Prevalence of histologic chorioamnionitis in patients with spontaneous pre-term labour in Popayán, Colombia, 2014-2016
DOI:
https://doi.org/10.18597/rcog.934Keywords:
Pre-term labour, histological chorioamnionitis, cross-sectional studyAbstract
Objective: To determine the presence of histologic chorioamnionitis in pregnant women in spontaneous pre-term labour, and to evaluate potential risk factors and association with clinical and paraclinical signs and symptoms.
Materials and methods: Descriptive prevalence study with secondary exploratory analysis in pregnant women under 37 weeks of gestation with spontaneous delivery in whom the placenta was used for histopathology testing, conducted over a 2-year period in a high complexity hospital in Popayán, Colombia. Secondary pre-term deliveries were excluded. Consecutive sampling, with a sample size of 166 pregnant women. Social, demographic, clinical, laboratory and imaging variables were measured, as well as the placental histopathology test result. The analysis estimated the prevalence of histological chorioamnionitis period. The prevalence ratio as a measure of association and the diagnostic OR (DOR) with its respective 95 % confidence interval were obtained.
Results: Overall, 160 pregnant women and their placentas were analyzed over a 2-year period. There were positive reports for 110 placentas with histological chorioamnionitis, for a prevalence of 68.75 % (95 % CI: 61.49-76.00), the prevalence being higher in gestations under 34 weeks (PR = 1.48; 95 % CI: 1.20-1.83). Regarding association of signs and symptoms, a significant association was found with fever (DOR = 4.7; 95 % CI: 1.05-21.09), maternal tachycardia (DOR = 4.22; 95 % CI: 1.81-9.81), foetal tachycardia (DOR = 3.74; 95 % CI: 1.23-11.35), absent breathing movements (DOR = 5.16; 95 % CI: 1.43-18.60), amniotic fluid lower than 2 cm (DOR = 5.67; 95 % CI: 1.24- 25.98), and presence of neutrophilia (DOR = 2.97; 95 % CI: 1.44-6.12).
Conclusions: The prevalence of histological chorioamnionitis was 67 % in pre-term deliveries and varied in accordance with gestational age.
Author Biographies
Carolina Arias-Peláez
Cristal Ximena Gallego-Betancourt
Geovanni Alexander Mera-Ijaji
Roberth Alirio Ortiz-Martínez
José Enrique Chagüendo-García
References
Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med. 2008;359:262-73. Disponible en: https://doi. org/10.1056/NEJMoa0706475
Marlow N, Wolke D, Bracewell MA, Samara M, EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med. 2005;352:9-19. https://doi.org/10.1056/NEJMoa041367
Hille ET, den Ouden AL, Saigal S, Wolke D, Lambert M, Whitaker A, et al. Behavioural problems in children who weigh 1000 g or less at birth in four countries. Lancet. 2001;357:1641-3. https://doi. org/10.1016/S0140-6736(00)04818-2
Strauss RS. Adult functional outcome of those born small for gestational age: Twenty-six-year follow-up of the 1970 British Birth Cohort. JAMA. 2000;283:625-32. https://doi. org/10.1001/jama.283.5.625.
Barker DJP, Forsen T, Uutela A, Osmond C, Eriksson JG. Size at birth and resilience to effects of poor living conditions in adult life: longitudinal study. BMJ. 2001;323:1273-6. https://doi. org/10.1136/bmj.323.7324.1273
Flood K, Malone FD. Prevention of preterm birth. Semin Fetal Neonatal Med. 2012;17:58-63. https://doi.org/10.1016/j.siny.2011.08.001
Bick D. Born too soon: The global issue of preterm birth. Midwifery. 2012;28:401-2. https://doi.org/10.1016/j.midw.2012.06.010.
Kim SM, Romero R, Park JW, Oh KJ, Jun JK, Yoon BH. The relationship between the intensity of intra-amniotic inflammation and the presence and severity of acute histologic chorioamnionitis in preterm gestation. J Matern Fetal Neonatal Med. 2015;28:1500-9. https://doi.org/10. 3109/14767058.2014.961009
Kim CJ, Romero R, Chaemsaithong P, Chaiya¬sit N, Yoon BH, Kim YM. Acute chorioamnion-itis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol. 2015;213(4 Suppl):S29-52. https:// doi.org/10.1016/j.ajog.2015.08.040
Lee SM, Park JW, Kim BJ, Park C-W, Park JS, Jun JK, et al. Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes. PLoS One. 2013;8:e79941. https://doi. org/10.1371/journal.pone.0079941.
Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol. 1991;164:1317-26. https://doi.org/10.1016/0002-9378(91)90707-X.
Newton ER. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol. 1993;36:795-808. https://doi.org/10.1097/00003081-199312000-00004.
Redline RW, Faye-Petersen O, Heller D, Qureshi F, Savell V, Vogler C. Amniotic infection syndrome: Nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol. 2003;6:435-48. https://doi.org/10.1007/s10024-003- 7070-y
Pacora P, Chaiworapongsa T, Maymon E, Kim YM, Gomez R, Yoon BH, et al. Funisitis and chorionic vasculitis: The histological counterpart of the fetal inflammatory response syndrome. J Matern Fetal Neonatal Med. 2002;11:18-25. https:// doi.org/10.1080/jmf.11.1.18.25
Xie AL, Di XD, Chen XM, Hu YC, Wang YH. [Factors and neonatal outcomes associated with histologic chorioamnionitis after premature rupture of membranes in the preterms]. Zhonghua Fu Chan Ke Za Zhi. 2012;47:105-9.
Xie A, Zhang W, Chen M, Wang Y, Wang Y, Zhou Q, et al. Related factors and adverse neonatal outcomes in women with preterm premature rupture of membranes complicated by histologic chorioamnionitis. Med Sci Monit. 2015;21:390-5. https://doi. org/10.12659/MSM.891203
Grether JK, Nelson KB. Maternal infection and cerebral palsy in infants of normal birth weight. JAMA. 1997;278:207-11. https://doi. org/10.1001/jama.1997.03550030047032.
Smulian J. Clinical chorioamnionitis and histologic placental inflammation. Obstet Gynecol. 1999;94: 1000-5. https://doi.org/10.1016/S0029-7844(99)00416-0.
Russell P. Inflammatory lesions of the human placenta. III: The histopathology of villitis of unknown aetiology. Placenta. 1980;1:227-44. https://doi. org/10.1016/S0143-4004(80)80005-1.
Romero R, Espinoza J, Gonçalves L, Kusanovic J, Friel L, Hassan S. The role of inflammation and infection in preterm birth. Semin Reprod Med. 2007;25:21-39. https://doi. org/10.1055/s-2006-956773.
Gonik B, Cotton D. The use of amniocentesis in preterm premature rupture of membranes. Am J Perinatol. 1985;2:21-4. https://doi. org/10.1055/s-2007-999905.
Romero R, Yoon BH, Mazor M, Gomez R, Gonzalez R, Diamond MP, et al. A comparative study of the diagnostic performance of amniotic fluid glucose, white blood cell count, interleukin-6, and gram stain in the detection of microbial invasion in patients with preterm premature rupture of membranes. Am J Obstet Gynecol. 1993;169:839-51. https://doi.org/10.1016/0002-9378(93)90014-A.
Gauthier DW, Meyer WJ, Bieniarz A. Correlation of amniotic fluid glucose concentration and intraamniotic infection in patients with preterm labor or premature rupture of membranes. Am J Obstet Gynecol. 1991;165:1105-10. https://doi. org/10.1016/0002-9378(91)90480-F.
Coultrip LL, Grossman JH. Evaluation of rapid diagnostic tests in the detection of microbial invasion of the amniotic cavity. Am J Obstet Gynecol. 1992;167:1231-42. https://doi.org/10.1016/S0002-9378(11)91694-9.
Curtis M, Riggs J, Blanco J. Declines in Patient Volume: An obstetrics and gynecology teaching program’s response. Am J Perinatol. 1998;15:173-6. https://doi.org/10.1055/s-2007-993920.
Epstein FH, Goldenberg RL, Hauth JC, Andrews WW. Intrauterine infection and preterm delivery. N Engl J Med. 2000;342:1500-7. https://doi.org/10.1056/NEJM200005183422007.
Yoon BH, Jun JK, Park KH, Syn HC, Gomez R, Romero R. Serum C-reactive protein, white blood cell count, and amniotic fluid white blood cell count in women with preterm premature rupture of membranes. Obstet Gynecol. 1996;88:1034-40. https://doi.org/10.1016/S0029-7844(96)00339-0.
Oyelese Y, Vintzileos AM. The uses and limitations of the fetal biophysical profile. Clin Perinatol. 2011;38:47- 64. Disponible en: https://doi.org/10.1016/j. clp.2010.12.008.
