[Placental histopathology in premature rupture of membranes. Its relationship with microbiological findings, maternal, and neonatal outcome].
BACKGROUND
There is a close relationship between premature membrane rupture, bacterial infections and premature labor.


OBJECTIVE
To study placental histological changes in patients with preterm membrane rupture. To establish a relationship between pathological findings, amniotic fluid and lower genital tract microbiological studies, maternal and neonatal outcome.


METHODS
Patients with premature membrane rupture of membranes between 24 and 34 weeks of gestation participated in this study. On admission, patients had no evidence of clinical chorioamnionitis, labor or fetal distress. Microbiological studies of the amniotic fluid and cervicovaginal secretions were performed and the placenta was sent for pathological study.


RESULTS
Seventy one placentas were available for the study. The main pathological findings were acute chorioamnionitis in 58%, trophoblastic proliferation in 38%, funisitis in 37%, villitis in 16%, fetal vascular lesions in 14% and no findings in 17%. Microbial invasion of amniotic cavity was present in 89% of acute chorioamnionitis. Sixty one percent of trophoblastic proliferation and all fetal vascular lesions were associated with negative amniotic and cervical cultures. Newborns with acute funisitis had a higher frequency of neonatal death (29%), severe asphyxia (42%) and neonatal infections (29%).


CONCLUSIONS
Acute chorioamnionitis is the most frequent finding in patients with preterm membrane rupture and microbial invasion of amniotic cavity. In the absence of intra amniotic infection, proliferation of the trophoblast and the presence of fetal vascular lesions predominate. Acute funisitis is strongly associated with adverse fetal outcome.
Ovalle
A
A
Hospital San Borja Arriarán, Departamento de Microbiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile. aovalle@hotmail.com
Martínez
M A
MA
Kakarieka
E
E
Gómez
R
R
Torres
J
J
Fuentes
A
A
Ruiz
M
M
Angel
R
R
D000653:Amniotic Fluid / Q000382:microbiology*; D001419:Bacteria / Q000302:isolation & purification; D015415:Biomarkers; D002584:Cervix Uteri / Q000382:microbiology / Q000473:pathology; D002821:Chorioamnionitis / Q000382:microbiology / Q000473:pathology; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010920:Placenta / Q000382:microbiology* / Q000473:pathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious
D015415:Biomarkers
Histopatología de la placenta en la rotura prematura de membranas de pretérmino. Relación con la microbiología aislada y con los resultados maternoneonatales.