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PubMedDate not supplied

Lack of relationship between histologic chorioamnionitis and duration of the latency period in preterm rupture of membranes.

It is often believed that the frequency of clinical chorioamnionitis in preterm premature rupture of membranes (PROM) increases with the duration of the interval between membrane rupture and delivery. We tested the hypothesis that the prevalence of histologic evidence of intrauterine infection increases proportionally to the duration of the latency period. A total of 191 consecutive placentas of singleton, nonanomalous, liveborn infants delivered at <32 weeks' gestation with PROM were examined prospectively. Demographic, obstetric, histopathologic, and neonatal information was obtained. Histopathologic evidence of acute inflammation in choriodecidua, amnion, umbilical cord, and chorionic plate was recorded and scored. The prevalence and severity of pathological evidence of intrauterine infection was correlated with the interval between membrane rupture and delivery. Maternal and neonatal outcomes were assessed in six groups defined by different intervals between membrane rupture and delivery. Statistical analysis utilized regression, Fisher's exact test, Chi-square, and one-way analysis of variance after log transformation where applicable. P < 0.05 was considered significant. No correlation was observed between total score of placental acute inflammation and the interval membrane rupture-to-delivery (r = 0.068, 95% confidence interval -0.075, 0.211; P = 0.35). There was no evidence that the rate of maternal (P = 0.4) or neonatal (P = 0.15) infectious morbidity, or the total score of acute placental inflammation (P = 0.13), acute amnionitis (P = 0.35), choriodeciduitis (P = 0.46), chorionic plate inflammation (P = 0.38), or umbilical and chorionic vasculitis (P = 0.06) increase with the prolongation of the PROM-to-delivery interval. This study had an 85% power to detect the lack of association that was actually observed. The rate of histologic evidence of chorioamnionitis in preterm PROM does not increase with the duration of the PROM-to-delivery interval.

Amnion↗
PubMed1991

Umbilical arterial and venous acid-base and blood gas values and the effect of chorioamnionitis on those values in a cohort of preterm infants.

Umbilical arterial and venous acid-base and blood gas values in uncomplicated premature births are similar to values that are reported in term infants and are unaffected by birth weight or gestational age. In this group of patients chorioamnionitis had no significant effects on umbilical arterial acid-base or blood gas values or on the percentage of patients that were born with acidemia. Apgar scores were significantly lower in the group with chorioamnionitis in spite of a virtual absence of acidemia, which again suggests that low Apgar scores alone do not confirm a diagnosis of birth asphyxia.

Apgar Score↗
PubMed1993

Chorioamnionitis and bacterial vaginosis.

An improved understanding of bacterial vaginosis and of clinical intraamniotic infection and histologic chorioamnionitis has produced data showing strong associations among these conditions. It has recently been shown that the microorganisms in both bacterial vaginosis and clinical intraamniotic infection are similar, of which anaerobes, Gardnerella vaginalis, and Mycoplasma hominis are the predominant organisms in both. Furthermore, in the amniotic fluid of women with intraamniotic infection, strong associations among anaerobes, G. vaginalis, and M. hominis have recently been observed. In two epidemiologic studies (one in a high-risk group of women in labor and another in a lower risk group of antepartum women), the presence of bacterial vaginosis has been associated with the development of intraamniotic infection. Additional recent studies have provided new evidence that histologic inflammation of the placental membranes is associated with both clinical intraamniotic infection and positive cultures of the placenta. Multiple logistic regression analysis has shown a relationship between isolation of organisms from the chorioamnion and bacterial vaginosis.

Chorioamnionitis↗
PubMed2006

HPTN 024 study: histologic chorioamnionitis, antibiotics and adverse infant outcomes in a predominantly HIV-1-infected African population.

