Re-evaluation of chorioamnionitis and funisitis with a special reference to subacute chorioamnionitis.
Our purpose is to prove that prolonged inflammation of the chorionic plate, which we have termed subacute chorioamnionitis (SCAM), is a distinctive entity and should be differentiated from acute chorioamnionitis (ACAM) because it is an excellent prognostic indicator of chronic lung disease (CLD), including Wilson-Mikity syndrome (WMS). Ninety singleton placentas with stage-3 chorioamnionitis were delivered at 23 to 32 weeks of gestation during 1993 to 1996, and the infants survived more than 28 days. There were 49 placentas with stage 3 SCAM, 33 placentas with stage 3 ACAM, and 8 placentas with subacute necrotizing funisitis (SNF) and without inflammation of the chorionic plate. Fifty-three of gestation- and birthweight-matched placentas without chorioamnionitis were selected as control. To determine the risk factors for CLD, 27 clinical and 6 histological variables were analyzed. Logistic regression analysis showed that amniotic necrosis (AN) (P =.0168) and low birthweight (P =.0341) were the major contributing risk factors for CLD. SNF was not significantly related to CLD. Patients with SCAM (AN+, SNF-) were highly susceptible to CLD. In conclusion, SCAM, especially when associated with AN, seems to be a unique prognostic indicator of CLD.
Ohyama
Makiko
M
Division of Neonatology, Obstetrics, and Pathology, Kanagawa Children's Medical Center, Yokohama City, Japan.
Itani
Yasufumi
Y
Yamanaka
Michiko
M
Goto
Akiko
A
Kato
Keisuke
K
Ijiri
Rieko
R
Tanaka
Yukichi
Y
D000650:Amnion / Q000473:pathology; D002821:Chorioamnionitis / Q000150:complications* / Q000473:pathology*; D002908:Chronic Disease; D005260:Female; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007249:Inflammation / Q000150:complications / Q000473:pathology*; D016015:Logistic Models; D008171:Lung Diseases / Q000209:etiology* / Q000473:pathology; D009336:Necrosis; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014470:Umbilical Cord / Q000473:pathology*