Startseite Medizin Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period
Artikel
Lizenziert
Nicht lizenziert Erfordert eine Authentifizierung

Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period

  • Boldizsár Horvath EMAIL logo , Ferenc Lakatos , Csaba Tóth , Tamás Bödecs und József Bódis
Veröffentlicht/Copyright: 14. Januar 2014

Abstract

Objective: To assess neonatal outcomes and associated findings in pregnant women identified after delivery as having had underlying subclinical chorioamnionitis by either histology or bacterial culture.

Methods: In 16 years, 8974 clinical, histological, and bacterial culture data were obtained retrospectively.

Results: Placental histology was analyzed in 4237 pregnancies (2785 term and 1452 preterm) and 4737 amniotic cavity cultures were obtained during 5446 cesarean deliveries (3268 term and 1469 preterm). Histological results and bacterial cultures were both available in 1270 of the preterm deliveries. Histology revealed inflammation, suggestive of infection, in 13.6% of placentas. Subclinical acute chorioamnionic inflammation was confirmed in 142 out of 2785 term pregnancies (5.1%) and in 436 out of 1452 preterm pregnancies (30.0%, P<0.001). Bacteriological culture of the intrauterine cavity was obtained from the lower uterine segment of the uterus during cesarean section. A positive culture was found in 19.9% of all cases (941/4737), this proportion was significantly higher in preterm deliveries (343/1273, 26.9%) than in term (17.3%, P<0.001). The lower the birth-weight or gestational age, the higher the frequency of silent infections in the uterine cavity.

Conclusions: Our study findings support the association between intra-amniotic infections and preterm delivery.


Corresponding author: Boldizsár Horvath, MD, Department of Obstetrics and Gynecology, Markusovszky Teaching Hospital, Markusovszky Str. 5., 9700 Szombathely, Hungary; and Department of Midwifery, University of Pécs, Szombathely, Hungary, E-mail:

References

[1] Anderson BL, Simham HN, Simons KM, Wiesenfeld HC. Untreated asymtomatic group B streptococcal bacteriuria early in pregnancy and chorioamnionitis at delivery. Am J Obstet Gynecol. 2007;196:524.e1–5.10.1016/j.ajog.2007.01.006Suche in Google Scholar

[2] Atlas RM. Handbook of microbiological media. 3rd ed. Boca Raton: CRC Press; 2006.Suche in Google Scholar

[3] Chandiramani M, Tribe RM, Shennan AH. Preterm labour and prematurity. Obstet Gynaecol Reprod Med. 2007;17:232–7.10.1016/j.ogrm.2007.06.004Suche in Google Scholar

[4] Darby MJ, Caritis SN, Shen-Schwartz S. Placental abruption in the preterm gestation: an association with chorioamnionitis. Obstet Gynecol. 1989;74:88–92.Suche in Google Scholar

[5] DiGiulio DB, Romero R, Amogan HP, Kusanovic JP, Bik EM, Gotsch F, et al. Microbial prevalence, diversity and abundance in amniotic fluid during preterm labor: a molecular and culture-based investigation. PloS One. 2008;3:e3056.10.1371/journal.pone.0003056Suche in Google Scholar

[6] Gervasi MT, Romero R, Bracalente G, Erez O, Dong Z, Hassan SS, et al. Midtrimester amniotic fluid concentrations of interleukin-6 and interferon-gamma-inducible protein-10: evidence for heterogeneity of intra-amniotic inflammation and association with sponteous early (<32 weeks) and late (>32 weeks) preterm delivery. J Perinat Med. 2012;40:329–43.10.1515/jpm-2012-0034Suche in Google Scholar

[7] Gibbs RS, Eschbach DA. Use of antibiotics to prevent preterm birth. Am J Obstet Gynecol. 1997;177:375–80.10.1016/S0002-9378(97)70201-1Suche in Google Scholar

[8] Gibbs RS, Romero R, Hillier SL, Eschbach DA, Sweet RL. A review of premature birth and subclinical infection. Am J Obstet Gynecol. 1992;166:1515–28.10.1016/0002-9378(92)91628-NSuche in Google Scholar

[9] Hecht JL, Onderdonk A, Delaney M, Allred EN, Kliman HJ, Zambrano E, et al. Characterization of chorioamnionitis in 2nd-trimester C-section placentas and correlation with microorganism recovery from subamniotic tissues. Pediatr Dev Pathol. 2008;11:15–22.10.2350/07-06-0285.1Suche in Google Scholar PubMed

[10] Hillier SL, Martius J, Krohn M, Kiviat N, Holmes KK, Eschbach DA. A case-control study of chorioamniotic infection and histologic chorioamnionitis in prematurity N Engl J Med. 1988;319:972–8.10.1056/NEJM198810133191503Suche in Google Scholar PubMed