OBJECTIVE: Histologic chorioamnionitis has been associated with preterm birth and low birthweight. Our goal was to evaluate the relationship between polymorphonuclear cell and mononuclear cell placental infiltrations and adverse infant outcomes. STUDY DESIGN: Data from women who were enrolled in a trial of antibiotics for prevention of mother-to-child transmission of HIV-1 and of preterm birth were analyzed. Women who had HIV and women who did not have HIV were assigned randomly to either metronidazole 250 mg and erythromycin 250 mg at 20 to 24 weeks of gestation 3 times daily for 7 days and metronidazole 250 mg and ampicillin 500 mg every 4 hours during labor or identical placebos. Women with HIV were offered nevirapine at delivery for the prevention of mother-to-child transmission. At delivery, various placental sites were evaluated for polymorphonuclear cell and mononuclear cell infiltration. RESULTS: Polymorphonuclear and mononuclear cell infiltrations were common in the decidua (18% and 43%, respectively) and chorioamnion (28% and 34%, respectively). Gestational age and birthweight were lower among women with polymorphonuclear cell infiltrations, with these relationships generally stronger at earlier gestational age and birthweight. Mononuclear infiltrations were not associated with adverse outcomes. Neither polymorphonuclear cell nor mononuclear placental infiltrations were associated with mother-to-child transmission of HIV. Antibiotic use was not associated with reduced polymorphonuclear or mononuclear cell infiltrations. CONCLUSION: Polymorphonuclear cell infiltrations were associated with preterm birth and decreased birthweight and gestational age. Antibiotic use was not associated with reductions in polymorphonuclear or mononuclear cell infiltrations. In this nevirapine-treated population, neither polymorphonuclear nor mononuclear cell infiltration was associated with the mother-to-child transmission of HIV.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Histological chorioamnionitis and neonatal leukemoid reaction in low-birth-weight infants.

We investigated whether histological chorioamnionitis (HCA) is a risk factor predisposing to leukemoid reaction (LR) and whether LR is associated with the preterm parturition syndrome and the systemic fetal inflammation response syndrome. A prospective histological study on placentas was performed in preterm infants (<or=32(+6) weeks' gestation) admitted to level III neonatal intensive care unit of Padua University from January 1998 to December 2003. Development of LR was related to evidence of HCA. Among the placentas of the 223 preterm examined infants, 61 (27%) were diagnosed with HCA. Overall incidence of LR was 5.3%. Of 61 preterm neonates with HCA, 8 (13%) developed LR; moreover, 4 (2%) of 162 preterm infants without HCA developed LR (odds ratio = 7.4). Neonates with both LR and HCA differ from neonates with LR and without HCA in occurrence of prolonged rupture of membranes (62.5% versus 0%, P < .01), mode of delivery (37.5% versus 100% cesarean delivery, P < .01), gestational age (26 +/- 1.6 versus 29.7 +/- 1.7 gestational weeks, P < .01), and bronchopulmonary dysplasia incidence (63% versus 25%, P < .01). Histological chorioamnionitis placental findings increase the risk for neonatal LR. The LR in low-birth-weight neonates with HCA is significantly associated with earlier delivery and bronchopulmonary dysplasia. Pathogenetic mechanisms of neonatal LR in low-birth-weight infants without HCA remain undefined.

Adult↗
PubMed2005

Chorioamnionitis and neonatal encephalopathy in term infants with fetal acidemia: histopathologic correlations.

The aim of this study was to determine whether the presence or severity of histologic abnormalities of infection/inflammation such as chorioamnionitis, vasculitis, or funisitis confers an additional risk for neonatal encephalopathy in term infants delivered in the presence of severe fetal acidosis. The medical records as well as placental pathology of term infants (n = 51) born with a cord umbilical arterial pH <7.00 were reviewed. Abnormal outcome was predefined as Sarnat stage 2 or 3 neonatal encephalopathy in the first week of life or neonatal death as a consequence of severe brain injury. Consistent with prior data, the presence of severe fetal acidemia, a low 5-minute Apgar score, and need for cardiopulmonary resuscitation were significantly associated with neonatal encephalopathy. However, the presence of histologic chorioamnionitis had a poor predictive value and did not confer additional risk for the subsequent development of neonatal encephalopathy.

Acidosis↗
PubMed1988

Short-course antibiotic therapy for the treatment of chorioamnionitis and postpartum endomyometritis.

