Roberto Romero1,2,3,4,5,6,7, Percy Pacora1,7, Juan Pedro Kusanovic1,8,9, Eunjung Jung1,7, Bogdan Panaitescu1,7, Eli Maymon1,7,10, Offer Erez1,7,10, Susan Berman1,7, David R Bryant1,7, Nardhy Gomez-Lopez1,7,11, Kevin R Theis1,11,12, Gaurav Bhatti1,7, Chong Jai Kim1,13, Bo Hyun Yoon1,14, Sonia S Hassan1,7,15,16, Chaur-Dong Hsu1,7,16, Lami Yeo1,7, Ramiro Diaz-Primera1,7, Julio Marin-Concha1,7, Kia Lannaman1,7, Ali Alhousseini1,7,16,17, Hunter Gomez-Roberts1,7, Aneesha Varrey1,7, Angel Garcia-Sanchez18, Maria Teresa Gervasi1,19. 1. Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, MD, and Detroit, MI, USA. 2. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA. 3. Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA. 4. Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA. 5. Detroit Medical Center, Detroit, MI, USA. 6. Department of Obstetrics and Gynecology, Florida International University, Miami, FL, USA. 7. Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI, USA. 8. Division of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. 9. Center for Research and Innovation in Maternal-Fetal Medicine (CIMAF), Department of Obstetrics and Gynecology, Sótero del Río Hospital, Santiago, Chile. 10. Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel. 11. Department of Biochemistry, Microbiology, and Immunology, Wayne State University School of Medicine, Detroit, MI, USA. 12. Perinatal Research Initiative in Maternal, Perinatal and Child Health, Wayne State University School of Medicine, Detroit, MI, USA. 13. Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea. 14. Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea. 15. Office of Women's Health, Integrative Biosciences Center, Wayne State University, Detroit, MI, USA. 16. Department of Physiology, Wayne State University School of Medicine, Detroit, MI, USA. 17. Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, MI, USA. 18. Department of Obstetrics, Gynecology, and Pediatrics, University of Salamanca, Salamanca, Spain. 19. Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Abstract
OBJECTIVES: Clinical chorioamnionitis at term is considered the most common infection-related diagnosis in labor and delivery units worldwide. The syndrome affects 5-12% of all term pregnancies and is a leading cause of maternal morbidity and mortality as well as neonatal death and sepsis. The objectives of this study were to determine the (1) amniotic fluid microbiology using cultivation and molecular microbiologic techniques; (2) diagnostic accuracy of the clinical criteria used to identify patients with intra-amniotic infection; (3) relationship between acute inflammatory lesions of the placenta (maternal and fetal inflammatory responses) and amniotic fluid microbiology and inflammatory markers; and (4) frequency of neonatal bacteremia. METHODS: This retrospective cross-sectional study included 43 women with the diagnosis of clinical chorioamnionitis at term. The presence of microorganisms in the amniotic cavity was determined through the analysis of amniotic fluid samples by cultivation for aerobes, anaerobes, and genital mycoplasmas. A broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry was also used to detect bacteria, select viruses, and fungi. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin-6 (IL-6) concentration ≥2.6 ng/mL. RESULTS: (1) Intra-amniotic infection (defined as the combination of microorganisms detected in amniotic fluid and an elevated IL-6 concentration) was present in 63% (27/43) of cases; (2) the most common microorganisms found in the amniotic fluid samples were Ureaplasma species, followed by Gardnerella vaginalis; (3) sterile intra-amniotic inflammation (elevated IL-6 in amniotic fluid but without detectable microorganisms) was present in 5% (2/43) of cases; (4) 26% of patients with the diagnosis of clinical chorioamnionitis had no evidence of intra-amniotic infection or intra-amniotic inflammation; (5) intra-amniotic infection was more common when the membranes were ruptured than when they were intact (78% [21/27] vs. 38% [6/16]; p=0.01); (6) the traditional criteria for the diagnosis of clinical chorioamnionitis had poor diagnostic performance in identifying proven intra-amniotic infection (overall accuracy, 40-58%); (7) neonatal bacteremia was diagnosed in 4.9% (2/41) of cases; and (8) a fetal inflammatory response defined as the presence of severe acute funisitis was observed in 33% (9/27) of cases. CONCLUSIONS: Clinical chorioamnionitis at term, a syndrome that can result from intra-amniotic infection, was diagnosed in approximately 63% of cases and sterile intra-amniotic inflammation in 5% of cases. However, a substantial number of patients had no evidence of intra-amniotic infection or intra-amniotic inflammation. Evidence of the fetal inflammatory response syndrome was frequently present, but microorganisms were detected in only 4.9% of cases based on cultures of aerobic and anaerobic bacteria in neonatal blood.