[11] Horvath B, Grasselly M, Bödecs T, Boncz I, Bódis J. Chorioamnionitis is associated with cerebral palsy in preterm neonates. Eur J Obstet Gynecol Reprod Biol. 2012;163:160–4.10.1016/j.ejogrb.2012.05.012Suche in Google Scholar PubMed

[12] Horvath B, Grasselly M, Bödecs T, Boncz I, Bódis J. Screening pregnant women for group B streptococcus infection between 30 and 32 weeks of pregnancy in a population at high risk for premature birth. Int J Gynaecol Obstet. 2013;122:9–12.10.1016/j.ijgo.2013.01.027Suche in Google Scholar PubMed

[13] Horváth B, Turay A, Pálvölgyi A, Illei G. Prematurity and intrauterine infection. Orv Hetil. 1984;125:2487–9.Suche in Google Scholar

[14] Hoyme UB, Saling E. Efficient prematurity prevention is possible by pH-self easurement and immediate therapy of threatening ascending infection. Eur J Obstet Gynecol Reprod Biol. 2004;115:148–53.10.1016/j.ejogrb.2004.02.038Suche in Google Scholar

[15] Lamont RF. New approaches in the management of preterm labour of infective aetiology. Br J Obstet Gynaecol. 1998;105:134–7.10.1111/j.1471-0528.1998.tb10040.xSuche in Google Scholar

[16] Lee SM, Lee KA, Kim AM, Park CW, Yoon BH. The risk of intra-amniotic infection, inflammation and histologic chorioamnionitis in term pregnant women with intact membranes and labor. Placenta 2011;32:516–21.10.1016/j.placenta.2011.03.012Suche in Google Scholar

[17] Maching G. Funisitis and chorionic vasculitis: relation to chorioamniontis, timing and scoring. Fetal Perinat Pathol. 2011;30:414–30.10.3109/15513815.2011.618872Suche in Google Scholar

[18] Markenson GR, Martin RK, Tillotson-Criss M, Foley KS, Stewart RS Jr, Yancey M. The use of the polymerase chain reaction to detect bacteria in amniotic fluid in pregnancies complicated by preterm labor. Am J Obstet Gynecol. 1997;177:1471–7.10.1016/S0002-9378(97)70093-0Suche in Google Scholar

[19] Meis PJ, Goldenberg RL, Mercer B, Moawad A, Das A, McNellis D, et al. The preterm prediction study: significance of vaginal infections. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 1995;173:1231–5.10.1016/0002-9378(95)91360-2Suche in Google Scholar

[20] Minkoff H. Prematurity: infection as an etiologic factor. Obstet Gynecol. 1983;62:137–41.Suche in Google Scholar

[21] Miyazaki K, Furuhashi M, Matsuo K, Minami K, Yoshida K, Kuno N, et al.: Impact of subclinical chorioamnionitis on maternal and neonatal outcomes. Acta Obstet Gynecol Scand. 2007;86:191–7.10.1080/00016340601022793Suche in Google Scholar

[22] Morgan MA, Goldenberg RL, Schulkin J. Obstetrician-gynecologists’ screening and management of preterm birth. Obstet Gynecol. 2008;112:35–41.10.1097/AOG.0b013e31817c50fcSuche in Google Scholar

[23] Murray PM, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH. Manual of Clinical Microbiology. 8th ed. American Society for Microbiology: Washington, DC; 1998.Suche in Google Scholar

[24] Oyarzún E, Yamamoto M, Kato S, Gómez R, Lizama L, Moenne A. Specific detection of 16 micro-organisms in amniotic fluid by polymerase chain reaction and its correlation with preterm delivery occurrence. Am J Obstet Gynecol. 1998;179:1115–9.10.1016/S0002-9378(98)70115-2Suche in Google Scholar

[25] Pankuch GA, Appelbaum PC, Lorenz RP, Botti JJ, Schachter J, Naeye RL. Placental microbiology and histology and the pathogenesis of chorioamnionitis. Obstet Gynecol. 1984;64:802–6.Suche in Google Scholar

[26] Park KH, Hong JS, Kang WS, Shin DM. Transvaginal ultrasonographic measurement of cervical length in predicting intra-amniotic infection and impending preterm deklicery in preterm labor: a comparison with amnionic fluid white blood cell count. J Perinat Med. 2008;36:479–84.Suche in Google Scholar

[27] Pathology of the placenta, membranes, and umbilical cord in bacterial, fungal, and viral infections in man. In: Naeye RL, Kissane JM, Kaufman N, editors. Perinatal Diseases. Internal Academy of Pathology Monograph. Baltimore: Williams and Wilkins; 1981. p. 67–132.Suche in Google Scholar

[28] Quinn PA, Buraty J, Taylor J, Hannah W. Chorioamnionitis: its association with pregnancy outcome and microbial infection. Am J Obstet Gynecol. 1987;156:379–87.10.1016/0002-9378(87)90288-2Suche in Google Scholar