The development of chorioamnionitis and endomyometritis has traditionally required treatment with broad-spectrum antibiotic therapy and extended hospitalization. In the past, once parenteral antibiotic therapy was instituted, it was continued for 5 to 7 days and until the patient remained afebrile for 48 hours. To shorten the length of hospital stay, the length of parenteral antibiotic administration was reduced and an oral antibiotic was added, to complete a 7- to 10-day course of therapy. We evaluated the effectiveness of an even shorter course of parenteral antibiotics without the addition of oral antibiotics. Forty-two patients with chorioamnionitis and 64 with endomyometritis were enrolled in the study. Antibiotic therapy was continued until the patient's temperature was less than 99.5 degrees F for 12 to 24 hours. Of the 106 patients, only two were readmitted, both as a result of superficial wound separation. No patient had an infectious complication. A shorter course of parenteral antibiotics without the addition of an oral antibiotic gives results comparable to the standard extended treatment regimens, but is advantageous with respect to cost, patient compliance, and hospital stay.

Adolescent↗
PubMed2001

Subclinical chorioamnionitis as an etiologic factor in preterm deliveries.

OBJECTIVE: This study was performed to determine the possible relationship between histologic chorioamnionitis and genital tract cultures and their contribution to preterm delivery. METHODS: The study group consisted of 45 preterm and 37 term pregnancies. Cervico-vaginal cultures were obtained from all patients at admission and placentas were histopathologically evaluated and graded for inflammation of the chorial plate, amniochorionic membrane, umbilical cord and villi. Inflammation scores and presence of pathogenic bacteria were compared between the preterm and term patients. RESULTS: Severe chorionic plate inflammation was present in 35.5% of 45 preterm deliveries as compared to 5.4% of 37 term deliveries. Amniochorionic-decidual inflammation was not present in 14 of the term deliveries (38%), mild (Grade 1--2) in 20 (54%) and severe (Grade 3--4) in 3 (8%) as compared to 14 (31%), 17 (38%), and 14 (31%) in the preterm group, respectively (P<0.05). Pathogenic bacteria were isolated from the lower genital tracts of all patients who had severe chorionic plate (CP) and/or chorioamnionic (CA) inflammation while this was true only in 37.5% of the patients with no or only mild chorionic plate inflammation (P<0.001 for CP, P<0.01 for CA). CONCLUSION: Our results show that pathogenic bacterial colonisation of the cervicovaginal region is closely associated with placental inflammation, preterm labor and cervico-vaginal cultures which may be useful in determining the pregnancies at risk for preterm labor.

Adult↗
PubMed2002

Puerperal adrenal abscess complicating chorioamnionitis.

BACKGROUND: An abscess in the adrenal gland is a rare finding described only a few times in the literature. We present a case report of chorioamnionitis complicated by a puerperal adrenal abscess diagnosed and drained percutaneously using ultrasound and computed tomography. CASE: A 22-year-old woman delivered prematurely because of chorioamnionitis. Amoxicillin clavulanate was administered, and her fever defervesced. Six days later, the patient presented with a temperature of 40C and right flank pain. Workup revealed an abscess in the right adrenal gland, which was diagnosed by computed tomography scan, and then drained percutaneously. Follow-up revealed regression of the abscess to complete recovery. CONCLUSION: Adrenal abscess has not been described in the past as a possible complication of choriamnionitis. It is important to assess the entire abdominal cavity by ultrasound or computed tomography in febrile patients who do not respond to medical therapy.

Abscess↗
PubMed2002

Chorioamnionitis and brain injury.

The limited available evidence supports a strong association of chorioamnionitis with neonatal encephalopathy and CP in the term infant. The association of chorioamnionitis with depressed Apgar scores or neonatal seizures and with CP is equivocal in the preterm infant. Different study results may be related to differences in study populations, perhaps specifically to differences in susceptibility by stages of neurologic development as well as differences in gene frequencies associated with inflammation and thrombophilia. We require further understanding of the normal roles of cytokines in brain development, pregnancy, and inflammatory homeostasis before clinical interventions directed at cytokines, their receptors, or the inflammatory process are considered.

Anti-Bacterial Agents↗
PubMed1999

Chorioamnionitis with intact membranes caused by Capnocytophaga sputigena.

