Pathology of the Placenta and Cord in Ascending and in Haematogenous Infection

Blanc, William A.

doi:10.1002/9780470720608.ch3

Cited by 42 publications

(36 citation statements)

References 16 publications

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“…Genital mycoplasmas can induce severe inflammatory responses in the amniotic cavity and surrounding tissues 116-120 , which may be characterized by the migration of maternal neutrophils into this compartment, as demonstrated herein. In this scenario, neutrophils possibly invade the amniotic cavity by migrating from the maternal vasculature of the decidua or the intervillous space 48 . This is consistent with the findings reported herein showing that women included in this study had acute maternal inflammatory responses in both the chorioamniotic membranes and chorionic plate membranes.…”

Section: Discussionmentioning

confidence: 99%

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Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Gomez‐Lopez

Romero

et al. 2017

American Journal of Obstetrics and Gynecology

101

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Background Neutrophils are the most abundant white blood cells found in the amniotic cavity of women with intra-amniotic infection and/or inflammation. The current belief is that these neutrophils are of fetal origin. However, abundant neutrophils have been found in the amniotic fluid of women with a severe acute maternal inflammatory response but without a fetal inflammatory response in the placenta, suggesting that these innate immune cells can also be of maternal origin or a mixture of both fetal and maternal neutrophils. Objectives To investigate the origin of amniotic fluid neutrophils from women with intra-amniotic infection and/or inflammation, and to correlate these findings with acute histologic maternal and fetal inflammatory responses in the placenta. Study Design Amniotic fluid was collected from 15 women with suspected intra-amniotic infection and/or inflammation (positive microbiological cultures and/or interleukin (IL)-6 concentrations≥2.6 ng/mL). Amniotic fluid neutrophils were purified by fluorescence-activated cell sorting, DNA was extracted, and DNA fingerprinting was performed. DNA fingerprinting was also performed in the umbilical cord and maternal blood DNA. Fluorescence in situ hybridization (FISH) was assayed in women with male neonates. Blinded placental histopathological evaluations were conducted. Results 1) DNA fingerprinting revealed that 43% (6/14) of the women who underwent a single amniocentesis had mostly fetal neutrophils in the amniotic fluid; 2) DNA fingerprinting showed that 36% (5/14) of the women who underwent a single amniocentesis had predominantly maternal neutrophils in the amniotic fluid; 3) DNA fingerprinting indicated that 21% (3/14) of the women who underwent a single amniocentesis had an evident mixture of fetal and maternal neutrophils in the amniotic fluid; 4) DNA fingerprinting revealed that a woman who underwent two amniocenteses (patient #15) had fetal neutrophils first, and as infection progressed, abundant maternal neutrophils invaded the amniotic cavity ; 5) FISH confirmed DNA fingerprinting results by showing that both fetal and maternal neutrophils are present in the amniotic fluid; 6) Most of the women who had predominantly amniotic fluid neutrophils of fetal origin at the time of collection delivered extremely preterm neonates [71% (5/7)]; 7) All of the women who had predominantly amniotic fluid neutrophils of maternal origin at the time of collection delivered term or late preterm neonates [100% (6/6)]; 8) Two of the women who had an evident mixture of fetal and maternal neutrophils in the amniotic fluid at the time of collection delivered extremely preterm neonates [67% (2/3)], and the third woman delivered a term neonate [33% (1/3)]; and 9) Most of the women included in this study presented acute maternal and fetal inflammatory responses in the placenta [87 % (13/15)]. Conclusion Amniotic fluid neutrophils can be either predominantly of fetal or maternal origin, or a mixture of both fetal and maternal origin, in women with intra-amniotic inf...

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Section: Discussionmentioning

confidence: 99%

“…Amniotic fluid neutrophils were initially thought to be of maternal origin 48 . Yet, experimental evidence showed that amniotic fluid neutrophils from women 49 or rhesus monkeys 50 undergoing preterm labor were of fetal origin.…”

Section: Introductionmentioning

confidence: 99%

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Gomez‐Lopez

Romero

et al. 2017

American Journal of Obstetrics and Gynecology

101

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“…All patients underwent cardiotocography, ultrasound measurement of cervical length, cervico-vaginal fetal fibronectin (fFN) sampling, and blood sampling, Diagnosis of bacterial vaginosis was performed by the presence of at least three of the Amsel's criteria at the clinical evaluation [13], or by a Nugent Score 7 [14]. For all patients we investigated the following markers of inflammation/infection: maternal serum C-reactive protein (CRP) 4 1 ng/ml, on the basis of our laboratory cut-off, and leukocytosis, presence of bacterial vaginosis, and chorioamnionitis at placental histological examination [15].…”

Section: Methodsmentioning

confidence: 99%

Inflammatory and infectious risk factors are associated with the response to tocolysis in patients with preterm labor

Torricelli

Voltolini

Conti

et al. 2010

The Journal of Maternal-Fetal & Neonatal Medicine

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“…7,15 The maternal cellular inflammatory response begins in the subchorionic fibrin and at membranous choriodecidual interface (stage 1), spreads to the fibrous chorion and amnion (stage 2), and eventually leads to necrosis of the amnionic epithelium (stage 3). The Amsterdam criteria recognize only stages 2e3 to represent a fully developed histological chorioamnionitis, with stage 1 being a sensitive but less specific early indicator of evolving amniotic fluid infection.…”

Section: Infectious Inflammatory Lesionsmentioning

confidence: 99%

Classification of placental lesions

Redline

2015

American Journal of Obstetrics and Gynecology

350

224

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Placental pathology can be useful in a variety of ways including immediate diagnosis of important conditions affecting the mother or infant, identifying conditions that are likely to recur in subsequent pregnancies, separating clinical syndromes into distinct pathological phenotypes for further investigation, and uncovering the underlying cause of unexpected adverse outcomes. Classification of placental lesions has evolved from being a purely descriptive exercise through a stage in which the major pathophysiological processes such as disorders of maternal implantation and the amniotic fluid infection syndrome were first described to a recently proposed comprehensive classification system that includes all of the major maternal and fetal vascular and infectious and idiopathic/immune inflammatory processes (Amsterdam Placental Workshop Group). Implementation of this unified system with reproducible grading and staging should help establish evidence-based recommendations for placental submission and facilitate progress in studying the pathogenesis, diagnosis, and treatment of obstetric disorders with an underlying placental etiology.

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Pathology of the Placenta and Cord in Ascending and in Haematogenous Infection

Cited by 42 publications

References 16 publications

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Are amniotic fluid neutrophils in women with intraamniotic infection and/or inflammation of fetal or maternal origin?

Inflammatory and infectious risk factors are associated with the response to tocolysis in patients with preterm labor

Classification of placental lesions

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