Sequelae of chorioamnionitis

Hagberg, Henrik; Wennerholm, Ulla‐Britt; Sävman, Karin

doi:10.1097/00001432-200206000-00014

Cited by 134 publications

(84 citation statements)

References 53 publications

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“…These morbidities, in turn, have been linked to the development of chronic conditions such as bronchopulmonary dysplasia (BPD) and cerebral palsy (CP) and developmental delay. 3,4 However, a direct causal relationship between CA and these prematurity-related morbidities is still controversial, with some studies showing no effect or even opposite results. The reason for such discrepancies could be the different definitions of CA used in the studies, and the diversity of criteria to include patients.…”

Section: Introductionmentioning

confidence: 99%

“…Clinical diagnosis of CA is most frequently based on criteria adapted from Gibbs,14,15 consisting of maternal fever >38°C in at least two occasions separated by 1 hour, plus two or more of the following: uterine tenderness defined as pain referred by the mother on abdominal examination in the absence of uterine contractions, leukocytosis (>15,000 cells/ mm 3 ), maternal tachycardia (>100 bpm), fetal tachycardia (>160 bpm), or foul smelling vaginal discharge. However, the term CCA is mainly used to express clinical suspicion before there is any laboratory or histological confirmation of the inflammation/infection, and there is growing concern about the excessive use of this term.…”

Section: Introductionmentioning

confidence: 99%

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Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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Abstract:The term chorioamnionitis (CA) is commonly used to refer to different clinical or pathological conditions characterized by an infectious and/or inflammatory process that affects primarily the chorioamniotic membranes, but also the amniotic fluid, vessels of the chorionic plate, and, eventually, the umbilical cord (funisitis) and the fetus. Its incidence is higher at lower gestational ages, and the main mechanism is believed to be the ascending bacterial infection from the maternal genital tract. It can be diagnosed by clinical criteria, amniotic fluid examination for inflammatory mediators, and/or isolation of microorganisms, or by histopathological examination of the placenta. CA is an important cause of stillbirth and is related to an increased incidence of premature rupture of membranes, preterm delivery, and adverse maternal and neonatal outcomes such as early-onset neonatal sepsis and necrotizing enterocolitis. An independent causal association to other neonatal morbidities is more controversial. The heterogeneity in the diagnostic criteria and in the operative definitions for morbidity makes comparison of studies difficult, and results are inconsistent. In addition, the intensity and duration of the process are usually not considered. For all these reasons, evidence-based recommendations for the management of mother and infant under these circumstances are difficult to establish, and clinical practice varies widely.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Chorioamnionitis and neonatal morbidity: current perspectives

Henríquez¹,

Rodrigo²

2017

RRN

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“…Inflammation, as defined by the presence of HCA, has been demonstrated to be present in the majority of early spontaneous preterm births (2). The existence of intrauterine inflammation in a preterm birth has significant clinical implications as preterm infants born in this setting have an increased risk for adverse outcomes (3,4). More specifically, infants born from pregnancies complicated by HCA are at increased risk for neonatal brain abnormalities, such as PVL and intraventricular hemorrhage (IVH) (5)(6)(7).…”

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confidence: 99%

Elucidating the Early Signal Transduction Pathways Leading to Fetal Brain Injury in Preterm Birth

2006

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Adverse neurologic outcome, including cerebral palsy, is a significant contributor to long-term morbidity in preterm neonates. However, the mechanisms leading to brain injury in the setting of a preterm birth are poorly understood. In the last decade, there has been a growing body of evidence correlating infection or inflammation with preterm birth. The presence of intrauterine inflammation significantly increases the risk for adverse neurologic outcome in the neonate. These studies were performed to elucidate the early signal transduction pathways activated in the fetal brain that may result in long-term neurologic injury. Using our mouse model of localized intrauterine inflammation, the activation of TH1/TH2 pathways in the placenta, fetus corpus, fetal liver, and fetal brain was investigated. Additional studies determined whether activation of TH1/TH2 pathways could promote cell death and alter glial development. Real-time PCR studies demonstrated that a robust TH1/TH2 response occurs rapidly in the fetal brain after exposure to intrauterine inflammation. The cytokine response in the fetus and placenta was not significantly correlated with the response in the fetal brain. Along with an immune response, cell death pathways were activated early in the fetal brain in response to intrauterine LPS. Implicating TH1/TH2 and cell death pathways in permanent brain injury are our findings of an increase in GFAP mRNA and protein as well as a loss of pro-oligodendrocytes. With increased understanding of the mechanisms by which inflammation promotes brain injury in the preterm neonate, identification of potential targets to limit adverse neonatal outcomes becomes possible. (Pediatr Res 59: 50-55, 2006)

