title: Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns.
abstract: Clinically responsive placental examination seeks to provide useful information regarding the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to assemble and validate a complete set of the placental reaction patterns seen with amniotic fluid infection in the hope that this might provide a standardized diagnostic framework useful for practicing pathologists. Study cases (14 with amniotic fluid infection, 6 controls) were reviewed blindly by six pathologists after agreement on a standard set of diagnostic criteria. After analysis of initial results, criteria were refined and a second, overlapping set of cases were reviewed. Majority vote served as the gold standard. Grading and staging of maternal and fetal inflammatory responses was found to be more reproducible using a two- versus three-tiered grading system than a three- versus five-tiered staging system (overall agreement 81% vs. 71%). Sensitivity, specificity, and efficiency for individual observations ranged from 67-100% (24/30 > 90%). Reproducibility was measured by unweighted kappa values and interpreted as follows: < 0.2, poor; 0.2-0.6, fair/moderate; > 0.6, substantial. Kappa values for the 12 lesions evaluated in 20 cases by the six pathologists were: acute chorioamnionitis/maternal inflammatory response (any, 0.93; severe 0.76; advanced stage, 0.49); chronic (subacute) chorioamnionitis (0.25); acute chorioamnionitis/fetal inflammatory response (any, 0.90; severe, 0.55; advanced stage, 0.52); chorionic vessel thrombi (0.37); peripheral funisitis (0.84); acute villitis (0.90); acute intervillositis/intervillous abscesses (0.65), and decidual plasma cells (0.30). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a framework for future clinical research.
authors.affiliation: Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA. raymond.redline@uhhs.com
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Redline
authors.forename: Ona
authors.initials: O
authors.lastname: Faye-Petersen
authors.forename: Debra
authors.initials: D
authors.lastname: Heller
authors.forename: Faisal
authors.initials: F
authors.lastname: Qureshi
authors.forename: Van
authors.initials: V
authors.lastname: Savell
authors.forename: Carole
authors.initials: C
authors.lastname: Vogler
mesh_terms: D000328:Adult; D002821:Chorioamnionitis / Q000145:classification / Q000473:pathology; D005260:Female; D006801:Humans; D010920:Placenta / Q000473:pathology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015203:Reproducibility of Results; D016037:Single-Blind Method; D013577:Syndrome; D009626:Terminology as Topic