title: Funisitis is associated with adverse neonatal outcome in low-risk unselected deliveries at or near term.
abstract: This study aimed to determine the incidence and clinical outcomes for varying patterns of placental histological inflammation (consistent with fetal or maternal inflammatory response) in an unselected population of >1000 women with a singleton pregnancy resulting in live birth delivering at or near term. One thousand one hundred nineteen cases were studied in a blind, prospective, unselected study with placentas categorized into five histological subgroups reflecting underlying maternal or fetal inflammatory response. Clinical outcomes studied included interventional delivery, an Apgar score <7 at 1 min, neonatal acidosis (pH < 7.2) and admission to neonatal special care. One hundred eighty-eight placentas (17%) showed histological evidence of acute inflammation: 64 with funisitis (with or without other inflammation; 6%); 16 with extensive acute inflammation across the chorionic plate, free membranes and subchorionic fibrin (1%); 28 with acute inflammation restricted to the chorionic plate (2%); 12 with acute inflammation restricted to the free membranes (1%) and 68 with acute inflammation restricted to the subchorionic fibrin (6%). Features of extensive acute inflammation were significantly associated with increased rate of interventional delivery (assisted vaginal delivery or emergency caesarean section; P < 0.01). The presence of funisitis was significantly associated with interventional delivery and other adverse outcomes including an Apgar score <7 at 1 min, clinical evidence of sepsis and admission to the neonatal intensive care unit (P < 0.05 for all). The data represent a quantitative rather than purely qualitative analysis of the contribution of histological lesions related to inflammation on short-term adverse neonatal outcomes and interventional delivery. Funisitis and extensive inflammation are associated with adverse clinical outcomes, but the precise mechanism underlying these remains to be elucidated.
authors: Department of Paediatric Pathology, Addenbrooke's Hospital, Cambridge, UK.
authors: F A
authors: FA
authors: Jessop
authors: Department of Fetal Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors: C C
authors: CC
authors: Lees
authors: Department of Fetal Medicine, Addenbrooke's Hospital, Cambridge, UK.
authors: S
authors: S
authors: Pathak
authors: Department of Paediatric Pathology, Addenbrooke's Hospital, Cambridge, UK.
authors: C E
authors: CE
authors: Hook
authors: Departments of Paediatric Pathology, Camelia Botnar Laboratories, Great Ormond Street Hospital and Institute of Child Health, Great Ormond Street, London, WC1N 3JH, UK. Neil.Sebire@gosh.nhs.uk.
authors: N J
authors: NJ
authors: Sebire
mesh_terms: D000328:Adult; D002821:Chorioamnionitis / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
keywords: Chorioamnionitis; Funisitis; Outcome; Placenta