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Chronic chorioamnionitis: a clinicopathologic study of 17 cases
D J Gersell1, N J Phillips, K Beckerman
1Department of Pathology, Washington University School of Medicine, St. Louis, Missouri.
Summary
This study reports on a rare form of chorioamnionitis with chronic inflammation in fetal membranes. Infectious causes were not identified, and affected infants often experienced preterm birth and low birth weight.
Area of Science:
- Pathology
- Obstetrics
- Perinatology
Background:
- Chorioamnionitis is typically characterized by acute inflammation in the fetal membranes.
- An unusual variant presents with predominantly chronic inflammatory infiltrates.
Purpose of the Study:
- To describe the clinicopathologic features of this rare chorioamnionitis variant.
- To investigate potential infectious etiologies and clinical outcomes.
Main Methods:
- Case series analysis of 17 patients with chronic chorioamnionitis.
- Histopathologic examination of fetal membranes and placentas.
- Infectious workup including stains, cultures, and serology.
Main Results:
- 17 cases of chronic chorioamnionitis identified, with some cases showing mixed acute inflammation.
- Concomitant lymphohistiocytic villitis was frequent but variable in severity.
- No specific infectious agent was identified despite extensive testing.
- High rates of preterm birth (13/17), low birth weight (76% ≤50th percentile), and adverse neonatal outcomes were observed.
Conclusions:
- This chronic inflammatory pattern of chorioamnionitis is distinct from the typical acute form.
- The etiology remains elusive, suggesting non-infectious or unidentified infectious agents.
- This condition is associated with significant adverse pregnancy outcomes, including preterm birth and fetal growth restriction.