Difference between revisions of "Chorioamnionitis"
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# | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Chorioamnionitis_-2-_very_high_mag.jpg | |||
| Width = | |||
| Caption = Chorioamnionitis. [[H&E stain]]. | |||
| Micro = [[neutrophil]]s present in the amnion, usu. associated with abundant subchorionic neutrophils | |||
| Subtypes = | |||
| LMDDx = [[membranitis]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = +/-opaque membranes | |||
| Grossing = | |||
| Site = [[placenta]] | |||
| Assdx = [[umbilical cord vasculitis]], [[funisitis]], [[placental meconium]] | |||
| Syndromes = | |||
| Clinicalhx = +/-premature rupture of membranes, +/-preterm labour, +/-failure to progress | |||
| Signs = fetal tachycardia, maternal fever, nonreassuring fetal heart rate | |||
| Symptoms = | |||
| Prevalence = common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = good | |||
| Other = | |||
| ClinDDx = other causes of maternal fever and fetal tachycardia | |||
| Tx = antibiotics | |||
}} | |||
'''Chorioamnionitis''' is a common pathology of the [[placenta]]. | |||
==General== | |||
*Associated with pre-term labour.<ref name=pmid22958008>{{Cite journal | last1 = Martinelli | first1 = P. | last2 = Sarno | first2 = L. | last3 = Maruotti | first3 = GM. | last4 = Paludetto | first4 = R. | title = Chorioamnionitis and prematurity: a critical review. | journal = J Matern Fetal Neonatal Med | volume = 25 Suppl 4 | issue = | pages = 29-31 | month = Oct | year = 2012 | doi = 10.3109/14767058.2012.714981 | PMID = 22958008 }}</ref> | |||
**Classically described as due to an ascending infection. | |||
*At term usually non-infectious.<ref name=pmid22412842>{{Cite journal | last1 = Roberts | first1 = DJ. | last2 = Celi | first2 = AC. | last3 = Riley | first3 = LE. | last4 = Onderdonk | first4 = AB. | last5 = Boyd | first5 = TK. | last6 = Johnson | first6 = LC. | last7 = Lieberman | first7 = E. | title = Acute histologic chorioamnionitis at term: nearly always noninfectious. | journal = PLoS One | volume = 7 | issue = 3 | pages = e31819 | month = | year = 2012 | doi = 10.1371/journal.pone.0031819 | PMID = 22412842 }}</ref> | |||
Clinical features: | |||
*Maternal fever. | |||
*Premature rupture of membranes (PROM). | |||
*Non-reassuring fetal heart rate (NRFHR). | |||
Management: | |||
*Antibiotics - usually ampicillin and gentamicin.<ref name=pmid20569811>{{Cite journal | last1 = Tita | first1 = AT. | last2 = Andrews | first2 = WW. | title = Diagnosis and management of clinical chorioamnionitis. | journal = Clin Perinatol | volume = 37 | issue = 2 | pages = 339-54 | month = Jun | year = 2010 | doi = 10.1016/j.clp.2010.02.003 | PMID = 20569811 | PMC = 3008318 }}</ref> | |||
==Gross== | |||
*Fetal membranes dull/opaque. | |||
==Microscopic== | |||
Features: | |||
*Neutrophils in the amnion. | |||
**Amnion: | |||
***The simple cuboidal epithelium and the paucicellular underlying connective tissue. | |||
***Separated from the chorion by an artefactual cleft. | |||
*+/-Microorganisms (e.g. cocci<ref>{{Cite journal | last1 = Murdoch | first1 = DA. | title = Gram-positive anaerobic cocci. | journal = Clin Microbiol Rev | volume = 11 | issue = 1 | pages = 81-120 | month = Jan | year = 1998 | doi = | PMID = 9457430 | PMC = 121377}} | |||
</ref>) - very uncommon to see. | |||
Note: | |||
*Severe cases may have [[umbilical cord vasculitis]] or [[funisitis]]. | |||
DDx: | |||
*[[Membranitis]]. | |||
*[[Placental meconium]] - associated with degeneration (apoptotic cells). | |||
*Intramembrane bleed - rare [[neutrophil]]s with [[red blood cell]]s in the amnion without significant neutrophils in the chorion and decidua. | |||
===Images=== | |||
<gallery> | |||
Image:Chorioamnionitis_-_low_mag.jpg | Chorioamnionitis - low mag. (WC) | |||
Image:Chorioamnionitis_-_high_mag.jpg | Chorioamnionitis - high mag. (WC) | |||
Image:Chorioamnionitis_-2-_very_high_mag.jpg | Chorioamnionitis - very high mag. (WC) | |||
</gallery> | |||
===Grading chorioamnionitis=== | |||
Chorioamnionitis:<ref name=Ref_Sternberg4_2311>{{Ref Sternberg4|2311}}</ref> | |||
# placental chorionic plate only. | |||
# 1 + subamniotic tissue. | |||
# 1 or 2 + necrosis ''or'' abscess. | |||
==Sign out== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAREAN SECTION: | |||
- CHORIOAMNIONITIS. | |||
- FETAL MEMBRANES NEGATIVE FOR MECONIUM. | |||
- THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI. | |||
- THROMBUS OF THE PLACENTAL DISC (1.3 CM - MAXIMAL DIMENSION). | |||
</pre> | |||
===Chorioamnionitis with vasculitis=== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION: | |||
