Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only

doi:10.1016/j.ajog.2005.01.017

American Journal of Obstetrics and Gynecology

Volume 193, Issue 3, September 2005, Pages 708-713

https://doi.org/10.1016/j.ajog.2005.01.017 Get rights and content

Objective

This study was undertaken to evaluate whether the proximity of infection of the chorion/amnion and fetal vessels affects neonatal outcomes.

Study design

We examined all (n = 2012) infants admitted to the British Columbia's Children's Hospital Neonatal Intensive Care Unit, from January 1996 to October 1997. We included infants with a placental examination (n = 1296), and stratified those with histologic chorioamnionitis into cases displaying a maternal inflammatory response only and cases also displaying a fetal inflammatory response (funisitis and/or fetal surface vessel angiitis).

Results

Histologic evidence of chorioamnionitis was present in 31% of placentas. Of those, 38% exhibited maternal inflammation only, whereas 62% also exhibited fetal inflammation. Neonatal mortality (9.2% vs 7.2%), morbidity, and resource use were significantly (P < .05) higher when fetal inflammation was present compared with when only maternal inflammation was present.

Conclusion

Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than when only a maternal inflammatory response is present.

Section snippets

Study population

The study cohort included all infants (n = 2012) admitted to the British Columbia's Children's Hospital NICU from January 1996 to October 1997. Infants were identified from standardized data collected by the Canadian Neonatal Network as part of a larger study of 17 tertiary NICUs across Canada, and which has been previously described.⁹ Trained research assistants abstracted patient information from the mothers' and infants' charts at each participating hospital on a daily basis. Data were entered

Results

Of the 2012 cases, 1296 had a record of placental pathology, representing 64% of all NICU admissions. Histologic evidence of a maternal inflammatory response was identified in 403 cases, or 31% of those with a pathology report. Of those 403 cases, 153 (38%) had maternal inflammation only, whereas 250 (62%) also displayed evidence of fetal inflammation. Infants who had histologic examination of their placentas were significantly (P < .05) more likely than infants who did not have a placental

Comment

The importance of placental pathology for the diagnosis and management of neonatal conditions has long been recognized. As early as 1892, a Scottish obstetrician, Ballantyne stated that “During the intrauterine life, the fetus, the membranes, the cord, and the placenta form an organic whole, and disease of any part must react upon and affect the others.”²⁰ Our findings that 31% of placentas examined in our cohort showed histologic evidence of chorioamnionitis, and that chorioamnionitis is

Acknowledgments

We acknowledge the assistance of Ruth Little in preparing this article, and the Canadian Neonatal Network for use of their data.

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: Supported by the Medical Research Council of Canada and the BC Research Institute for Children's and Women's Health.

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General Obstetrics and Gynecology: ObstetricsChorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only

Objective

Study design

Results

Conclusion

Section snippets

Study population

Results

Comment

Acknowledgments

Semin Neonatol

Hum Pathol

J Obstet Gynaecol Can

Am J Obstet Gynecol

J Pediatr

Am J Obstet Gynecol

Am J Obstet Gynecol

The relationship between placental histopathology findings and perinatal outcome in preterm infants

J Matern Fetal Neonatal Med

The effect of chorioamnionitis on perinatal outcome in preterm gestation

J Perinatol

Chorionic plate vessels as an origin of amniotic fluid neutrophils

Pathol Int

Maternal and fetal inflammatory responses in unexplained fetal death

J Matern Fetal Neonatal Med

Variations in practice and outcomes in the Canadian NICU Network: 1996-1997

Pediatrics

Pathology of the human placenta

General Obstetrics and Gynecology: Obstetrics
Chorioamnionitis with a fetal inflammatory response is associated with higher neonatal mortality, morbidity, and resource use than chorioamnionitis displaying a maternal inflammatory response only