Chorioamnionitis and the Prognosis for Term Infants

Alexander, J.; McIntire, Donald; Leveno, Kenneth J.

doi:10.1097/00006250-199908000-00023

Cited by 19 publications

(17 citation statements)

References 8 publications

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“…Chorioamnionitis (clinical and histologic combined), complicates as many as 40–70% of preterm births with premature membrane rupture or spontaneous labor [8] and 1–13% of term births [9–11]. Twelve percent of primary cesarean births at term involve clinical chorioamnionitis, with the most common indication for cesarean in these cases being failure to progress usually after membrane rupture [12].…”

Section: Epidemiology (Incidence and Risk Factors)mentioning

confidence: 99%

Diagnosis and Management of Clinical Chorioamnionitis

Tita

Andrews

2010

Clinics in Perinatology

763

548

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Chorioamnionitis is a common complication of pregnancy associated with significant maternal, perinatal, and long-term adverse outcomes. Adverse maternal outcomes include postpartum infections and sepsis while adverse infant outcomes include stillbirth, premature birth, neonatal sepsis, chronic lung disease and brain injury leading to cerebral palsy and other neurodevelopmental disabilities. Research in the last two decades has expanded our understanding of the mechanistic links between intraamniotic infection and preterm delivery as well as morbidities of preterm and term infants. Recent and ongoing clinical research into better methods for diagnosing, treating and preventing chorioamnionitis is likely to have a substantial impact on short and long-term outcomes in the neonate. KeywordsChorioamnionitis; infection; pregnancy; management DefinitionChorioamnionitis or intraamniotic infection is an acute inflammation of the membranes and chorion of the placenta, typically due to ascending polymicrobial bacterial infection in the setting of membrane rupture. Chorioamnionitis can occur with intact membranes, and this appears to be especially common for the very small fastidious genital mycoplasmas such as Ureaplasma species and Mycoplasma hominis, found in the lower genital tract of over 70% of women [1]. Only rarely is hematogeneous spread implicated in chorioamnionitis, as occurs with Listeria monocytogenes [2]. When characteristic clinical signs are present, the condition is referred to as clinical chorioamnionitis or clinical intraamniotic infection. Although there is significant overlap between clinical and histologic chorioamnionitis, the latter is a more common diagnosis based on pathologic findings on microscopic examination of the placenta that encompasses clinically unapparent (sub-clinical) chorioamnionitis as well as clinical chorioamnionitis. Funisitis, also a histopathologic diagnosis, is the extension of infection or inflammation to the umbilical cord. Overall the definition of chorioamnionitis a Corresponding author for proof and reprints: Dr. Alan T. N. Tita (alan.tita@obgyn.uab.edu Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Epidemiology (incidence and risk factors)Overall, 1-4% of all births in the US are complicated by chorioamnionitis [2]; however, the frequency of chorioamnionitis varies markedly by diagnostic criteria, specific risk factors and gestational age [3][4][5][6][7]. Chorioamnionitis (clinical and histologic combined), complicates as many as 40-70% of preterm births with premature membrane rupture or spontaneous la...

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Section: Epidemiology (Incidence and Risk Factors)mentioning

confidence: 99%

Diagnosis and Management of Clinical Chorioamnionitis

Tita

Andrews

2010

Clinics in Perinatology

763

548

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“…12,13,14 Regardless of the etiology, there are far going implications of intrapartum fever for the fetus, and a rise of maternal core temperature may lead to an adverse neonatal outcome even in the absence of infection. 1,[15][16][17][18][19][20][21] Intrauterine infection is an important risk factor for neonatal sepsis, meningitis, pneumonia, increased mortality, [21][22][23][24] and may have long-term consequences such as cerebral palsy. 25 Early diagnosis is therefore crucial.…”

mentioning

confidence: 99%

Intrapartum Fever at Term

Evers¹,

Nijhuis²,

Koster³

et al. 2012

Obstetrical &Amp; Gynecological Survey

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Intrauterine infection is a serious complication during labor at term and is associated with adverse neonatal outcome. Early and accurate diagnosis is of great concern for both obstetrician and pediatrician with the use of current diagnostics. Clinical symptoms are often regarded as the main sign of intrauterine infection but this approach is highly unreliable and leads to both underand overtreatment. Currently, no distinct fetal heart rate (FHR) patterns have been found that reliably identify neonates with intrauterine infection. Using a systematic literature search, this article reviews possible markers for the early detection of intrauterine or neonatal infection in maternal serum, amniotic fluid, and umbilical cord blood during labor at term. Maternal serum markers, with the possible exception of interleukin (IL)-8, are unreliable for the detection of intrauterine infection. In contrast, amniotic fluid levels of especially IL-6 and IL-8 are significantly associated with intrauterine infection. Umbilical cord blood IL-6 has been extensively investigated and is usually elevated in case of intrauterine or neonatal infection but shows only modest positive and negative predictive values (NPVs) for clinical use. Umbilical cord IL-8 concentration could be a valuable addition in the diagnostic process, as it has shown to have an NPV of 84% to 92% in the detection of neonatal infection and histological chorioamnionitis. Future research is essential and should focus on the combination of different markers and on the development of a prediction model, to improve the positive and NPVs of our arsenal to detect intrauterine and neonatal infections. Amniotic fluid and umbilical cord values of IL-6 and IL-8 levels are likely candidates for such a prediction model. Target Audience: Obstetricians & Gynecologists and Family PhysiciansLearning Objectives: After the completing the CME activity, physicians should be better able to evaluate the use of clinical chorioamnionitis with regard to histological evidence and as a diagnostic tool in early diagnosis of intra-amniotic infection. Asses the use of amniotic fluid IL-6 and IL-8 as diagnostic tools to detect early intra-amniotic infection and assess umbilical cord blood IL-8 in case of intrauterineor neonatal infection using positive (PPV) and negative predictive values (NPV).

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“…The most common indicator used is maternal fever in labour, associated in controlled studies with heightened risk of NE 14 15. Clinical chorioamnionitis defined as maternal fever was twice as frequent as identified asphyxial birth events in neonates admitted for therapeutic hypothermia16 and is a frequent antecedent of low Apgar scores 17 18. Neonatal seizures are a common feature of NE; a clinical diagnosis of chorioamnionitis, other maternal infection and isolated fever were all associated with increased risk of neonatal seizures 19.…”

Section: Clinical Chorioamnionitismentioning

confidence: 99%