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PubMed1999

Chronic peripheral separation of placenta. The significance of diffuse chorioamnionic hemosiderosis.

Diffuse nonmeconium-related pigment was observed in the chorioamnion of 36 of 1,023 placentas over 4 years and evaluated by iron staining. Stains were negative in 13 cases and positive in chorionic plate and membranes (diffuse chorioamnionic hemosiderosis [DCH]) in 23 cases (3/1,000 deliveries; 25/1,000 placentas). Gestational age at delivery was lower in DCH and was inversely proportional to the magnitude of iron staining. Placentas with DCH were more likely to show circumvallation, old peripheral blood clots, increased chorionic-villous macrophages, and green discoloration. To evaluate demographic, obstetric, and perinatal factors associated with DCH, 2 gestational age-matched controls were selected for each DCH case. Multiparity, smoking, and chronic vaginal bleeding all were increased significantly with DCH, while intrauterine growth retardation and oligohydramnios were increased but did not achieve statistical significance. Gestational hypertension and advanced maternal age were significantly decreased with DCH, and cocaine abuse was uncommon (3 cases). Long-term neurologic sequelae of DCH were evaluated in a separate series of gestational age-matched very-low-birth-weight infants with and without neurologic impairment at 2 years of age. No increased risk of neurologic impairment was found in patients with DCH.

Case-Control Studies↗
PubMed1982

Chorioamnionitis and possible neonatal infection associated with Lactobacillus species.

A patient is described with premature labor at 32 weeks of gestation complicated by chorioamnionitis associated with Lactobacillus species, subsequent premature delivery, and possible neonatal infection. Mother and infant did well with antibiotic therapy. The significance of chorioamnionitis and neonatal pneumonia due to this organism group is discussed.

Adult↗
PubMed1985

Separated chorioamnion and elevated chorion: sonographic features and clinical significance.

The clinical presentation and outcome of pregnancy was analyzed in thirteen patients in whom a free-floating intrauterine membrane was found on sonography. The cases were divided into two groups: those with elevated chorion and those with chorioamniotic separation. Five of seven patients with chorioamniotic separation progressed normally to term and delivered normal infants. In the two pregnancies with chorioamniotic separation that did not progress to term, one was associated with a placental chorioangioma and the other had a dead fetus that had a cystic hygroma indicative of Turner's syndrome. Of the six patients with elevated chorion, all presented with an episode of vaginal bleeding in the early second trimester. Five of six patients with elevated chorion progressed to term with the delivery of normal infants. One patient with extensive elevation of the chorion aborted. Three patients with elevated chorion had a subchorionic clot, whereas this was not present in patients with separated chorioamnion. Follow-up sonographic examination of patients with separated chorioamnion and elevated chorion revealed that most (11 of 13), but not all pregnancies in which an intrauterine membrane was found progressed to term without complications.

Abortion, Spontaneous↗
PubMed1975

Initiation of human parturition. II. Identification of phospholipase A2 in fetal chorioamnion and uterine decidua.

In this study, the presence of a phospholipase has been demonstrated in the human chorioamnion and uterine decidua. That the chorioamnionic enzyme is of the phospholipase A2 type was established by product identification following the incubation of the enzyme with either radioactive phosphatidylcholine or phosphatidylethanolamine. The potential relationship between the expression of the activity of this enzyme and the regulation of arachidonic acid release, prostaglandin formation, and the initiation of labor is considered.

Amnion↗
PubMed1979

The changing perinatal and maternal outcome in chorioamnionitis.

Chorioamnionitis is difficult to detect clinically, but its recognition in those at risk is essential. A retrospective study of 140 patients from among 26,129 deliveries was conducted over a 2-year period. The findings suggest that in modern obstetric practice, both perinatal and maternal complications associated with chorioamnionitis (particularly sepsis) are infrequent problems. Four neonatal deaths occurred but no infants died of sepsis. There were no maternal deaths, but 38 patients developed postpartum infections. Cesarean section did not appear to improve either perinatal or maternal outcome. With the use of appropriate modern antibiotics, extraperitoneal cesarean section and cesarean hysterectomy are probably no longer indicated. Not all neonates born out of a microbiologically contaminated intrauterine environment required antibiotic therapy, however, and individualization is recommended.

Amnion↗
PubMed1979

Intramembranous localization of bacteria in beta-hemolytic group B streptococcal chorioamnionitis.

