Placental acute inflammation infiltrates and pregnancy outcomes: a retrospective cohort study.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
17 12 2021
17 12 2021
Historique:
received:
05
05
2021
accepted:
26
11
2021
entrez:
18
12
2021
pubmed:
19
12
2021
medline:
1
2
2022
Statut:
epublish
Résumé
Chorioamnionitis can be either an infection or a sterile inflammation. This study aims to analyze the prevalence of acute inflammatory lesions of the placenta, the association with a positive result of the microbiological examination, and the fetal-maternal outcomes. This retrospective study considered all single, consecutive pregnancies and their placental pathological examination during 2014-2017. The evidence of funisitis, chorionic vasculitis, and chorioamnionitis was assessed by a pathologist, including stage and grade. Moreover, maternal fever, placental microbiological examination, and neonatal outcomes were also recorded. Among the 5910 pregnancies in the considered period, 1770 had a placental pathological examination, and 358 (6.06%) had acute placental inflammation. Microbiological examination was performed in 125 cases, revealing 64 cases with a positive microbiological outcome. In the presence of acute placental inflammation, there was a higher rate of neonatal cardiopulmonary resuscitation, admission to neonatal intensive care unit, and postnatal death of the newborn. Multivariate analysis inferred that acute inflammation of membranes was a risk factor for neonatal cardiopulmonary resuscitation (OR 2.12; CI.95 1.36-3.31; p < 0.05), acute funisitis was a risk factor for admission to intensive neonatal care unit (OR 3.2; CI.95 1.67-6.12; p < 0.05), and chorionic vasculitis was a risk factor for postnatal death of the newborn (OR 5.38; CI.95 1.37-21.06; p < 0.05). The prevalence of chorioamnionitis was 6.06%, and about half of the cases were sterile inflammation. Chorioamnionitis was associated with higher rates of adverse fetal and neonatal outcomes; in particular, chorionic vasculitis was a risk factor for postnatal death.
Identifiants
pubmed: 34921193
doi: 10.1038/s41598-021-03655-4
pii: 10.1038/s41598-021-03655-4
pmc: PMC8683439
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
24165Informations de copyright
© 2021. The Author(s).
Références
Higgins, R. D. et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: Summary of a workshop. Obstet. Gynecol. 127, 426–436 (2016).
pubmed: 26855098
pmcid: 4764452
doi: 10.1097/AOG.0000000000001246
Kim, C. J. et al. Acute chorioamnionitis and funisitis: Definition, pathologic features, and clinical significance. Am. J. Obstet. Gynecol. 213, S29–S52 (2015).
pubmed: 26428501
pmcid: 4774647
doi: 10.1016/j.ajog.2015.08.040
Gibbs, R. S. & Duff, P. Progress in pathogenesis and management of clinical intraamniotic infection. Am. J. Obstet. Gynecol. 164, 1317–1326 (1991).
pubmed: 2035575
doi: 10.1016/0002-9378(91)90707-X
Tita, A. T. N. & Andrews, W. W. Diagnosis and management of clinical chorioamnionitis. Clin. Perinatol. 37, 339–354 (2010).
pubmed: 20569811
pmcid: 3008318
doi: 10.1016/j.clp.2010.02.003
Romero, R. et al. A novel molecular microbiologic technique for the rapid diagnosis of microbial invasion of the amniotic cavity and intra-amniotic infection in preterm labor with intact membranes. Am. J. Reprod. Immunol. 71, 330–358 (2014).
pubmed: 24417618
pmcid: 3954440
doi: 10.1111/aji.12189
Romero, R. et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. J. Matern. Fetal Neonatal Med. 28, 1394–1409 (2015).
pubmed: 25190175
doi: 10.3109/14767058.2014.958463
Soper, D. E., Mayhall, C. G. & Dalton, H. P. Risk factors for intraamniotic infection: A prospective epidemiologic study. Am. J. Obstet. Gynecol. 161, 562–566 (1989) ((discussion 566–568)).
pubmed: 2782335
doi: 10.1016/0002-9378(89)90356-6
Newton, E. R. Chorioamnionitis and intraamniotic infection. Clin. Obstet. Gynecol. 36, 795–808 (1993).
pubmed: 8293582
doi: 10.1097/00003081-199312000-00004
Fahey, J. O. Clinical management of intra-amniotic infection and chorioamnionitis: A review of the literature. J. Midwifery Women’s Health. 53, 227–235 (2008).
