Histologic Chorioamnionitis and Preterm Delivery

Abstract

Inconsistent findings linking placental histologic chorioamnionitis (HCA) and preterm delivery may result from variations in HCA definition, population studied, and exclusion criteria. This analysis from the 1998-2004 Pregnancy Outcomes and Community Health Study (five Michigan communities) includes the first 1,053 subcohort women (239 preterm, 814 term) with completed placental assessments. Multiple HCA definitions were constructed by 1) varying polymorphonuclear leukocytes/high-powered field thresholds and placenta components included and 2) using polymorphonuclear leukocyte characteristics to assign low/high maternal, fetal inflammation stage and grade. In African Americans, HCA was associated with preterm delivery before 35 weeks. The effect size was modest for polymorphonuclear leukocytes/high-powered field thresholds of greater than 10 and greater than 30 (odds ratios (ORs) ¼ 0.8 and 2.0); larger for greater than 100 (OR ¼ 3.2, 95% confidence interval (CI): 1.4, 7.1); strengthened after excluding medically indicated preterm deliveries (OR ¼ 4.9, 95% CI: 2.0, 11.8); and strongest for high maternal/high fetal HCA (OR ¼ 5.6, 95% CI: 1.4, 22.1). These latter HCA criteria also produced the largest effect size in Whites/others (OR ¼ 2.7, 95% CI: 0.3, 26.9). Among preterm deliveries before 35 weeks excluding those medically indicated, 12% of Whites/others and 55% of African Americans had high maternal HCA. The authors conclude that HCA definition, exclusion criteria, and race/ethnicity influence the HCA-preterm delivery association and that HCA contributes to preterm delivery-related ethnic disparity.

The Incidence, Risk Factors and Common Foetal outcome of Chorioamnionitis in Women with Preterm Premature Rupture of Membrane (PPROM): A Single Centre Study

“…Clinical chorioamnionitis was observed in 25.4 % women of PPROM and 1.93 % of all the hospital deliveries. This rate is within the ranges published as 13-60% 15,16 but is little higher than the observation (14%) of Akter S 17 .This high prevalence can be explained by the cultural influences of early marriages, poverty, gender discrimination resulting in low maternal weight gain and lack of birth spacing which are significantly associated with PPROM as has been reported earlier 13,14,18 . In this study younger maternal age, and lower socioeconomic class were more commonly associated with chorioamnionitis in PPROM with higher rates of poverty (57.1% with monthly income <4000/-), illiteracy (46.4% £ SSC), unemployment and 4 th grade employment (60.7% of day laborers, garment workers and others); all together leading into lower standard of living (53.5%).…”

A clinicopathological study of episomal papillomavirus infection of the human placenta and pregnancy complications

“…The pathologist was unaware of maternal history, pregnancy complications, delivery circumstances, and ethnicity associated with each placenta, but informed of the gestational age (to assist in the assessment). Histopathological chorioamnionitis was assessed according to the criteria of Holzman et al 22 and low maternal/high fetal, high maternal/low fetal, and high-maternal/high-fetal response categories were recorded as clinically significant acute chorioamnionitis. Any further histopathological abnormalities, such as necrotizing deciduitis, were descriptively recorded.…”

Damage-Associated Molecular Pattern and Fetal Membrane Vascular Injury and Collagen Disorganization in Lipopolysaccharide-Induced Intra-amniotic Inflammation in Fetal Sheep

“…The presence of acute chorioamnionitis is associated with an increased risk of fetal organ injury. [1][2][3][4][5][6][7][8][9] One of the common associations of chorioamnionitis is prelabor rupture of membrane (PROM). 10 Prelabor rupture of membrane can predispose to chorioamnionitis by permitting migration of microorganisms from lower genital tract to upper genital tract.…”