Fetal origin of amniotic fluid polymorphonuclear leukocytes

Objective. Funisitis is the histologic counterpart of the fetal inflammatory response syndrome, which is a multisystemic disorder associated with impending preterm delivery and adverse neonatal outcome. The purpose of this study was to examine the relationship between funisitis and the microbiologic status of amniotic fluid (AF) and AF white blood cell (WBC) count in patients at term. Methods. The relationship between the presence of funisitis, AF culture, and AF WBC count was examined in 832 consecutive patients who delivered a term neonate within 72 hours of amniocentesis. AF was cultured for aerobic and anaerobic bacteria, as well as for mycoplasmas. Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton's jelly. AF WBC count was analyzed in a hemocytometer chamber. Nonparametric statistics were used for data analysis. Results. Funisitis was present in 4% (30/832) of cases. A positive AF culture was more common in cases with funisitis than in those without funisitis (17% vs. 5%; p 5 0.05). Patients with funisitis had a significantly higher median AF WBC count than those without funisitis (median 41000 cells/mm 3 vs. median 2 cells/mm 3 ; p 5 0.001). The frequency of funisitis and of a positive AF culture was 1% in women without labor and with intact membranes and the frequencies and the median AF WBC count increased in the presence of labor or rupture of membranes. Conclusion. Funisitis is present in 4% of women at term and is associated with microbial invasion of the amniotic cavity (MIAC) and inflammation as reflected by increased AF WBC count.

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“…This interpretation is in keeping with the observation that neutrophils in the amniotic cavity are of fetal origin [20].…”

Section: The Clinical Significance Of Funisitissupporting

confidence: 89%

Funisitis in term pregnancy is associated with microbial invasion of the amniotic cavity and intra-amniotic inflammation

Lee

Romero

Kim

et al. 2006

The Journal of Maternal-Fetal & Neonatal Medicine

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“…These cytokines stimulate uterine contractions through the production of prostaglandins, primarily by the amnion and decidua, and through stimulation of fetal or maternal neutrophils (47,48). Similar signaling cascades may be activated by noninfectious inflammation, triggered by damage-associated molecular patterns (DAMPs), which activate signals such as the receptor for advanced glycation end products (RAGE) and resulting in the production of parturition-triggering cytokines (49).…”

Section: Established Pathways Implicated In Term and Preterm Parturitionmentioning

confidence: 99%

Prevention of preterm birth: Harnessing science to address the global epidemic

et al. 2014

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“…21 The origin of the WBC present in the AF of patients with CCA is mostly fetal. 22 An in-depth discussion of the histological aspects and the gradation of the inflammatory process that occurs during chorioamnionitis are beyond the scope of the present work. We refer the reader to the comprehensive chorioamnionitis grading and staging system as proposed by Redline and colleagues.…”

mentioning

confidence: 94%

Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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Abstract:The term chorioamnionitis (CA) is commonly used to refer to different clinical or pathological conditions characterized by an infectious and/or inflammatory process that affects primarily the chorioamniotic membranes, but also the amniotic fluid, vessels of the chorionic plate, and, eventually, the umbilical cord (funisitis) and the fetus. Its incidence is higher at lower gestational ages, and the main mechanism is believed to be the ascending bacterial infection from the maternal genital tract. It can be diagnosed by clinical criteria, amniotic fluid examination for inflammatory mediators, and/or isolation of microorganisms, or by histopathological examination of the placenta. CA is an important cause of stillbirth and is related to an increased incidence of premature rupture of membranes, preterm delivery, and adverse maternal and neonatal outcomes such as early-onset neonatal sepsis and necrotizing enterocolitis. An independent causal association to other neonatal morbidities is more controversial. The heterogeneity in the diagnostic criteria and in the operative definitions for morbidity makes comparison of studies difficult, and results are inconsistent. In addition, the intensity and duration of the process are usually not considered. For all these reasons, evidence-based recommendations for the management of mother and infant under these circumstances are difficult to establish, and clinical practice varies widely.

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Fetal origin of amniotic fluid polymorphonuclear leukocytes

Cited by 137 publications

References 16 publications

Funisitis in term pregnancy is associated with microbial invasion of the amniotic cavity and intra-amniotic inflammation

Funisitis in term pregnancy is associated with microbial invasion of the amniotic cavity and intra-amniotic inflammation

Prevention of preterm birth: Harnessing science to address the global epidemic

Chorioamnionitis and neonatal morbidity: current perspectives

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