doi: 10.1016/j.jmwh.2008.01.001
Londero, A. P., Rossetti, E., Pittini, C., Cagnacci, A. & Driul, L. Maternal age and the risk of adverse pregnancy outcomes: A retrospective cohort study. BMC Pregnancy Childbirth. 19, 261 (2019).
pubmed: 31337350
pmcid: 6651936
doi: 10.1186/s12884-019-2400-x
Londero, A. P. et al. High placental index and poor pregnancy outcomes: A retrospective study of 18,386 pregnancies. Gynecol. Endocrinol. 29, 666–669 (2013).
pubmed: 23772778
doi: 10.3109/09513590.2013.798273
The American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia: ACOG practice bulletin summary, number 222. Obstet. Gynecol. 135, 1492–1495 (2020).
doi: 10.1097/AOG.0000000000003892
Bertozzi, S. et al. Influence of the couple on hypertensive disorders during pregnancy: A retrospective cohort study. Pregnancy Hypertens. Int. J. Women’s Cardiovasc. Health. 1, 156–163 (2011).
Visentin, S. et al. Fetal abdominal aorta: Doppler and structural evaluation of endothelial function in intrauterine growth restriction and controls. Ultraschall Med. 40, 55–63 (2019).
pubmed: 30253430
doi: 10.1055/s-0043-122230
Barfield WD, Newborn CoFA. Standard terminology for fetal, infant, and perinatal deaths. Pediatrics 137 (2016).
Baergen, R. N. Manual of Pathology of the Human Placenta 2nd edn. (Springer, 2011).
doi: 10.1007/978-1-4419-7494-5
Khong, T. Y. et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group consensus statement. Arch. Pathol. Lab. Med. 140, 698–713 (2016).
pubmed: 27223167
doi: 10.5858/arpa.2015-0225-CC
Redline, R. W. et al. Amniotic infection syndrome: Nosology and reproducibility of placental reaction patterns. Pediatr. Dev. Pathol. 6, 435–448 (2003).
pubmed: 14708737
doi: 10.1007/s10024-003-7070-y
Cornaglia, G. et al. (eds) European Manual of Clinical Microbiology (European Society for Clinical Microbiology and Infections Diseases, 2012).
Leber, A.L. Clinical Microbiology Procedures Handbook. (2016).
Meyer, T. & Buder, S. The laboratory diagnosis of neisseria gonorrhoeae: Current testing and future demands. Pathogens. 9, E91 (2020).
pubmed: 32024032
doi: 10.3390/pathogens9020091
Screm, M., Santolo, M.D., Scarparo, C., Arzese, A. P2.047 evaluation of a multiplex real-time PCR assay for rapid detection of C. trachomatis and N. gonorrhoeae from genital clinical specimens. Sex Transm. Infect. 89, A102.2–A102 (2013).
The American College of Obstetricians and Gynecologists. Prelabor rupture of membranes: ACOG practice bulletin summary, number 217. Obstet. Gynecol. 135, 739–743 (2020).
doi: 10.1097/AOG.0000000000003701
The American College of Obstetricians and Gynecologists. Committee opinion no. 712: Intrapartum management of intraamniotic infection. Obstet Gynecol. 130, e95–e101 (2017).
da Mota, V. Q. et al. Correlation between placental bacterial culture results and histological chorioamnionitis: A prospective study on 376 placentas. J. Clin. Pathol. 66, 243–248 (2013).
doi: 10.1136/jclinpath-2012-201124
Bhola, K. et al. Placental cultures in the era of peripartum antibiotic use. Aust. N. Z. J. Obstet. Gynaecol. 48, 179–184 (2008).
pubmed: 18366492
doi: 10.1111/j.1479-828X.2008.00833.x
Russel, P. Inflammatory lesions of the human placenta. I. Clinical significance of acute chorioamnionitis. Am. J. Diagn. Gynecol. Obstet. 1, 127–137 (1979).
Woodd S.L. et al. Incidence of maternal peripartum infection: A systematic review and meta-analysis. PLoS Med. 2019, 16 (2019).
