Association between clinical chorioamnionitis and histological funisitis at term

Area of Science:

• Obstetrics and Gynecology
• Perinatal Medicine
• Infectious Disease in Pregnancy

Background:

• Clinical chorioamnionitis is a common complication during labor.
• Accurate prediction of histological funisitis is crucial for appropriate management.
• Maternal fever alone has limited predictive value for placental inflammation.

Purpose of the Study:

• To evaluate the predictive value of clinical chorioamnionitis symptoms for histological funisitis in term pregnancies.
• To identify specific clinical signs that accurately indicate the presence of funisitis.

Main Methods:

• Retrospective analysis of 251 term pregnancies with maternal fever (≥38°C) during labor.
• Assessment of clinical maternal findings (fever, uterine tenderness, tachycardia, discharge characteristics, WBC count) and fetal tachycardia.
• Microscopic histopathological examination of placental tissue post-delivery.

Main Results:

• Maternal fever alone had a low positive predictive value (15.5%) for histological funisitis.
• The combination of maternal fever, uterine fundal tenderness, and purulent or foul-smelling amniotic fluid/cervical discharge showed a 100% positive predictive value for histological chorioamnionitis.
• Uterine fundal tenderness and foul-smelling discharge were key indicators.

Conclusions:

• Clinical signs like uterine fundal tenderness and foul-smelling amniotic fluid or cervical discharge are highly predictive of histological funisitis in febrile term pregnancies.
• These specific symptoms improve the accuracy of diagnosing placental inflammation compared to maternal fever alone.
• Early identification of funisitis can guide timely clinical interventions.