Transactions of the Twentieth Annual Meeting of the Society For Maternal-Fetal Medicine—Continued
The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis,☆☆

Presented at the Twentieth Annual Meeting of the Society for Maternal-Fetal Medicine, Miami Beach, Florida, January 31–February 5, 2000.
https://doi.org/10.1067/mob.2000.109035Get rights and content

Abstract

Objective: The purpose of this study was to determine whether funisitis (inflammation of the umbilical cord detected by histologic examination of the placenta) is associated with changes in the umbilical cord plasma concentration of interleukin 6, microbial invasion of the amniotic cavity, and neonatal sepsis. Study Design: The relationship among the presence of funisitis, interleukin 6 concentrations in umbilical cord plasma at birth, the results of amniotic fluid culture performed within 3 days of birth, and the occurrence of congenital neonatal sepsis was examined in 315 consecutive singleton preterm births (20-35 weeks’ gestation). Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton jelly. The interleukin 6 concentration was measured with a specific immunoassay. Amniocentesis was performed in 106 patients within 3 days of birth. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas. Results: (1) Funisitis was present in 25% of patients (78/315). (2) Patients with funisitis had a significantly higher median cord plasma interleukin 6 and a lower gestational age at birth than did those without funisitis (cord interleukin 6: median, 52.4 pg/mL; range, 0.9-19,230 pg/mL; vs median, 4.6 pg/mL; range, 0-18,108 pg/mL; gestational age: median, 31.1 weeks’ gestation; range, 21.0-35.0 weeks’ gestation; vs median, 32.9 weeks’ gestation; range, 21.4-35.0 weeks’ gestation; P <.001 for each comparison). (3) A cord plasma interleukin 6 of ≥17.5 pg/mL had a sensitivity of 70% and a specificity of 78% in the identification of funisitis. (4) Microbial invasion of the amniotic cavity and clinical chorioamnionitis were more common among patients with funisitis than among those without funisitis (positive amniotic fluid culture: 53% [20/38]; vs 12% [8/68]; clinical chorioamnionitis: 18% [14/78]; vs 4% [9/237]; P <.001 for each comparison). (5) Neonates with funisitis had a significantly higher rate of congenital sepsis than did those without this lesion (12% [8/66] vs 1% [3/216]; P <.001); this difference remained significant after adjustment for gestational age at birth (odds ratio, 7.2; 95% confidence interval, 1.8-29.0). Conclusion: (1) Umbilical cord plasma interleukin 6 concentrations were higher in neonates born with funisitis than in those without this lesion. (2) Funisitis is associated with amniotic fluid infection, congenital neonatal sepsis, and the fetal inflammatory response syndrome. (Am J Obstet Gynecol 2000;183:1124-9.)

Section snippets

Study design

The relationships between the presence of funisitis and the level of IL-6 in umbilical cord plasma at birth, the results of amniotic fluid culture, and the occurrence of congenital neonatal sepsis were examined in 315 consecutive singleton preterm births (20-35 weeks’ gestation) delivered at the Seoul National University Hospital (Seoul, Korea). Many patients included in this study had undergone transabdominal amniocentesis for either the evaluation of microbiologic status of the amniotic

Results

Funisitis was present in 25% of cases (78/315). Table I describes the clinical characteristics and outcomes of the study population according to the presence or absence of funisitis.Patients with funisitis had a lower gestational age at birth and higher rates of clinical chorioamnionitis, amniotic fluid culture positive for microorganisms, and congenital neonatal sepsis than did those without funisitis (Table I). After we adjusted for the effect of gestational age at birth, the presence of

Comment

Funisitis occurred more frequently among patients with preterm premature rupture of membranes, positive amniotic fluid culture results, clinical chorioamnionitis, and histologic evidence of inflammation of the amniochorial membranes. Moreover, neonates whose placentas demonstrated funisitis had a higher rate of congenital neonatal sepsis and were born at a lower gestational age than those without funisitis. We also noted that inflammation of the umbilical cord was extremely rare in the absence

References (25)

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    A large proportion (70 %) of women who delivered early had confirmed inflammation on placental histology; incidence was inversely related to gestational age (R2 = −0.87). This suggests that infection is a more common aetiological factor at earlier gestations, as previously described [6]. The diagnosis of subclinical chorioamnionitis poses a significant clinical conundrum in obstetrics.

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    Acute funisitis, rather than the maternal immune response of histologic chorioamnionitis, serves as an indicator of fetal inflammatory response.3 To this end, studies have shown a strong relationship between acute funisitis and release of acute phase reactants in fetal circulation (eg, interleukin-6, interleukin-8, and matrix metalloproteinase 8).3–11 In contrast with histologic chorioamnionitis, acute funisitis has consistently been associated with culture-proven intraamniotic infection and adverse neonatal outcomes, including early-onset sepsis and retinopathy of prematurity.7,12,13

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Supported by grant 2000-N-NL-01-C-078 from the Korea Institute of Science and Technology Evaluation and Planning (KISTEP), Republic of Korea.

☆☆

Reprint requests: Bo Hyun Yoon, MD, PhD, Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 110-744, Korea.

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