Frozen section in amniotic infection, an underutilized diagnostic tool?

Abstract

Introduction: Chorioamnionitis and funisitis produce high impact maternal, fetal and neonatal repercussions; intra-amniotic infections are present in 40-70% of preterm deliveries; additionally, intrauterine infections trigger systemic inflammatory conditions in 50% of exposed fetuses. On the contrary, maternal symptoms register low sensitivity for diagnosis of intrauterine infections. Herein, we discuss the need for a new diagnostic tool that will allow for early capture of subclinical cases. Methods: Between 2020 and 2022, we included 30 patients born with (Group 1:15) or without (Group 2:15) suspected intra-amniotic infection . We compared frozen sections to final paraffin sections, we correlated conventional process to neonate clinical outcome, taking into account changes in treatment based on early diagnosis of the infection. Results: Group 1 presented the largest number of cases for preterm delivery, low birth weight, complications and total hospital stay. Furthermore, in Group 1, we found 33.3% early sepsis diagnosis, as opposed to 6.67% in Group 2; following positive pathology report, both duration of antibiotic management and length of clinical observation: it was extended over a greater length of time than expected as standard. Discussion: Research has validated the premise on which we based our study, a clear relation between chorioamnionitis and fetal death and preterm delivery, the outcome of which also results in an increase in comorbidities. Early diagnosis of infection, especially of funisitis, is clinically useful for subsequent intervention. Conclusions: The use of frozen biopsy in ascending subclinical infection can aid in reaching early chorioamniontis/funisitis diagnosis, thereby providing guidance in medical interventions. This technique has proven its performance in predicting definitive infection outcomes. However, there is still a need for further studies on how to profile patients with subclinical infections who would benefit from frozen biopsy analysis.