Histologic chorioamnionitis as a consideration in the management of newborns of febrile mothers

Hoang, Danthanh; Charlagorla, Pradeepkumar; Salafia, Carolyn M.; VanHorn, Samantha; Dygulska, Beata; Narula, Pramod; Gad, Ashraf

doi:10.3109/14767058.2012.751368

Cited by 9 publications

(4 citation statements)

References 37 publications

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“…A previous study reported that adding placental inflammation (amnionitis) to clinical factors (gestational age, clinical chorioamnionitis, duration of labor, maternal age, race, and parity), which are used in the identification of neonatal infection, decreased the administration of antibiotics from 35% to 10% [257]. Hoang et al also proposed to use the presence or absence of acute histologic chorioamnionitis to guide the duration of antimicrobial treatment in neonates at risk for sepsis [258]. …”

Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Romero¹,

Chaemsaithong²,

Docheva³

et al. 2015

Journal of Perinatal Medicine

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Objective Neonates born to mothers with clinical chorioamnionitis at term are at an increased risk of infection. Acute subchorionitis, chorioamnionitis, and funisitis are considered placental histologic features consistent with acute inflammation according to the Society for Pediatric Pathology. The objectives of this study were to examine the performance of placental histologic features in the identification of: 1) microbial-associated intra-amniotic inflammation (intra-amniotic infection); and 2) a fetal inflammatory response syndrome (FIRS). Methods and Materials This retrospective cohort study included women with the diagnosis of clinical chorioamnionitis at term (n=45), who underwent an amniocentesis to determine: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad range primers]; and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay (ELISA). The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of placental histologic features consistent with acute inflammation was determined for the identification of microbial-associated intra-amniotic inflammation and FIRS. Results 1) The presence of acute histologic chorioamnionitis and funisitis was associated with the presence of proven intra-amniotic infection assessed by amniotic fluid analysis; 2) funisitis was also associated with the presence of FIRS; 3) the negative predictive value of acute funisitis ≥ stage 2 for the identification of neonates born to mothers with intra-amniotic infection was less than 50%, and therefore, suboptimal to exclude fetal exposure to bacteria in the amniotic cavity; and 4) acute funisitis ≥ stage 2 had a negative predictive value of 86.8% for the identification of FIRS in a population with a prevalence of 20%. Conclusion Acute histologic chorioamnionitis and funisitis are associated with intra-amniotic infection and the presence of FIRS. However, current pathologic methods have limitations in the identification of the fetus exposed to microorganisms present in the amniotic cavity. Further studies are required to determine whether molecular markers can enhance the performance of placental pathology in the identification of neonates at risk for neonatal sepsis.

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Section: Discussionmentioning

confidence: 99%

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Romero¹,

Chaemsaithong²,

Docheva³

et al. 2015

Journal of Perinatal Medicine

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“…The exact mechanism of epidural anesthesia on hyperthermia occurrence remains unknown, but it is assumed that sympathetic blockade of thermoregulatory processes underlied it [14]. However, there is no reliable way to distinguish the hyperthermia of infectious etiology and hyperthermia caused by epidural anesthesia [113,116].…”

Section: Clinical Chorioamnionitismentioning

confidence: 99%

The Chorioamnionitis - Still an Enigma in Perinatology

Varjacic,

Jovic

2024

Experimental and Applied Biomedical Research (EABR)

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Chorioamnionitis is one of the most common causes of preterm premature rupture of fetal membranes and consequent preterm birth. The variety of mechanisms underlie pathophysiology of chorioamnionitis represents its greatest enigma. The unspecific clinical manifestations of chorioamnionitis considered an aggravating issue for perinatologist to diagnose it timely. There are no absolutely sensitive, non-invasive diagnostic procedures for certain establishment of chorioamnionitis diagnosis. The more sensitive diagnostic procedures are also invasive, so the question of their application in routine practice arises. Certainly, the perinatologist is always in a dilemma when there is a suspicion of chorioamnionitis, whether and how it should be treated, having in mind the facts about possible side effects on the fetus, but also on the mother. This paper presents a summary of all known facts about the etiopathogenesis, classification and clinical manifestations of chorioamnionitis, providing a basis for further research regarding the identification of more sensitive diagnostic markers, as well as the treatment of this condition.

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“…However, dysfunctional labor may be related mostly to low-grade fever during labor, rather than high-grade fever and fever ≥39.0°C that is most probably a sign of maternal infection, specifically chorioamnionitis [27]. Of note, 16 placentas of HFF were pathologically examined and 15 of them revealed features consistent with chorioamnionitis.…”

Section: Discussionmentioning

confidence: 99%

Very High Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes

Dior¹,

Kogan²,

Eventov‐Friedman

et al. 2015

Neonatology

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Background: Intrapartum fever is a well-known risk factor for adverse perinatal outcomes. Maternal intrapartum fever ≥39.0°C at term is a rare event during labor, and there is scarce evidence regarding its implications. Objectives: To investigate the association between very high intrapartum maternal fever and perinatal outcomes in term pregnancies. Methods: A retrospective cohort analysis including 43,560 term, singleton live births in two medical centers between the years 2003 and 2011 was performed. We compared parturients who experienced a maximal intrapartum fever of <38.0°C with two subgroups of parturients who experienced respective maximal fevers of 38.0-38.9°C and ≥39°C. Adjusted risks for adverse perinatal outcomes were calculated by using multiple logistic regression models to control for confounders. Results: Compared with normal intrapartum temperature, intrapartum fever ≥39.0°C was associated with an extremely elevated risk for neonatal sepsis 16.08 (95% CI: 2.15, 120.3) as well as with low Apgar scores and neonatal intensive care unit admissions (p < 0.001). Additionally, very high intrapartum fever was related to significantly higher risk for operative delivery (p < 0.001). Conclusions: Extremely elevated intrapartum fever is an important indicator of severe neonatal morbidity and operative delivery.

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Histologic chorioamnionitis as a consideration in the management of newborns of febrile mothers

Abstract: Maternal fever is associated with HCA. The HCA in conjunction with an elevated CRP can guide the duration of antimicrobial therapy in infants born to febrile mothers.

Cited by 9 publications

References 37 publications

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity

The Chorioamnionitis - Still an Enigma in Perinatology

Very High Intrapartum Fever in Term Pregnancies and Adverse Obstetric and Neonatal Outcomes

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