An unusual pathologic finding consisting of large colonies of bacteria, localized immediately beneath the epithelial layer of the amnion, has been observed in association with an example of group B beta-hemolytic streptococcal chorioamnionitis. Postpartum endometritis as well as neonatal sepsis and meningitis occurred. Histologic examination of the umbilical cord and placenta revealed routine features of intraamniotic inflammation, but the membranes were characterized by the presence of unusual darkly staining deposits of material immediately beneath the amniotic epithelium. Subsequent special stains revealed these to be colonies of gram-positive cocci. We have been unable to find a previous description of this observation in association with streptococcal or with other types of chorioamnionitis.

Adult↗
PubMed1976

Chorioamnionitis.

Chorioamnionitis is an inflammatory reaction occurring in the fetal membranes of the placenta. It is usually associated with premature rupture of the membranes, whether spontaneous or artificial. Rupture of the fetal membranes sets off a time bomb that threatens both maternal and fetal welfare. The seriousness of this threat is dependent upon several variables: the length of gestation, economic status of the patient and the duration of the rupture. There is a controversy about the relative importance of these variables and about the proper degree of aggressiveness necessary to achieve optimum fetal salvage. When chorioamnionitis occurs, most obstetricians agree that the uterus should be evacuated by the most expeditious route. Usually oxytocic induction will accomplish delivery without difficulty, but should it fail to effect cervical ripening and dilatation within a reasonable time, cesarean section should be performed without further delay. If cesarean section is necessary in the presence of gross infection, hysterectomy is advocated by some.

Abortion, Therapeutic↗
PubMed2026

MicroRNA-155 modulates STAT3 signaling by targeting KPNA1 in chronic chorioamnionitis of human placenta.

Chronic chorioamnionitis (CCA) is a placental inflammatory lesion characterized by maternal T cell infiltration and trophoblast apoptosis, resembling allograft rejection. MicroRNA-155 (miR-155) is a central regulator of immune and inflammatory pathways, but its role in CCA remains unclear. This study investigated whether miR-155 contributes to the pathogenesis of CCA by targeting karyopherin α1 (KPNA1) and modulating STAT3 signaling in human trophoblasts. Placental tissues from 28 CCA cases and 16 gestational age-matched controls were analyzed for miR-155 expression using quantitative RT-PCR and in situ hybridization. Functional assays were conducted in Swan 71 trophoblast cells following miR-155 overexpression and siRNA-mediated KPNA1 knockdown. Microarray and qRT-PCR analyses identified gene expression changes, while western blotting and dual-luciferase reporter assays were conducted to evaluate STAT3 activity and direct target binding. miR-155 expression was significantly elevated in CCA fetal membranes. KPNA1 was identified as a direct target of miR-155, and its suppression reduced STAT3 phosphorylation and nuclear translocation. Dual-luciferase assays confirmed that miR-155 binds to the 3' untranslated region of KPNA1 mRNA, thereby inhibiting its translation. These findings suggest that miR-155 downregulates KPNA1, leading to inhibition of STAT3 signaling in trophoblasts, which may contribute to maternal-fetal immune dysregulation and trophoblast apoptosis in CCA. The miR-155-KPNA1-STAT3 axis may represent a potential therapeutic target in pregnancy-related inflammatory disorders.

Humans↗
PubMedDate not supplied

Preterm prelabour amniorrhexis: relation to histological chorioamnionitis.

Infection-mediated inflammation may be responsible for premature delivery in cases of preterm prelabour amniorrhexis. Histological examination of the cord and placenta was performed in 54 such pregnancies, in addition to amniocentesis and cordocentesis at presentation. Histological chorioamnionitis was more likely in those with positive amniotic fluid and/or fetal blood cultures, and in those cases with histological evidence of inflammation, the interval to delivery was short regardless of the culture results. Inflammation rather than infection per se may be the best indicator of preterm delivery in preterm prelabour amniorrhexis.

Amniocentesis↗
PubMedDate not supplied

Candida chorioamnionitis: a report of two cases.

Intra-amniotic infection (IAI) across intact membranes by Candida albicans is a rare occurrence. We report two cases of preterm labor and Candida chorioamnionitis that were diagnosed by intrapartum amniocentesis. The diverse maternal and neonatal outcomes observed indicate that Candida IAI is associated with significant, unpredictable maternal and neonatal morbidity.

Adult↗
PubMedDate not supplied

Case of chorioamnionitis in an immunocompetent woman caused by Morganella morganii.

