Chorioamnionitis: a multiorgan disease of the fetus?

Abstract

The bacterial infection of chorion and amnion is a common finding in premature delivery and is referred to as chorioamnionitis. As the mother rarely shows symptoms of a systemic inflammation, the course of chorioamnionitis is frequently asymptomatic and chronic. In contrast, the fetal inflammatory response syndrome represents a separate phenomenon, including umbilical inflammation and increased serum levels of proinflammatory cytokines in the fetus. Ascending maternal infections frequently lead to systemic fetal inflammatory reaction. Clinical studies have shown that antenatal exposure to inflammation puts the extremely immature neonates at a high risk for worsening pulmonary, neurological and other organ development. Interestingly, the presence of chorioamnionitis is associated with a lower rate of neonatal mortality in extremely immature newborns. In the following review, the pathogeneses of inflammation-associated perinatal morbidity are outlined. The concept of fetal multiorganic disease during intrauterine infection is introduced and discussed.

Effects of intra-amniotic lipopolysaccharide exposure on the fetal lamb lung as gestation advances

“…In this study, we focused on the lungs. From literature, it is known that chorioamnionitis is a multiorgan disease that affects the central nervous system, skin, and the gut in clinics and experimental models (3,35,36). The interaction of the different organs is not very well understood, but the role of the immune system of the fetus, as well as the role of endotoxins in human chorioamnionitis, warrants further research.…”

“…Conversely, chorioamnionitis is associated with an increase in bronchopulmonary dysplasia (4,7,8) due to inflammatory disruption of lung alveolar and vascular development (9,10). Chorioamnionitis may also negatively affect neonatal outcomes by modulating the fetal immune system (3,11,12). The fetal lung, gut, and skin are directly exposed to the inflammation associated with chorioamnionitis, although other organs and the immune system, which are not in direct contact with the amniotic fluid, can also be affected adversely (3).…”

“…Chorioamnionitis may also negatively affect neonatal outcomes by modulating the fetal immune system (3,11,12). The fetal lung, gut, and skin are directly exposed to the inflammation associated with chorioamnionitis, although other organs and the immune system, which are not in direct contact with the amniotic fluid, can also be affected adversely (3).…”

“…In chorioamnionitis, the fetus is exposed to inflammation through direct contact with amniotic fluid or via the placental-fetal circulation (2,3). Often, chorioamnionitis is identified only by histological examination of the placental and fetal membranes after birth.…”

Selective IL-1α exposure to the fetal gut, lung, and chorioamnion/skin causes intestinal inflammatory and developmental changes in fetal sheep

“…[3][4][5] Bacterial infection of the amniotic cavity results in direct exposure of the lung (by fetal breathing), gastrointestinal tract (by swallowing), skin, and chorioamnion to bacteria and their inflammatory components in the contaminated amniotic fluid. The fetal inflammatory response to chorioamnionitis is associated with multiorgan dysfunction, 6,7 which increase the incidence of periventricular leukomalacia, 8 bronchopulmonary dysplasia, 9 and necrotizing enterocolitis. 10,11 We have used a translational ovine model of chorioamnionitis to investigate the impact of intrauterine inflammation on fetal organs.…”