Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia implications for clinical care

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dc.contributor.authorRomero, Roberto
dc.contributor.authorPacora, Percy
dc.contributor.authorKusanovic, Juan Pedro
dc.contributor.authorJung, Eunjung
dc.contributor.authorPanaitescu, Bogdan
dc.contributor.authorMaymon, Eli
dc.contributor.authorErez, Offer
dc.contributor.authorBerman, Susan
dc.contributor.authorBryant, David R.
dc.contributor.authorGomez-Lopez, Nardhy
dc.contributor.authorTheis, Kevin R.
dc.contributor.authorBhatti, Gaurav
dc.contributor.authorKim, Chong Jai
dc.contributor.authorYoon, Bo Hyun
dc.contributor.authorHassan, Sonia S.
dc.contributor.authorHsu, Chaur-Dong
dc.contributor.authorYeo, Lami
dc.contributor.authorDiaz-Primera, Ramiro
dc.contributor.authorMarin-Concha, Julio
dc.contributor.authorLannaman, Kia
dc.contributor.authorAlhousseini, Ali
dc.contributor.authorGomez-Roberts, Hunter
dc.contributor.authorVarrey, Aneesha
dc.contributor.authorGarcia-Sanchez, Angel
dc.contributor.authorGervasi, Maria Teresa
dc.date.accessioned2025-01-20T23:52:10Z
dc.date.available2025-01-20T23:52:10Z
dc.date.issued2021
dc.description.abstractObjectives: Clinical chorioamnionitis at term is considered the most common infection-related diagnosis in labor and delivery units worldwide. The syndrome affects 5-12% of all term pregnancies and is a leading cause of maternal morbidity and mortality as well as neonatal death and sepsis. The objectives of this study were to determine the (1) amniotic fluid microbiology using cultivation and molecular microbiologic techniques; (2) diagnostic accuracy of the clinical criteria used to identify patients with intraamniotic infection; (3) relationship between acute inflammatory lesions of the placenta (maternal and fetal inflammatory responses) and amniotic fluid microbiology and inflammatory markers; and (4) frequency of neonatal bacteremia.
dc.description.abstractMethods: This retrospective cross-sectional study included 43 women with the diagnosis of clinical chorioamnionitis at term. The presence of microorganisms in the amniotic cavity was determined through the analysis of amniotic fluid samples by cultivation for aerobes, anaerobes, and genital mycoplasmas. A broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry was also used to detect bacteria, select viruses, and fungi. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin-6 (IL-6) concentration >= 2.6 ng/mL.
dc.description.abstractResults: (1) Intra-amniotic infection (defined as the combination of microorganisms detected in amniotic fluid and an elevated IL-6 concentration) was present in 63% (27/43) of cases; (2) the most common microorganisms found in the amniotic fluid samples were Ureaplasma species, followed by Gardnerella vaginalis; (3) sterile intra-amniotic inflammation (elevated IL-6 in amniotic fluid but without detectable microorganisms) was present in 5% (2/43) of cases; (4) 26% of patients with the diagnosis of clinical chorioamnionitis had no evidence of intra-amniotic infection or intra-amniotic inflammation; (5) intra -amniotic infection was more common when the membranes were ruptured than when they were intact (78% [21/27] vs. 38% [6/16]; p=0.01); (6) the traditional criteria for the diagnosis of clinical chorioamnionitis had poor diagnostic performance in identifying proven intra-amniotic infection (overall accuracy, 40-58%); (7) neonatal bacteremia was diagnosed in 4.9% (2/41) of cases; and (8) a fetal inflammatory response defined as the presence of severe acute funisitis was observed in 33% (9/27) of cases.
dc.description.abstractConclusions: Clinical chorioamnionitis at term, a syndrome that can result from intra-amniotic infection, was diagnosed in approximately 63% of cases and sterile intra-amniotic inflammation in 5% of cases. However, a substantial number of patients had no evidence of intra-amniotic infection or intra-amniotic inflammation. Evidence of the fetal inflammatory response syndrome was frequently present, but microorganisms were detected in only 4.9% of cases based on cultures of aerobic and anaerobic bacteria in neonatal blood.
dc.fuente.origenWOS
dc.identifier.doi10.1515/jpm-2020-0297
dc.identifier.eissn1619-3997
dc.identifier.issn0300-5577
dc.identifier.urihttps://doi.org/10.1515/jpm-2020-0297
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/94894
dc.identifier.wosidWOS:000626597700005
dc.issue.numero3
dc.language.isoen
dc.pagina.final298
dc.pagina.inicio275
dc.revistaJournal of perinatal medicine
dc.rightsacceso restringido
dc.subjectamniotic fluid
dc.subjectfunisitis
dc.subjecthistologic chorioamnionitis
dc.subjectintra-amniotic infection
dc.subjectintra-amniotic inflammation
dc.subjectintrapartum fever
dc.subjectmicrobial invasion of the amniotic cavity (MIAC)
dc.subjectPCR/ESI-MS
dc.subjectneonatal bacteremia
dc.subjectsterile intra-amniotic inflammation
dc.subject.ods05 Gender Equality
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa05 Igualdad de género
dc.subject.odspa03 Salud y bienestar
dc.titleClinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia implications for clinical care
dc.typeartículo
dc.volumen49
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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