Gotsch F, Romero R, Kusanovic JP, Mazaki-Tovi S, Pineles BL, Erez O, et al. The fetal inflammatory response syndrome. Clin Obstet Gynecol. 2007; 50:652-83. https://doi.org/10.1097/ GRF.0b013e31811ebef6.
Vintzileos AM, Campbell WA, Nochimson DJ, Connolly ME, Fuenfer MM, Hoehn GJ. The fetal biophysical profile in patients with premature rupture of the membranes–an early predictor of fetal infection. Am J Obstet Gynecol. 1985;152:510-6. https://doi.org/10.1016/0002-9378(85)90617-9.
Vintzileos AM, Bors-Koefoed R, Pelegano JF, Campbell WA, Rodis JF, Nochimson DJ, et al. The use of fetal biophysical profile improves pregnancy outcome in premature rupture of the membranes. Am J Obstet Gynecol. 1987;157:236-40. https:// doi.org/10.1016/S0002-9378(87)80141-2.
Heatley MK. Haines & Taylor Obstetrical and Gynaecological Pathology, 5th edition. The Obstetrician & Gynaecologist. 2005;7:218. https:// doi.org/10.1576/toag.7.3.218.27108.
Prophet EB, Instituto de las Fuerzas Armadas (Washington). Métodos histotecnológicos; 1995. p. 280.
Holzman C, Lin X, Senagore P, Chung H. Histologic chorioamnionitis and preterm deliver y. Am J Epidemiol. 2007;166:786-94. https:// doi.org/10.1093/aje/kwm168.
Nowak M, Oszukowski P, Szpakowski M, Malinowski A, Maciołek-Blewniewska G. [Intrauterine infections. I. The role of C-reactive protein, white blood cell count and erythrocyte sedimentation rate in pregnant women in the detection of intrauterine infection after preliminary rupture of membranes]. Ginekol Pol. 1998;69:615-22.
Newton ER. Preterm labor, preterm premature rupture of membranes, and chorioamnionitis. Clin Perinatol. 2005;32:571-600. https://doi.org/10.1016/j.clp.2005.05.001.
Hameed C, Tejani N, Verma UL, Archbald F. Si¬lent chorioamnionitis as a cause of preterm labor refractory to tocolytic therapy. Am J Obstet Gyne¬col. 1984;149:726-30. https://doi. org/10.1016/0002-9378(84)90111-X.
Wu HC, Shen CM, Wu YY, Yuh YS, Kua KE. Subclinical histologic chorioamnionitis and related clinical and laboratory parameters in preterm deliveries. Pediatr Neonatol. 2009;50:217-21. https://doi.org/10.1016/S1875-9572(09)60066-8.
Le Ray I, Mace G, Sediki M, Lirussi F, Riethmuller D, Lentz N, et al. Changes in maternal blood inflammatory markers as a predictor of chorioamnionitis: A prospective multicenter study. Am J Reprod Immunol. 2015;73:79-90. https://doi.org/10.1111/aji.12323.
Curtin WM, Katzman PJ, Florescue H, Metlay LA, Ural SH. Intrapartum fever, epidural analgesia and histologic chorioamnionitis. J Perinatol. 2015;35:396- 400. https://doi.org/10.1038/jp. 2014.235.
Curtin WM, Katzman PJ, Florescue H, Metlay LA. Accuracy of signs of clinical chorioamnionitis in the term parturient. J Perinatol. 2013;33:422-8. https://doi.org/10.1038/jp.2012.135.
Heller DS, Rimpel LH, Skurnick JH. Does histologic chorioamnionitis correspond to clinical chorioamnio¬nitis? J Reprod Med. 2008;53:25-8.
Salafia CM, Ghidini A, Sherer DM, Pezzullo JC. Abnormalities of the fetal heart rate in preterm deliveries are associated with acute intra-amniotic infection. Obstet Gynecol Surv. 1999;54:93-4. https://doi.org/10.1097/00006254- 199902000-00008.
Sherer DM, Spong CY, Salafia CM. Fetal breathing movements within 24 hours of delivery in prematurity are related to histologic and clinical evidence of amnionitis. Am J Perinatol. 1997;14:337-40. https://doi.org/10.1055/s-2007-994156.
Ghidini A, Salafia CM, Kirn V, Doria V, Spong CY. Biophysical profile in predicting acute ascending infection in preterm rupture of membranes before 32 weeks. Obstet Gynecol. 2000;966:201-6. https://doi.org/10.1016/S0029- 7844(00)00908-X.
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