[29] Rana A, Sawhney H, Gopalan S, Panigrahi D, Nijhawan R. Abruptio placentae and choriamnionitis-microbiological and histologic correlation. Acta Obstet Gynecol Scand. 1999;78:363–6.Suche in Google Scholar

[30] Redline RW. Placental pathology: a systematic approach with clinical correlations. Placenta. 2008;29:S86–91.10.1016/j.placenta.2007.09.003Suche in Google Scholar

[31] Romero R, Espinoza J, Kusanovic J, Gotsch F, Hassan S, Erez O, et al. The preterm parturition syndrome. Br J Obstet Gynecvol. 2006;113:17–42.10.1111/j.1471-0528.2006.01120.xSuche in Google Scholar

[32] Romero R, Salafia CM, Athanassiadis AP, Hanaoka S, Mazor M, Sepulveda W, et al. The relationship between acute inflammatory lesion of the preterm placenta and amniotic fluid microbiology. Am I Obstet Gynecol. 1992;166:1382–8.10.1016/0002-9378(92)91609-ESuche in Google Scholar

[33] Romero R, Sibai B, Caritis S, Paul R, Depp R, Rosen M, et al. Antibiotic treatment of preterm labor with intact membranes: A multicenter, randomized, double-blinded, placebo-controlled trial. Am J Obstet Gynecol. 1993;169:764–74.10.1016/0002-9378(93)90003-2Suche in Google Scholar

[34] Shennan AH, Bewley S. Why should preterm births be rising? Br Med J. 2006;332:924–35.10.1136/bmj.332.7547.924Suche in Google Scholar PubMed PubMed Central

[35] Swadpanich U, Lumbiganon P, Prasertcharoensook W, Laoaiboon M. Antenatal lower genital tract infection screening and treatment programs for preventing preterm delivery. Cochrane Database Syst Rev. 2008;16:CD006178.10.1097/LGT.0b013e318189583eSuche in Google Scholar

[36] Valkenburg-Van Den Berg AW, Sprij AJ, Dekker FW, Dörr PJ, Kanhai HH. Association between colonisation with Group B Streptococcus and preterm delivery: a systematic review. Acta Obstet Gynecol. 2009;88:958–67.10.1080/00016340903176800Suche in Google Scholar PubMed

[37] Verma RP, Kaplan C, Southerton K, Niwas R, Verma R, Fang H. Placental histopathology in the extremely low birth-weight infants. Fetal Pediatr Pathol. 2008;27:53–61.10.1080/15513810802026559Suche in Google Scholar PubMed

[38] Zlatnik FJ, Gellhaus TM, Benda JA, Koontz FP, Burmeister LF. Histologic chorioamnionitis, microbial infection, and prematurity. Obstet Gynecol. 1990;76:355–9.Suche in Google Scholar

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2013-7-26
Accepted: 2013-11-18
Published Online: 2014-1-14
Published in Print: 2014-7-1

©2014 by Walter de Gruyter Berlin/Boston

Artikel in diesem Heft

  1. Frontmatter
  2. Review articles
  3. The relationship between gestational weight gain and fetal growth: time to take stock?
  4. Risk factors for pregnancy-associated venous thromboembolism: a review
  5. Academy’s Corner
  6. Africa is only 14 km away from my country
  7. Primary prevention of preterm birth
  8. Original articles – Obstetrics
  9. Mother knows best? Comparing primiparous parturients’ expectations and predictions with actual birth outcomes
  10. Silent chorioamnionitis and associated pregnancy outcomes: a review of clinical data gathered over a 16-year period
  11. Clinical factors associated with failed trials of labor in late preterm and term twin pregnancies
  12. Relation of placental diagnosis in stillbirth to fetal maceration and gestational age at delivery
  13. Evaluation of a novel placental alpha microglobulin-1 (PAMG-1) test to predict spontaneous preterm delivery
  14. The relationship of praise/criticism to learning during obstetrical simulation: a randomized clinical trial
  15. Sickle cell disease and pregnancy outcomes: population-based study on 8.8 million births
  16. Differences between external and internal fetal heart rate monitoring during the second stage of labor: a prospective observational study
  17. Perinatal management of preterm premature ruptured membranes affects neonatal prognosis
  18. Impact of the nitric oxide-donor pentaerythrityl-tetranitrate on perinatal outcome in risk pregnancies: a prospective, randomized, double-blinded trial
  19. Umbilical vein volume flow in monochorionic twin pairs at 11–14 weeks
  20. Gestational weight gain according to number of fetuses in Japanese women
  21. Original article – Fetus
  22. Prenatal diagnosis of sex chromosome aneuploidies and disorders of sex development – a retrospective analysis of 11-year data
  23. Short communication
  24. Reference range for amniotic fluid index measurements in a Brazilian population
  25. Congress Calendar
  26. Congress Calendar
Heruntergeladen am 14.12.2025 von https://www.degruyterbrill.com/document/doi/10.1515/jpm-2013-0186/html?lang=de
Button zum nach oben scrollen