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“…Estos riesgos han sido relacionados con invasión microbiana de la cavidad amnió-tica (IMCA) (3-5) y en menor grado con infección cérvicovaginal (6). Las consecuencias de la infección intrauterina (corioamnionitis clínica, corioamnionitis histológica, funisitis y aumento de citoquinas intraamnióticas) en el niño se asocian con sepsis, bronconeumonía, enterocolitis necrotizante (3-5), con daños neurológicos (leucomalacia periventricular, hemorragia intraventricular, paráli-sis cerebral) y enfermedad crónica pulmonar (7)(8)(9)(10). El pronóstico adverso del neonato se ha correlacionado particularmente con la funisitis, presente en 61% de las embarazadas con IMCA (11).…”

Section: Introductionunclassified

Relación Entre Doppler De La Arteria Umbilical, Invasión Microbiana De La Cavidad Amniótica, Funisitis Y Resultado Adverso Neonatal en La Rotura Prematura De Membranas De Pretérmino

et al. 2005

Rev. chil. obstet. ginecol.

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RESUMENObjetivo: Evaluar la utilidad del Doppler de la arteria umbilical (AU) para predecir invasión microbiana de la cavidad amniótica (IMCA), funisitis y resultado adverso neonatal (RA) en pacientes con rotura prematura de membranas de pretérmino (RPMPT). Métodos: Se estudian 80 embarazadas entre 24 y 34 semanas de gestación con diagnóstico de rotura prematura de membranas. Se excluyeron embarazadas con condiciones materno-fetales severas que pudiesen alterar el resultado perinatal. Todas tuvieron ultrasonografía para biometría fetal y Doppler de la arteria umbilical dentro de una semana del nacimiento y microbiología de líquido amniótico. Se creó una variable compuesta que incluyó morbilidad neonatal severa, secuelas o muerte neonatal. Las pacientes recibieron antibióticos, esteroides y manejo expectante hasta las 35 semanas. IMCA se definió por el cultivo positivo del líquido amniótico; funisitis por la presencia de leucocitos polimorfonucleares en la pared de los vasos umbilicales o gelatina de Warthon. Se usaron análisis de curva ROC y tablas de contingencia para el cálculo estadístico. Resultados: Se incluyeron 68 pacientes. El RA compuesto se presentó en 19,4%. Los fetos que desarrollaron RA tuvieron relación S/D de AU, significativamente más alta que los fetos con resultado bueno (RB) (65,6±30,9 vs 30,0±20,4 p<0,001), así como también más alta proporción de valores de la relación S/D de la AU sobre el percentil 90 (30,8% vs 0%, respectivamente, p<0,0001). No hubo diferencias en la relación S/D de la AU en los grupos con y sin IMCA y con o sin funisitis. Fetos con relación S/D de la AU con percentil >41 tuvieron significativo más alto riesgo de RA que fetos con percentil < 41 (odds ratio: 15,7; 95% CI 2,73-118; p<0,001), con sensibilidad de 85%, tasa de falso-positivo de 56%, especificidad de 74% y falso negativo de 5%. Conclusiones: En la RPMPT, la relación S/D de la AU, predice el resultado neonatal adverso; este procedimiento no detecta IMCA y funisitis.PALABRAS CLAVES: Velocimetría Doppler, arteria umbilical, rotura prematura de membranas de pretérmino, pronóstico perinatal adverso, funisitis SUMMARYObjective: To evaluate the usefulness of Doppler velocimetry of umbilical artery in the prediction of microbial invasion of the amniotic cavity (MIAC), funisitis and adverse neonatal outcome in patients with

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Sequelae of chorioamnionitis

Cited by 134 publications

References 53 publications

Chorioamnionitis and neonatal morbidity: current perspectives

Chorioamnionitis and neonatal morbidity: current perspectives

Elucidating the Early Signal Transduction Pathways Leading to Fetal Brain Injury in Preterm Birth

Relación Entre Doppler De La Arteria Umbilical, Invasión Microbiana De La Cavidad Amniótica, Funisitis Y Resultado Adverso Neonatal en La Rotura Prematura De Membranas De Pretérmino

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