We report a case of chorioamnionitis with intact membranes caused by Capnocytophaga sputigena. The pregnant woman was hospitalised in preterm labor without fever, neither tenderness, just regular contractions. In spite of the tocolitic treatment the patient gave birth to a girl at 29 weeks' gestation, weighing 1220 g and transferred to intensive care. The newborn had clinical and biological signs of infections and was initially treated by Ampicillin, cephalosporin and metronidazol. Capnocytophaga sputigena was found on membranes, cord, amniotic fluid and placenta. It was also identified in maternal endocervix culture. Histologic findings showed a focal chorioamnionitis. This was the fourteenth reported case of infection due to Capnocytophaga species occurring in pregnancy. All the cases are reviewed.

Capnocytophaga↗
PubMed2001

Maternal serum C-reactive protein level does not change significantly after fetal reduction: it could be used as an indicator of chorioamnionitis.

PURPOSE: This study was aimed at investigating the diagnostic value of maternal serum C-reactive protein (CRP) in the recognition of chorioamnionitis in patients undergoing fetal reduction. METHODS: Seventy-one gravidas with high-order multifetal pregnancies, including 46 with triplets, 18 with quadruplets, and 7 with quintuplets, who underwent transabdominal fetal reduction to twins during the 10th-14th gestational week were recruited. The subjects were followed up clinically and ultrasonographically 1 week and 1 month after fetal reduction for signs of infection, premature uterine contraction, and premature rupture of the membranes CRP levels were measured prior to fetal reduction and at follow-up examinations, and were compared. RESULTS: Among the 71 mothers, 65 (92%) were normal after fetal reduction. The CRP levels were not significantly different prior to the procedure (0.27 +/- 0.26 mg/dL), and 1 week (0.23 +/- 0.24 mg/dL) and 1 month (0.24 +/- 0.20 mg/dL) later. There was no correlation between the number of fetuses reduced and the CRP levels. Six (8%) experienced leakage of amniotic fluid after fetal reduction. Three patients had normal CRP levels at that time and at the following tests. The pregnancies continued smoothly after conservative treatment. The other three patients had elevated CRP levels when leakage of amniotic fluid occurred. Fever and uterine irritability developed subsequently despite parenteral antibiotics and tocolytic therapy. Daily checks showed increasing CRP levels. The pregnancies were aborted, and the histology of the placental membranes revealed chorioamnionitis with infiltration of acute inflammatory cells. CONCLUSIONS: The absorption of inactive gestational tissue after fetal reduction did not affect CRP levels. CRP may be used as a marker of intrauterine infection after fetal reduction.

C-Reactive Protein↗
PubMed2005

Histological chorioamnionitis and the risk of early intraventricular hemorrhage in infants born < or =28 weeks gestation.

OBJECTIVE: To test the hypothesis that histological chorioamnionitis (CA) is not associated with increased risk of early onset intraventricular hemorrhage (IVH). STUDY DESIGN: Clinical data were prospectively collected for 62 consecutive neonates born before 28 weeks of gestation. Placental histology for CA was performed by a pathologist unaware of the head ultrasound scan (HUS) results. The first HUS was obtained by 30 minutes of life. Follow-up HUS were performed before 24 hours and again at 48 to 72 postnatal hours of life. An IVH (grade I to IV) at less than 72 hours of life was deemed an early hemorrhage. RESULTS: Nine of the 62 (14.5%) infants had early onset IVH. In all, 29 infants were born to women with histological evidence of CA; 33 infants did not have CA. Infants did not differ in birth weight, gestational age, sex, cord blood pH, 5-minute Apgar score of <7, cesarean delivery, prenatal use of steroids, administration of tocolytics, need for resuscitation, presence of pneumothorax, platelet count at birth, or use of surfactant. Early IVH rates (3/29 in CA vs 6/33 in non-CA) were similar (p=0.48). Two infants in each group with early IVH died before 2 weeks of age. Five additional infants from the CA group developed IVH at more than 72 postnatal hours of life (late onset IVH), and two of those infants progressed to develop periventricular leukomalacia (PVL). In contrast, only three non-CA infants had late IVH and none developed PVL. Logistic regression confirmed that no perinatal variables including CA were associated with early onset IVH. CONCLUSION: Chorioamnionitis is not associated with increased risk of early IVH.

