Chorioamnionitis

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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.
  • +/-Microorganisms (e.g. cocci[4]) - very uncommon to see.

Note:

DDx:

Images

Grading chorioamnionitis

Chorioamnionitis:[5]

  1. placental chorionic plate only.
  2. 1 + subamniotic tissue.
  3. 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

  1. 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.
  2. 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.
  3. 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. //www.ncbi.nlm.nih.gov/pmc/articles/PMC3008318/.
  4. Murdoch, DA. (Jan 1998). "Gram-positive anaerobic cocci.". Clin Microbiol Rev 11 (1): 81-120. PMC 121377. PMID 9457430. //www.ncbi.nlm.nih.gov/pmc/articles/PMC121377/.
  5. 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.