The relationship between acute inflammatory lesions of the preterm placenta and amniotic fluid microbiology.
OBJECTIVE
Our objective was to determine the relationship between microbial invasion of the amniotic cavity and the presence and severity of acute inflammatory lesions in the placenta.


METHODS
Placental histologic and amniotic fluid microbiologic studies were performed in 92 consecutive patients who were admitted with preterm labor and intact membranes and delivered within 48 hours after amniocentesis.


RESULTS
The prevalence of a positive amniotic fluid culture was 38% (35 of 92). There was a strong association between the presence and severity of inflammation in the amnion, chorion-decidua, umbilical cord, and chorionic plate and the results of the amniotic fluid culture (p less than 0.0001 for each tissue section). Three patterns of inflammation of the chorion-decidua were identified: marginating, nonmarginating, and a mixed pattern. The marginating and the mixed patterns of inflammation were strongly associated with the presence of a positive amniotic fluid culture. Acute inflammation of the chorionic plate was the most sensitive indicator of a microbial invasion of the amniotic cavity (sensitivity 96.6%), and funisitis and umbilical vasculitis had the highest specificity (85.7%).


CONCLUSIONS
The presence of acute inflammatory lesions of the chorioamniotic membranes can serve as a marker of microbial invasion of the amniotic cavity.
Romero
R
R
Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut.
Salafia
C M
CM
Athanassiadis
A P
AP
Hanaoka
S
S
Mazor
M
M
Sepulveda
W
W
Bracken
M B
MB
D000650:Amnion / Q000382:microbiology / Q000473:pathology; D000653:Amniotic Fluid / Q000382:microbiology*; D001419:Bacteria / Q000302:isolation & purification; D002821:Chorioamnionitis / Q000382:microbiology / Q000473:pathology; D002823:Chorion / Q000382:microbiology / Q000473:pathology; D003656:Decidua / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000382:microbiology*; D010922:Placenta Diseases / Q000382:microbiology* / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000382:microbiology*; D014470:Umbilical Cord / Q000382:microbiology / Q000473:pathology