Morganella morganii is an opportunistic organism that leads to serious morbidity. It is an enteric organism commonly associated with immunocompromise and chronic urinary catheterization. We present a case of a healthy gravid individual who presented with chorioamnionitis and neonatal seizures associated with M. morganii. This organism, which causes severe morbidity, is fortunately rare in obstetrics and gynecology.

Adult↗
PubMed1995

Bacteremia and chorioamnionitis due to cryptic genospecies of Haemophilus Influenzae biotype I.

Nontypable strains of Haemophilus influenzae are well-known causes of maternal and neonatal infections. Using DNA-DNA hybridization techniques, some of these strains have been shown to belong to a cryptic genospecies of Haemophilus, which is distantly related to Haemophilus influenzae and Haemophilus hemolyticus. This report describes the first case of sepsis and chorioamnionitis due to Haemophilus influenzae biotype I, which was identified using the RapIDNH system and then confirmed by multilocus enzyme electrophoresis to belong to this cryptic genospecies of Haemophilus. The electromorph type 92 of the isolate was consistent with that of biotype I of the cryptic genospecies.

Adult↗
PubMed1991

The association between Chlamydia cervicitis, chorioamnionitis and neonatal complications.

In a prospective study on genital infections, the influence of Chlamydial cervicitis on pregnancy outcome was evaluated. In eleven women with Chlamydial cervicitis perinatal outcome was recorded, the placenta was examined and the newborns were screened for Chlamydial conjunctivitis. They were compared with 13 women who were negative for Chlamydia and were delivered immediately after a Chlamydia positive woman. Compared to negative women, women with Chlamydia cervicitis were younger and presented for antenatal care at a later gestational age (difference not significant) and started having sexual intercourse at an earlier age (P less than 0.02). There was a significant association between Chlamydial infection and chorioamnionitis, lower birth weight and severe neonatal infection (P less than 0.05); but a contribution from concomitant genital pathogens could not be completely ruled out. Therefore a screening program for Chlamydia should include screening for other genital infections. While almost all cases of Chlamydia could have been suspected by this technique, a screening based on lactobacillary grades in Pap smears might be helpful for this purpose, even more so because it also facilitates tracing other genital pathogens. Detection of Chlamydial antigen from conjunctival swabs taken immediately after birth did not adequately reflect the risks of neonatal infection in this small group.

Adult↗
PubMed2004

The value of the soluable intercellular adhesion molecule-1 levels in matermal serum for determination of occult chorioamnionitis in premature rupture of membranes.

To compare the diagnostic value of soluble intercellular adhesion molecule 1 (sICAM-1) with that of c-reactive protein (CRP) for detecting chorioamnionitis (CAM) in serum of women with premature rupture of membranes (PROM), 55 pregnant women with PROM, including 18 pregnant women with preterm premature rupture of membranes (PPROM) and 20 normal pregnant women at term (TPROM) were studied. Maternal serum were measured by Sandwish enzyme-linked immunoabsorbent assay (ELISA) for sICAM. CAM was histologically confirmed after delivery. The results revealed that (1) maternal serum levels of sICAM-1 and CRP were significantly higher in women with PROM than those without it; (2) maternal serum levels of sICAM-1 and CRP were significantly higher in women with CAM than those without it; (3) serum levels of sICAM-1 in PPROM women were similar to those in TPROM women, whereas serum levels of CRP in PPROM women were significantly higher than those in TPROM women; (4) the sensitivity, specificity, positive predictive value, negative predictive value, Kappa index and area under receiver operating characteristic (ROC) curve of maternal serum sICAM-1 (cutoff 104.7 ng/ml) and CRP (cutoff 1.03 mg/dl) for diagnosing CAM were 100%, 91.2%, 87.5%, 100%, 0.20, 0.995 and 81.0%, 73.5%, 65.4%, 86.2%, 0.13, 0.811, respectively; (5) among the mild histological CAM group, severe histological CAM group and clinical CAM group, the difference in maternal serum levels of sICAM-1 were significantly (P<0.001), with the order of concentration from high level to low level corresponding to the severity of CAM. It is concluded that maternal serum level of ICAM-1 is superior to that of CRP as biomarker for diagnosing intraamniotic infection in pregnant women with PROM.

Biomarkers↗
PubMedDate not supplied

Differences among acute, subacute, and chronic chorioamnionitis based on levels of inflammation-associated proteins in cord blood.

