Elsevier

Obstetrics & Gynecology

Volume 94, Issue 6, December 1999, Pages 1000-1005
Obstetrics & Gynecology

Original Articles
Clinical chorioamnionitis and histologic placental inflammation1,

https://doi.org/10.1016/S0029-7844(99)00416-0Get rights and content

Abstract

Objective: To estimate the rate of histologic chorioamnionitis in the presence of diagnosed clinical chorioamnionitis and determine whether clinical markers of maternal and neonatal infection are associated with histologic chorioamnionitis.

Methods: We identified singleton pregnancies from 1996 in which discharge diagnoses included clinical chorioamnionitis and reviewed maternal and neonatal records for clinical evidence of chorioamnionitis and suspected or confirmed neonatal infections. Placentas were examined for acute histologic chorioamnionitis.

Results: One hundred thirty-nine pregnancies with the discharge diagnosis of maternal clinical chorioamnionitis were included. Eighty-six (61.9%) had the clinical diagnosis supported by histologic chorioamnionitis. Histologic chorioamnionitis was associated with an earlier gestational age at delivery (35.7 ± 6.5 weeks versus 38.6 ± 2.9 weeks, P = .002), lower epidural usage (72.1% versus 92.5%, P = .004), less internal monitoring (47.7% versus 75.5%, P = .001), and possible neonatal sepsis (60.5% versus 35.8%, P = .005). For 19 of 71 (26.8%) infants with possible neonatal sepsis, placentas did not show histologic chorioamnionitis.

Conclusion: Clinical chorioamnionitis and possible neonatal infection were not supported by histologic evidence for infection in 38.1% and 26.8% of cases, respectively, suggesting other noninflammatory causes of signs and symptoms.

Section snippets

Materials and methods

This was a retrospective cohort study with institutional review board approval. Study subjects were identified by review of discharge diagnoses of women who delivered at St. Peter’s University Hospital, New Brunswick, New Jersey, in 1996. All women with discharge diagnoses of chorioamnionitis were eligible for inclusion. Only singleton gestations delivered after 20 weeks’ gestation with histologic placental examinations were included. Maternal and neonatal medical records were reviewed for

Results

Among 6294 women who delivered in 1996, 189 (3%) had hospital discharge diagnoses of maternal chorioamnionitis. Of the identified pregnancies, 139 (73.5%) had maternal and infant records available and placental histologic examinations. Histologic evidence of chorioamnionitis was identified in 86 (61.9%, 95% CI 53.8%, 70%) of those pregnancies and was absent in 53 (38.1%, 95% CI 30%, 46.2%). Demographic features of cases with and without chorioamnionitis are presented in Table 1. Significant

Discussion

True clinical chorioamnionitis is a difficult diagnosis. Standardized clinical criteria have been suggested, including maternal temperature of at least 100.4F, with or without additional features such as maternal tachycardia, fetal tachycardia, uterine tenderness, foul-smelling AF, and maternal leukocytosis (more than 15,000 cells/mm3).9, 10 Unfortunately, a variety of clinical management practices can alter the reliability of some of those features, especially in preterm gestations.11, 12, 13,

References (23)

  • R.L Naeye et al.

    The clinical significance of placental villous edema

    Pediatrics

    (1983)
  • Cited by (120)

    • An evaluation into the use of procalcitonin levels as a biomarker of bacterial sepsis to aid the management of intrapartum pyrexia and chorioamnionitis

      2022, AJOG Global Reports
      Citation Excerpt :

      Evidence is emerging that challenges the correlation between clinical chorioamnionitis and histologic chorioamnionitis.33–35 A study by Smulian et al34 focused on clinical chorioamnionitis and histologic placental inflammation in 139 pregnancies. They concluded that clinical chorioamnionitis and possible neonatal infection were not supported by histologic evidence of infection in 38.1% and 26.8% of cases, respectively, suggesting other noninflammatory causes of signs and symptoms.

    View all citing articles on Scopus

    Dr. Ananth is supported, in part, by a grant from the Robert Wood Johnson Foundation, New Jersey, awarded to The Center for Perinatal Health Initiatives (Grant #-029553).

    1

    The opinions, views, and conclusions expressed in this manuscript are those of the author(s) and not necessarily those of the Robert Wood Johnson Foundation.

    View full text