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Updated: Jun 8, 2026
Human Placental and Decidual Organ Cultures to Study Infections at the Maternal-fetal Interface
Published on: July 21, 2016
Placental intravascular organisms: a case report
A Matoso1, S Shapiro, M E De Paepe
1Department of Pathology, Rhode Island Hospital, Providence, RI, USA.
Abstract:
Ascending amniotic fluid bacterial infection is a cause of perinatal morbidity and mortality. A diagnosis of amniotic cavity infection can be inferred by documenting maternal (acute chorioamnionitis) and/or fetal (chorionic plate vasculitis; umbilical vasculitis/funisitis) inflammatory response. A definitive diagnosis of intrauterine/neonatal sepsis as a cause of stillbirth requires positive blood cultures obtained at postmortem examination. However, if postmortem examination is not performed, acute chorioamnionitis with/without fetal inflammatory response cannot be classified as a cause of demise. We present a case of intrauterine demise associated with acute chorioamnionitis, villitis, and intervillositis of the placenta. Although postmortem examination was denied, a conclusive diagnosis of intrauterine sepsis could be rendered by demonstration of gram-positive cocci within fetal vessels of umbilical cord, chorionic plate, and stem villi. This report highlights the importance of identification of placental intravascular organisms as unequivocal evidence of fetal sepsis, especially in cases where cultures cannot be obtained.
Insights
Ascending amniotic fluid infection causes perinatal issues. Identifying bacteria in fetal vessels confirms intrauterine sepsis, even without postmortem cultures, aiding diagnosis of stillbirth causes.
Area of Science:
- Perinatology
- Pathology
- Microbiology
Background:
- Ascending amniotic fluid bacterial infection is a significant cause of perinatal morbidity and mortality.
- Diagnosing amniotic cavity infection involves identifying maternal (acute chorioamnionitis) and/or fetal inflammatory responses.
- Definitive diagnosis of intrauterine/neonatal sepsis requires positive postmortem blood cultures.
Observation:
- A case of intrauterine demise presented with acute chorioamnionitis, villitis, and intervillositis.
- Postmortem examination was declined, preventing traditional sepsis diagnosis.
- Gram-positive cocci were identified within fetal vessels of the umbilical cord, chorionic plate, and stem villi.
Findings:
- Demonstration of intravascular organisms in placental tissues provides unequivocal evidence of fetal sepsis.
- This diagnostic method is crucial when postmortem cultures are unobtainable.
- Acute chorioamnionitis with fetal inflammatory response can be definitively linked to intrauterine sepsis through placental pathology.
Implications:
- Highlights the importance of placental histopathology in diagnosing intrauterine sepsis.
- Offers a method for diagnosing fetal sepsis in stillbirths when postmortem examination is not performed.
- Emphasizes the role of identifying intravascular bacteria in fetal vessels as definitive evidence of sepsis.
