Difference between revisions of "Chorioamnionitis"

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#redirect [[Placenta#Chorioamnionitis]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Chorioamnionitis_-2-_very_high_mag.jpg
| Width      =
| Caption    = Chorioamnionitis. [[H&E stain]].
| Micro      =
| Subtypes  =
| LMDDx      =
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[placenta]]
| Assdx      = [[funisitis]]
| Syndromes  =
| Clinicalhx =
| Signs      = fetal tachycardia, maternal fever
| Symptoms  =
| Prevalence = common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = good
| Other      =
| ClinDDx    =
}}
'''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]].
 
===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 and 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]]

Revision as of 11:59, 27 September 2013

Chorioamnionitis
Diagnosis in short

Chorioamnionitis. H&E stain.
Site placenta
Associated Dx funisitis
Signs fetal tachycardia, maternal fever
Prevalence common
Prognosis good

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:

  • Severe cases may have umbilical cord vasculitis or funisitis.

Images

  • Chorioamnionitis - low mag. (WC)

  • Chorioamnionitis - high mag. (WC)

  • Chorioamnionitis - very high mag. (WC)

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 and 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. https://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. https://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.
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