemsaithong

Romero

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective Acute atherosis is a lesion of the spiral arteries characterized by fibrinoid necrosis of the vessel wall, an accumulation of fat-containing macrophages, and a mononuclear perivascular infiltrate, which can be found in patients with preeclampsia, fetal death, small-for-gestational age (SGA), spontaneous preterm labor/premature prelabor rupture of membrane, and spontaneous mid-trimester abortion. This lesion is thought to decrease blood flow to the intervillous space which may lead to other vascular lesions of the placenta. The objective of this study was to test whether there is an association between acute atherosis and placental lesions that are consistent with maternal vascular underperfusion, amniotic fluid infection, fetal vascular thrombo-occlusive disease or chronic inflammation. Material and methods A retrospective cohort study of pregnant women who delivered between July 1998 and July 2014 at Hutzel Women’s Hospital/Detroit Medical Center was conducted examine 16,457 placentas. The frequency of placenta lesions (diagnosed using the criteria of the Perinatal Section of the Society for Pediatric Pathology) was compared between pregnancies with and without atherosis. Results Among 16,457 women who were enrolled, 10.2% (1,671/16,457) were excluded, leaving 14,786 women who contributed data for analysis. Among them, the prevalence of acute atherosis was 2.2% (326/14,786). Women with acute atherosis were more than six times as likely as those without to have placental lesions consistent with maternal underperfusion (adjusted odds ratio- aOR: 6.7; 95% CI 5.2–8.6). To a lesser degree, acute atherosis was also associated with greater risks of having either lesions consistent with fetal vascular thrombo-occlusive disease (aOR 1.7; 95% CI 1.2–2.3) or chronic chorioamnionitis (aOR 1.9; 95% CI 1.3–3), but not with other chronic inflammatory lesions, after adjusting for gestational age at delivery. In contrast, women with acute atherosis were 60% less likely to have lesions consistent with amniotic fluid infecition, adjusting for gestational age at delivery (aOR 0.4; 95% CI 0.3–0.5). Conclusions Acute atherosis is associated with increased risks of having placental lesions consistent with maternal vascular underperfusion, and to a lesser extent, chronic chorioamnionitis and those consistent with fetal vascular thrombo-occlusive disease.

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“…Acute histologic chorioamnionitis was defined as the presence of acute inflammatory changes characterized by the infiltration of neutrophils in the choriodecidua and amnion [55, 56], respectively; acute funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton’s jelly, using previously published criteria [55–60]. Significant neonatal morbidity was defined as the presence of any of the following conditions: respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage (grade ≥II), periventricular leukomalacia, proven congenital neonatal sepsis, or necrotizing enterocolitis.…”

Section: Methodsmentioning

confidence: 99%

Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

Kim

Hong

et al. 2017

American Journal of Obstetrics and Gynecology

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Background Recent studies on clinical chorioamnionitis at term suggest that some patients with this diagnosis have neither intra-amniotic infection nor intra-amniotic inflammation. A false-positive diagnosis of clinical chorioamnionitis in preterm gestation may lead to unwarranted preterm delivery. Objective To determine the frequency of intra-amniotic inflammation and microbiologically proven amniotic fluid infection in patients with preterm clinical chorioamnionitis. Study design Amniocentesis was performed in singleton pregnant women with preterm clinical chorioamnionitis (<36 weeks of gestation). Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas and assayed for matrix metalloproteinase-8 concentration. Microbial invasion of the amniotic cavity was defined as a positive amniotic fluid culture; intra-amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration of >23 ng/mL. Non-parametric and survival techniques were used for analysis. Results Among patients with preterm clinical chorioamnionitis, 24% (12/50) had microbiologic evidence of neither intra-amniotic infection nor intra-amniotic inflammation. Microbial invasion of the amniotic cavity was present in 34% (18/53) and intra-amniotic inflammation in 76% (38/50) of patients. The most common microorganisms isolated from the amniotic cavity were the Ureaplasma species. Finally, patients without microbial invasion of the amniotic cavity or intra-amniotic inflammation had significantly lower rates of adverse outcomes (including lower gestational age at delivery, a shorter amniocentesis-to-delivery interval, acute histologic chorioamnionitis, acute funisitis, and significant neonatal morbidity) than those with microbial invasion of the amniotic cavity and/or intra-amniotic inflammation. Conclusion Among patients with preterm clinical chorioamnionitis, 24% had no evidence of either intra-amniotic infection or intra-amniotic inflammation, and 66% had negative amniotic fluid cultures, using standard microbiologic techniques. These observations call for a re-examination of the criteria used to diagnose preterm clinical chorioamnionitis.

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The frequency and risk factors of funisitis and histologic chorioamnionitis in pregnant women at term who delivered after the spontaneous onset of labor

Cited by 68 publications

References 35 publications

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Placental lesions associated with acute atherosis

Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation

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