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 histological chorioamnionitis and funisitis of labor dystocia 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 cases 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 staged 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, 15.4; 95% confidence interval, 2.3–101.3), and funisitis stage ≥2 (adjusted odds ratio, 18.5; 95% confidence interval, 2.5–134.0). 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, 6.6; 95% confidence interval, 1.4–30.6). 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.

Amniotic Sludge and Prematurity: Systematic Review and Meta-analysis

“…Although amniotic fluid is not considered a sterile environment, the presence of intraamniotic sludge was associated with the risk of developing both clinical (RR: 2.95; 95%CI: 1.41-6.19) and histological chorioamnionitis (RR: 2.34; 95% CI: 1.7-3.12), which strengthens the hypothesis that sludge is a marker of microbial infection, which is the main known cause of premature labor. 37 These facts reiterate the hypothesis that sludge is an indicator of microbial invasion within the amniotic cavity, which would explain its relationship to clinical and histological chorioamnionitis, premature labor, and neonatal sepsis.…”

“…Although amniotic fluid is not considered a sterile environment, the presence of intraamniotic sludge was associated with the risk of developing both clinical (RR: 2.95; 95%CI: 1.41–6.19) and histological chorioamnionitis (RR: 2.34; 95%CI: 1.7–3.12), which strengthens the hypothesis that sludge is a marker of microbial infection, which is the main known cause of premature labor. 37…”

Clinical implications of uterine cultures obtained during urgent caesarean section

“…We report a relatively high rate of histopathological chorioamnionitis after emergency CS. A previous study showed that labour dystocia increased the risk of histopathological chorioamnionitis 27 . The importance of histopathological chorioamnionitis should not be ignored, as it was found to be associated with EOS and perinatal comorbidities 28 .…”

“…A previous study showed that labour dystocia increased the risk of histopathological chorioamnionitis. 27 The importance of histopathological chorioamnionitis should not be ignored, as it was found to be associated with EOS and perinatal comorbidities. 28 The reported rate of chorioamnionitis of 13% in women with positive uterine culture is higher than the rate of 1-4% reported in a large database.…”

Association of labour duration in spontaneous deliveries with low neonatal Apgar scores and foetal acidosis: the Japan Environment and Children’s Study

“…However, extended LD may cause recurrent, prolonged, and excessive reduction of uteroplacental perfusion, which may exceed the ability of the foetus to tolerate the hypoxia and lead to foetal asphyxia and acidosis. Furthermore, because labour is affected by inflammatory status in the myometrium, cervix, and foetal membranes 25 – 27 , prolonged LD may be associated with an inflammatory condition that may also affect foetal asphyxia and acidosis, along with the effects of labour dystocia on histological chorioamnionitis and funisitis 28 .…”