Amnion↗
PubMed2001

Acute perforated neonatal appendicitis associated with chorioamnionitis.

Perforation of the appendix is rare in term neonates and even more rare in prematures. In most of the reported cases it is a complication of necrotizing enterocolitis (NEC) but can also complicate Hirschsprung's disease (HD), cystic fibrosis (CF) or acute appendicitis (AA). We present a pre-term newborn, born to a mother who had bacteriaemia associated with chorioamnionitis. On his sixth day of life he had clinical and radiological signs of perforated abdominal viscus. Laparotomy and histologic findings indicated acute perforated appendicitis. The association of acute perforated appendicitis with chorioamnionitis points to the role of maternal foetal infection in the aetiology of neonatal acute appendicitis.

Adult↗
PubMed1997

Emphysematous chorioamnionitis diagnosed by ultrasonography.

Preterm labor, cervical cerclage (especially when performed as an emergency procedure), and diabetes mellitus are all associated with an increased risk of chorioamnionitis. It might be expected that the combination of all 3 could lead to especially severe infection. We report such a case. A woman with a history of two spontaneous midtrimester abortions had had cervical cerclage performed at 13 weeks. She was referred at 24 weeks' gestation with preterm labor, and the cervix was found to be dilated. An emergency repeat cerclage was performed. The following day, ultrasonography revealed the presence of intra-amniotic gas. Infection was confirmed by the presence of a purulent cervical discharge, a neutrophilia with a left shift, and an elevated C-reactive protein level. The cervical stitch was removed and labor induced. The infant was liveborn, but succumbed to the complications of prematurity and sepsis. E. coli was isolated. In her subsequent pregnancy, severe gestational diabetes was diagnosed and following pregnancy, permanent diabetes mellitus was confirmed. The combination of infection, diabetes, and intact membranes may lead to a particularly severe form of chorioamnionitis, with the production of gas within the amniotic cavity. Infection should be excluded before emergency cervical cerclage, especially in the woman with diabetes mellitus.

Adult↗
PubMed1997

Repeated courses of steroids in preterm membrane rupture do not increase the risk of histologic chorioamnionitis.

Antenatal administration of steroids (betamethasone 12 mg i.m. twice q 24 hr) enhances fetal lung maturation and reduces neonatal morbidity in preterm prelabor rupture of membranes (PROM). However, the risks of repeated administration of steroids 7 days after the initial course are unknown. We evaluated the prevalence of histologic evidence of chorioamnionitis in patients receiving single versus multiple courses of steroids for fetal lung maturation. We performed a retrospective analysis of consecutive cases of preterm PROM at < 32 weeks' gestation prospectively collected between July 1988 and March 1994. Obstetric and clinical information were obtained for women who did not receive steroids for fetal lung maturity (n = 55), those who received a single course (n = 47), and those with > or = 2 courses of steroids (n = 89). Placental pathology examination was performed after delivery, and histologic evidence of acute placental inflammation was determined and scored semiquantitatively on a scale of 0-4, as previously described. Potential confounding variables considered were: presence of oligohydramnios (vertical pocket of amniotic fluid < or = 1 cm at ultrasound), onset of labor prior to delivery, gestational age at delivery, and mode of delivery. The three groups were comparable for gestational age at membrane rupture and at delivery, rate of oligohydramnios, labor prior to delivery, and mode of delivery. Administration of multiple courses of steroids was associated with a decrease in the rate of clinical chorioamnionitis (p < 0.0001) and severity of histologic acute placental inflammation (mean +/- SD total score of acute inflammation: 10.7 +/- 7.2 vs. 7.3 +/- 6.0 vs. 6.9 +/- 6.0, p = 0.005) compared with the groups receiving no steroids or administration of a single course of steroids. In preterm PROM at < 32 weeks, repeated administration of courses of steroids is not associated with an increase in the prevalence of clinical or histologic evidence of infectious outcome. These findings may reflect a greater likelihood for noninfected patients to remain quiescent and thus receive repeated courses of steroids.

Adult↗