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Re-evaluation of chorioamnionitis and funisitis with a special reference to subacute chorioamnionitis
Makiko Ohyama1, Yasufumi Itani, Michiko Yamanaka
1Division of Neonatology, Obstetrics, and Pathology, Kanagawa Children's Medical Center, Yokohama City, Japan.
Abstract:
Our purpose is to prove that prolonged inflammation of the chorionic plate, which we have termed subacute chorioamnionitis (SCAM), is a distinctive entity and should be differentiated from acute chorioamnionitis (ACAM) because it is an excellent prognostic indicator of chronic lung disease (CLD), including Wilson-Mikity syndrome (WMS). Ninety singleton placentas with stage-3 chorioamnionitis were delivered at 23 to 32 weeks of gestation during 1993 to 1996, and the infants survived more than 28 days. There were 49 placentas with stage 3 SCAM, 33 placentas with stage 3 ACAM, and 8 placentas with subacute necrotizing funisitis (SNF) and without inflammation of the chorionic plate. Fifty-three of gestation- and birthweight-matched placentas without chorioamnionitis were selected as control. To determine the risk factors for CLD, 27 clinical and 6 histological variables were analyzed. Logistic regression analysis showed that amniotic necrosis (AN) (P =.0168) and low birthweight (P =.0341) were the major contributing risk factors for CLD. SNF was not significantly related to CLD. Patients with SCAM (AN+, SNF-) were highly susceptible to CLD. In conclusion, SCAM, especially when associated with AN, seems to be a unique prognostic indicator of CLD.
Insights
Subacute chorioamnionitis (SCAM) is a distinct placental condition. It serves as a key predictor for chronic lung disease (CLD) in premature infants, differentiating it from acute chorioamnionitis.
Area of Science:
- Perinatal pathology
- Neonatal medicine
- Obstetrics
Background:
- Chorioamnionitis is inflammation of the fetal membranes.
- Acute chorioamnionitis (ACAM) is a well-recognized condition.
- The prognostic significance of prolonged chorionic plate inflammation was unclear.
Purpose of the Study:
- To establish subacute chorioamnionitis (SCAM) as a distinct entity.
- To differentiate SCAM from ACAM.
- To evaluate SCAM as a prognostic indicator for chronic lung disease (CLD) in preterm infants.
Main Methods:
- Analysis of 90 placentas from preterm infants (23-32 weeks gestation) with stage-3 chorioamnionitis.
- Classification of placentas into SCAM, ACAM, and subacute necrotizing funisitis (SNF) groups.
- Comparison with 53 control placentas without chorioamnionitis; logistic regression analysis of clinical and histological variables.
Main Results:
- Subacute chorioamnionitis (SCAM) was identified in 49 placentas.
- Amniotic necrosis (AN) and low birthweight were significant risk factors for CLD.
- Patients with SCAM, particularly those with AN, showed high susceptibility to CLD.
Conclusions:
- Subacute chorioamnionitis (SCAM) is a distinct pathological entity.
- SCAM, especially with associated amniotic necrosis, is a significant prognostic indicator for CLD.
- Differentiating SCAM from ACAM is crucial for predicting infant outcomes.