Romero, R. et al. The relationship between acute inflammatory lesions of the preterm placenta and amniotic fluid microbiology. Am. J. Obstet. Gynecol. 166, 1382–1388 (1992).
pubmed: 1595794
doi: 10.1016/0002-9378(92)91609-E
Romero, R. et al. Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: Prevalence and clinical significance. J. Matern. Fetal Neonatal Med. 28, 1343–1359 (2015).
pubmed: 25123515
doi: 10.3109/14767058.2014.954243
Romero, R. et al. Clinical chorioamnionitis at term I: Microbiology of the amniotic cavity using cultivation and molecular techniques. J. Perinat. Med. 43, 19–36 (2015).
pubmed: 25720095
pmcid: 5881909
doi: 10.1515/jpm-2014-0249
Stewart, E. J. Growing unculturable bacteria. J. Bacteriol. 194, 4151–4160 (2012).
pubmed: 22661685
pmcid: 3416243
doi: 10.1128/JB.00345-12
Romero, R. et al. Clinical chorioamnionitis at term: New insights into the etiology, microbiology, and the fetal, maternal and amniotic cavity inflammatory responses. Nogyogyaszati Szuleszeti Tovabbkepzo Szemle. 20, 103–112 (2018).
pubmed: 30320312
pmcid: 6177213
Oh, K. J. et al. Twenty-four percent of patients with clinical chorioamnionitis in preterm gestations have no evidence of either culture-proven intraamniotic infection or intraamniotic inflammation. Am. J. Obstet. Gynecol. 216, 604.e1-604.e11 (2017).
doi: 10.1016/j.ajog.2017.02.035
Schubert, P.T. Spectrum of changes seen with placental intravascular organisms. Pediatr. Dev. Pathol. 22, 229–235 (2019).
Waites, K. B., Katz, B. & Schelonka, R. L. Mycoplasmas and ureaplasmas as neonatal pathogens. Clin. Microbiol. Rev. 18, 757–789 (2005).
pubmed: 16223956
pmcid: 1265909
doi: 10.1128/CMR.18.4.757-789.2005
Sperling, R. S., Newton, E. & Gibbs, R. S. Intraamniotic infection in low-birth-weight infants. J. Infect. Dis. 157, 113–117 (1988).
pubmed: 3335795
doi: 10.1093/infdis/157.1.113
Salas, A. A. et al. Histologic characteristics of the fetal inflammatory response associated with neurodevelopmental impairment and death in extremely preterm infants. J. Pediatr. 163, 652-657.e2 (2013).
pubmed: 23664630
pmcid: 3744601
doi: 10.1016/j.jpeds.2013.03.081
Lau, J. et al. Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only. Am. J. Obstet. Gynecol. 193, 708–713 (2005).
pubmed: 16150264
doi: 10.1016/j.ajog.2005.01.017
Moyo, S. R. et al. Stillbirths and intrauterine infection, histologic chorioamnionitis and microbiological findings. Int. J. Gynecol. Obstet. 54, 115–123 (1996).
doi: 10.1016/0020-7292(96)02705-1
Gotsch, F. et al. The fetal inflammatory response syndrome. Clin. Obstet. Gynecol. 50, 652–683 (2007).
pubmed: 17762416
doi: 10.1097/GRF.0b013e31811ebef6
Ducey, J., Owen, A., Coombs, R. & Cohen, M. Vasculitis as part of the fetal response to acute chorioamnionitis likely plays a role in the development of necrotizing enterocolitis and spontaneous intestinal perforation in premature neonates. Eur. J. Pediatr. Surg. 25, 284–291 (2015).
pubmed: 24819242
doi: 10.1055/s-0034-1373849
Yoder, P. R., Gibbs, R. S., Blanco, J. D., Castaneda, Y. S. & Clair, P. J. S. A prospective, controlled study of maternal and perinatal outcome after intra-amniotic infection at term. Am. J. Obstet. Gynecol. 145, 695–701 (1983).
pubmed: 6829656
doi: 10.1016/0002-9378(83)90575-6
Morales, W. J., Washington, S. R. & Lazar, A. J. The effect of chorioamnionitis on perinatal outcome in preterm gestation. J. Perinatol. 7, 105–110 (1987).
pubmed: 3505603
Alexander, J. M., McIntire, D. M. & Leveno, K. J. Chorioamnionitis and the prognosis for term infants. Obstet. Gynecol. 94, 274–278 (1999).
pubmed: 10432142
Raines, D. A., Wagner, A. & Salinas, A. Intraamniotic infection and the term neonate. Neonatal Netw. 36, 385–387 (2017).
pubmed: 29185951
doi: 10.1891/0730-0832.36.6.385
Sibley, C. P. Treating the dysfunctional placenta. J. Endocrinol. 234, R81–R97 (2017).
pubmed: 28483805
pmcid: 5516438
doi: 10.1530/JOE-17-0185