Labor Dystocia and Risk of Histological Chorioamnionitis and Funisitis: A Study from a Single Tertiary Referral Center

Abstract

Background: Intrauterine inflammation affects short- and long-term neonatal outcomes. Histological chorioamnionitis and funisitis are acute inflammatory responses in the fetal membranes and umbilical cord, respectively. Although labor dystocia includes a potential risk of intrauterine inflammation, the risk of labor dystocia in histological chorioamnionitis and funisitis has not been evaluated yet. This study aimed to examine the association between labor dystocia and risk of histological chorioamnionitis and funisitis.Methods: In this retrospective cohort study, the patients who underwent histopathological examinations of the placenta and umbilical cord at Fukushima Medical University Hospital, Japan, between 2015 and 2020, were included. From the dataset, the pathological findings of the patients with labor dystocia and spontaneous preterm birth were reviewed. Based on the location of leukocytes, the inflammation in the placenta (histological chorioamnionitis) and umbilical cord (funisitis) was graded as 0–3. Multiple logistic regression analysis was performed to evaluate the risk of histological chorioamnionitis, histological chorioamnionitis stage ≥2, funisitis, and funisitis stage ≥2.Result: Of 317 women who met the study criteria, 83 and 144 women had labor dystocia and spontaneous preterm birth, respectively, and 90 women were included as controls. Labor dystocia was a risk factor for histological chorioamnionitis (adjusted odds ratio, 6.3; 95% confidential interval, 1.9-20.5), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 6.0; 95% confidence interval, 1.7-21.8), funisitis (adjusted odds ratio, 9.4; 95% confidence interval, 1.8-48.2), and funisitis stage ≥2 (adjusted odds ratio, 23.5; 95% confidence interval, 2.3-23.8). Spontaneous preterm birth was also a risk factor for histological chorioamnionitis (adjusted odds ratio, 3.7; 95% confidence interval, 1.7-7.8), histological chorioamnionitis stage ≥2 (adjusted odds ratio, 3.0; 95% confidence interval, 1.2-7.9), and funisitis (adjusted odds ratio, 4.5; 95% confidence interval, 1.2-16.8). However, the adjusted odds ratio was smaller in spontaneous preterm births than in labor dystocia. Conclusion: Labor dystocia is a risk factor for severe histological chorioamnionitis and funisitis. Further studies are required to evaluate the effects of histological chorioamnionitis and funisitis on long-term neonatal outcomes.

Gestational weight gain as a risk factor for dystocia during first delivery: a multicenter retrospective cohort study in Japan

“…We noted that although previous studies have identified nullipara, fetal macrosomia, older maternal age, infertility treatment as risk factors for dystocia [4,5,26,27], data on the association between pre-pregnancy BMI and dystocia or optimal gestational weight gain to reduce the risk of dystocia have not been comprehensively examined among nulliparous women.…”

“…The main strength of our study is that the data were derived from two tertiary care Maternal-Fetal medical units where all women who delivered were managed using approximately the same protocol [5,37]. Furthermore, all participants in this study were Japanese women and, therefore, there were no effects of ethnic diversity on measured outcomes.…”

“…Dystocia is described as a cephalic presentation for delivery in a woman, requiring either (1) operative vaginal delivery with several trials of maternal effort due to arrest of the active phase of labor for at least 4 h, when cervical dilation is 10 cm, with or without the use of an augmentation agent or (2) no progression of cervical dilation despite clinically adequate effective labor, which is defined as one contraction every 10 min, irrespective of augmentation, such as the use of oxytocin or performance of amniotomy [5,18].…”

“…Identifying the risk of dystocia is essential as dystocia is associated with operative vaginal delivery, cesarean section (CS), and postpartum hemorrhage [3,4]. In addition to being a maternal health risk, dystocia also increases the risk of intrauterine and fetal inflammation, which can have a negative impact on the neurodevelopment of neonates [5,6].…”

Optimal gestational weight gain to reduce the risk of hypertension disorders of pregnancy among women with obesity: A single tertiary referral center study in Japan

“…The definition of GDM used in our institution has already been reported elesewhere 14 LD was defined as follows: a case with the cephalic presentation without a history of cesarean section (CS) and either operative vaginal delivery with several trials of maternal effort, due to arrest of the active phase for at least 4 h when the dilation of the cervix was 10 cm with or without an augmentation agent, or no progress in cervical dilation despite clinically adequate effective labor, irrespective of augmentation, such as the use of oxytocin or amniotomy. 15 Methods of delivery were categorized as emergent cesarean section or other. In clinical settings, emergent CS is usually conducted based on the attending doctor's decision, such as in cases of nonreassuring fetal status and LD.…”