- CHORIOAMNIONITIS, MODERATE. | |||
- THREE VESSEL UMBILICAL CORD WITH VASCULITIS, EARLY. | |||
- FETAL MEMBRANES NEGATIVE FOR MECONIUM. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI. | |||
</pre> | |||
===Chorioamnionitis with funisitis=== | |||
<pre> | |||
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION: | |||
- CHORIOAMNIONITIS, MODERATE. | |||
- THREE VESSEL UMBILICAL CORD WITH FUNISITIS, MILD. | |||
- FETAL MEMBRANES NEGATIVE FOR MECONIUM. | |||
- PLACENTAL DISC WITH THIRD TRIMESTER VILLI. | |||
- THROMBUS OF THE PLACENTAL DISC (1.3 CM - MAXIMAL DIMENSION). | |||
</pre> | |||
==See also== | |||
*[[Membranitis]]. | |||
*[[Funisitis]]. | |||
*[[Placenta]]. | |||
*[[Meconium]]. | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Diagnosis]] | [[Category:Diagnosis]] | ||
[[Category:Placenta]] | |||
Latest revision as of 12:09, 25 June 2014
| Chorioamnionitis | |
|---|---|
| Diagnosis in short | |
 Chorioamnionitis. H&E stain. | |
|
| |
| LM | neutrophils present in the amnion, usu. associated with abundant subchorionic neutrophils |
| LM DDx | membranitis |
| Gross | +/-opaque membranes |
| Site | placenta |
|
| |
| Associated Dx | umbilical cord vasculitis, funisitis, placental meconium |
| Clinical history | +/-premature rupture of membranes, +/-preterm labour, +/-failure to progress |
| Signs | fetal tachycardia, maternal fever, nonreassuring fetal heart rate |
| Prevalence | common |
| Prognosis | good |
| Clin. DDx | other causes of maternal fever and fetal tachycardia |
| Treatment | antibiotics |
Chorioamnionitis is a common pathology of the placenta.
General
- Associated with pre-term labour.[1]
- Classically described as due to an ascending infection.
- At term usually non-infectious.[2]
Clinical features:
- Maternal fever.
- Premature rupture of membranes (PROM).
- Non-reassuring fetal heart rate (NRFHR).
Management:
- Antibiotics - usually ampicillin and gentamicin.[3]
Gross
- Fetal membranes dull/opaque.
Microscopic
Features:
- Neutrophils in the amnion.
- Amnion:
- The simple cuboidal epithelium and the paucicellular underlying connective tissue.
- Separated from the chorion by an artefactual cleft.
- Amnion:
- +/-Microorganisms (e.g. cocci[4]) - very uncommon to see.
Note:
- Severe cases may have umbilical cord vasculitis or funisitis.
DDx:
- Membranitis.
- Placental meconium - associated with degeneration (apoptotic cells).
- Intramembrane bleed - rare neutrophils with red blood cells in the amnion without significant neutrophils in the chorion and decidua.
Images
Chorioamnionitis - low mag. (WC)
Chorioamnionitis - high mag. (WC)
Chorioamnionitis - very high mag. (WC)
Grading chorioamnionitis
Chorioamnionitis:[5]
- placental chorionic plate only.
- 1 + subamniotic tissue.
- 1 or 2 + necrosis or abscess.
Sign out
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAREAN SECTION: - CHORIOAMNIONITIS. - FETAL MEMBRANES NEGATIVE FOR MECONIUM. - THREE VESSEL UMBILICAL CORD WITHIN NORMAL LIMITS. - PLACENTAL DISC WITH THIRD TRIMESTER VILLI. - THROMBUS OF THE PLACENTAL DISC (1.3 CM - MAXIMAL DIMENSION).
Chorioamnionitis with vasculitis
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION: - CHORIOAMNIONITIS, MODERATE. - THREE VESSEL UMBILICAL CORD WITH VASCULITIS, EARLY. - FETAL MEMBRANES NEGATIVE FOR MECONIUM. - PLACENTAL DISC WITH THIRD TRIMESTER VILLI.
Chorioamnionitis with funisitis
PLACENTA, UMBILICAL CORD AND FETAL MEMBRANES, CESAERIAN SECTION: - CHORIOAMNIONITIS, MODERATE. - THREE VESSEL UMBILICAL CORD WITH FUNISITIS, MILD. - FETAL MEMBRANES NEGATIVE FOR MECONIUM. - PLACENTAL DISC WITH THIRD TRIMESTER VILLI. - THROMBUS OF THE PLACENTAL DISC (1.3 CM - MAXIMAL DIMENSION).
See also
References
- ↑ Martinelli, P.; Sarno, L.; Maruotti, GM.; Paludetto, R. (Oct 2012). "Chorioamnionitis and prematurity: a critical review.". J Matern Fetal Neonatal Med 25 Suppl 4: 29-31. doi:10.3109/14767058.2012.714981. PMID 22958008.
- ↑ Roberts, DJ.; Celi, AC.; Riley, LE.; Onderdonk, AB.; Boyd, TK.; Johnson, LC.; Lieberman, E. (2012). "Acute histologic chorioamnionitis at term: nearly always noninfectious.". PLoS One 7 (3): e31819. doi:10.1371/journal.pone.0031819. PMID 22412842.
- ↑ Tita, AT.; Andrews, WW. (Jun 2010). "Diagnosis and management of clinical chorioamnionitis.". Clin Perinatol 37 (2): 339-54. doi:10.1016/j.clp.2010.02.003. PMC 3008318. PMID 20569811. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3008318/.
- ↑ Murdoch, DA. (Jan 1998). "Gram-positive anaerobic cocci.". Clin Microbiol Rev 11 (1): 81-120. PMC 121377. PMID 9457430. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC121377/.
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 2311. ISBN 978-0781740517.