The serum concentration of inflammation-associated proteins and several complement components in the cord blood of 215 newborns with and without chorioamnionitis (CAM), who were delivered between 17 and 42 weeks of gestation, were measured. We investigated the relationship of levels of serum proteins to acute, subacute, and chronic CAM, and to subacute necrotizing funisitis (SNF). Complement components C3d, C3, and C4 levels increased in subacute CAM (P = 0. 0002, P = 0.0007, P = 0.0029, respectively), whereas factor B increased in each type of CAM (P = 0.0001, P = 0.0009, P = 0.0004, respectively). Among the immunoglobulins, IgG levels were unrelated to the presence or type of CAM, IgM levels increased in subacute CAM (P < 0.0001), and IgA levels increased in chronic CAM (P < 0.0001). Among the acute phase reactants (APR), haptoglobin and C-reactive protein (CRP) levels increased in acute (P < 0.0001, P = 0.0022, respectively) and chronic CAM (P = 0.0035, P = 0.0345, respectively), whereas orosomucoid levels increased in chronic CAM (P = 0.0003). IL-6 levels increased in acute (P = 0.0011) and subacute (P = 0. 0475) CAM. C3d (P = 0.0063), C3 (P = 0.0289), C4 (P = 0.0491), and IgM (P < 0.0001) levels were increased in SNF. These findings suggest that the histologic distinction of acute, subacute, and chronic CAM is a useful indicator of the inflammatory mediator status of the infants. The infants with SNF may have ended their initial active inflammatory states, but they still have subacute immune activation.

Acute Disease↗
PubMed1990

Production of prostaglandin E2 by human amnion in vitro in response to addition of media conditioned by microorganisms associated with chorioamnionitis and preterm labor.

To examine the potential role of bacterial infection in the cause of spontaneous preterm labor, human amnion cells in tissue culture were exposed to medium conditioned by culturing each of 21 microorganisms previously found in association with chorioamnionitis and preterm labor. At a final concentration of 0.1% bacterial conditioned medium, a significant stimulation of prostaglandin E2 production from amnion cells was observed for this range of microorganisms. Conditioned medium obtained from culturing Bacteroides fragilis caused a dose-related increase in prostaglandin production, final concentrations of 0.02% to 0.1% being stimulatory but greater concentrations (0.1% to 10%) causing a progressive inhibition of prostaglandin synthesis. A similar concentration-related response in which stimulation was followed by inhibition occurred on addition of increasing concentrations of phospholipase A2 to amnion cells. These data suggest that bacterial phospholipase may release arachidonic acid from amnion leading to prostaglandin E2 synthesis, but excessive addition of phospholipase and consequent increased arachidonic acid availability may give rise to substrate inhibition of cyclooxygenase enzyme and inhibit prostaglandin E2 synthesis. Overall it appears that a wide variety of microorganisms associated with preterm labor may secrete phospholipase, which liberates amnion arachidonic acid for conversion to the oxytocic agent prostaglandin E2.

Amnion↗
PubMed1993

Amniotic fluid interleukin-6 levels correlate with histologic chorioamnionitis and amniotic fluid cultures in patients in premature labor with intact membranes.

OBJECTIVES: Our purpose was (1) to determine the frequency of intraamniotic and extraamniotic intrauterine infection in patients with premature labor and intact membranes and (2) to determine if intrauterine infection is associated with elevated amniotic fluid interleukin-6 levels. STUDY DESIGN: Amniocentesis was performed on 57 patients in preterm labor and 201 controls at various gestational ages without labor and at term with labor. The amniotic fluid was evaluated with gram stain, cultures, and an enzyme-linked immunosorbent assay specific for interleukin-6. Placentas from study patients (n = 52) and term controls (n = 120) were analyzed. RESULTS: The frequency of positive amniotic fluid cultures (intraamniotic intrauterine infection) was 10 of 57 (18%) in the preterm labor group and zero of 201 for controls. Histologic chorioamnionitis (extraamniotic intrauterine infection) was present in 21 of 24 (88%) of patients in preterm labor that failed tocolysis and 28 of 120 (23%) of term laboring controls. An amniotic fluid interleukin-6 level of > or = 600 pg/ml was 100% sensitive and 89% specific (positive predictive value 85%, negative predictive value 100%) for the identification of intrauterine infection. CONCLUSION: Interleukin-6 is a sensitive and specific marker for the identification of both intraamniotic and extraamniotic intrauterine infection in patients in preterm labor with intact membranes.

Adult↗