Clinical chorioamnionitis at term VI: acute chorioamnionitis and funisitis according to the presence or absence of microorganisms and inflammation in the amniotic cavity.
OBJECTIVE
Neonates born to mothers with clinical chorioamnionitis at term are at an increased risk of infection. Acute subchorionitis, chorioamnionitis, and funisitis are considered placental histologic features consistent with acute inflammation according to the Society for Pediatric Pathology. The objectives of this study were to examine the performance of placental histologic features in the identification of: 1) microbial-associated intra-amniotic inflammation (intra-amniotic infection); and 2) fetal inflammatory response syndrome (FIRS).


METHODS
This retrospective cohort study included women with the diagnosis of clinical chorioamnionitis at term (n=45), who underwent an amniocentesis to determine: 1) the presence of microorganisms using both cultivation and molecular biologic techniques [polymerase chain reaction (PCR) with broad range primers]; and 2) interleukin (IL)-6 concentrations by enzyme-linked immunosorbent assay (ELISA). The diagnostic performance (sensitivity, specificity, accuracy, and likelihood ratios) of placental histologic features consistent with acute inflammation was determined for the identification of microbial-associated intra-amniotic inflammation and FIRS.


RESULTS
1) The presence of acute histologic chorioamnionitis and funisitis was associated with the presence of proven intra-amniotic infection assessed by amniotic fluid analysis; 2) funisitis was also associated with the presence of FIRS; 3) the negative predictive value of acute funisitis ≥stage 2 for the identification of neonates born to mothers with intra-amniotic infection was <50%, and therefore, suboptimal to exclude fetal exposure to bacteria in the amniotic cavity; and 4) acute funisitis ≥stage 2 had a negative predictive value of 86.8% for the identification of FIRS in a population with a prevalence of 20%.


CONCLUSIONS
Acute histologic chorioamnionitis and funisitis are associated with intra-amniotic infection and the presence of FIRS. However, current pathologic methods have limitations in the identification of the fetus exposed to microorganisms present in the amniotic cavity. Further studies are thus required to determine whether molecular markers can enhance the performance of placental pathology in the identification of neonates at risk for neonatal sepsis.
Roberto
R
Romero
Piya
P
Chaemsaithong
Nikolina
N
Docheva
Steven J
SJ
Korzeniewski
Juan P
JP
Kusanovic
Bo Hyun
BH
Yoon
Jung-Sun
JS
Kim
Noppadol
N
Chaiyasit
Ahmed I
AI
Ahmed
Faisal
F
Qureshi
Suzanne M
SM
Jacques
Chong Jai
CJ
Kim
Sonia S
SS
Hassan
Tinnakorn
T
Chaiworapongsa
Lami
L
Yeo
Yeon Mee
YM
Kim
D000653:Amniotic Fluid / Q000276:immunology / Q000382:microbiology; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D015331:Cohort Studies; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D018836:Inflammation Mediators / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008828:Microbiological Techniques; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis
C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6