OBJECTIVES: Clinical chorioamnionitis at term is considered the most common infection-related diagnosis in labor and delivery units worldwide. The syndrome affects 5-12% of all term pregnancies and is a leading cause of maternal morbidity and mortality as well as neonatal death and sepsis. The objectives of this study were to determine the (1) amniotic fluid microbiology using cultivation and molecular microbiologic techniques; (2) diagnostic accuracy of the clinical criteria used to identify patients with intra-amniotic infection; (3) relationship between acute inflammatory lesions of the placenta (maternal and fetal inflammatory responses) and amniotic fluid microbiology and inflammatory markers; and (4) frequency of neonatal bacteremia. METHODS: This retrospective cross-sectional study included 43 women with the diagnosis of clinical chorioamnionitis at term. The presence of microorganisms in the amniotic cavity was determined through the analysis of amniotic fluid samples by cultivation for aerobes, anaerobes, and genital mycoplasmas. A broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry was also used to detect bacteria, select viruses, and fungi. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin-6 (IL-6) concentration ≥2.6 ng/mL. RESULTS: (1) Intra-amniotic infection (defined as the combination of microorganisms detected in amniotic fluid and an elevated IL-6 concentration) was present in 63% (27/43) of cases; (2) the most common microorganisms found in the amniotic fluid samples were Ureaplasma species, followed by Gardnerella vaginalis; (3) sterile intra-amniotic inflammation (elevated IL-6 in amniotic fluid but without detectable microorganisms) was present in 5% (2/43) of cases; (4) 26% of patients with the diagnosis of clinical chorioamnionitis had no evidence of intra-amniotic infection or intra-amniotic inflammation; (5) intra-amniotic infection was more common when the membranes were ruptured than when they were intact (78% [21/27] vs. 38% [6/16]; p=0.01); (6) the traditional criteria for the diagnosis of clinical chorioamnionitis had poor diagnostic performance in identifying proven intra-amniotic infection (overall accuracy, 40-58%); (7) neonatal bacteremia was diagnosed in 4.9% (2/41) of cases; and (8) a fetal inflammatory response defined as the presence of severe acute funisitis was observed in 33% (9/27) of cases. CONCLUSIONS: Clinical chorioamnionitis at term, a syndrome that can result from intra-amniotic infection, was diagnosed in approximately 63% of cases and sterile intra-amniotic inflammation in 5% of cases. However, a substantial number of patients had no evidence of intra-amniotic infection or intra-amniotic inflammation. Evidence of the fetal inflammatory response syndrome was frequently present, but microorganisms were detected in only 4.9% of cases based on cultures of aerobic and anaerobic bacteria in neonatal blood.
Authors: David Metzgar; Mark Frinder; Robert Lovari; Donna Toleno; Christian Massire; Lawrence B Blyn; Raymond Ranken; Heather E Carolan; Thomas A Hall; David Moore; Christian J Hansen; Rangarajan Sampath; David J Ecker Journal: J Clin Microbiol Date: 2013-06-12 Impact factor: 5.948
Authors: P Pacora; T Chaiworapongsa; E Maymon; Y M Kim; R Gomez; B H Yoon; F Ghezzi; S M Berry; F Qureshi; S M Jacques; J C Kim; N Kadar; R Romero Journal: J Matern Fetal Neonatal Med Date: 2002-01
Authors: Roberto Romero; Piya Chaemsaithong; Steven J Korzeniewski; Juan P Kusanovic; Nikolina Docheva; Alicia Martinez-Varea; Ahmed I Ahmed; Bo Hyun Yoon; Sonia S Hassan; Tinnakorn Chaiworapongsa; Lami Yeo Journal: J Perinat Med Date: 2016-01 Impact factor: 1.901
Authors: R Romero; M Mazor; F Brandt; W Sepulveda; C Avila; D B Cotton; C A Dinarello Journal: Am J Reprod Immunol Date: 1992 Apr-May Impact factor: 3.886
Authors: Eunjung Jung; Roberto Romero; Bo Hyun Yoon; Kevin R Theis; Dereje W Gudicha; Adi L Tarca; Ramiro Diaz-Primera; Andrew D Winters; Nardhy Gomez-Lopez; Lami Yeo; Chaur-Dong Hsu Journal: J Perinat Med Date: 2021-07-07 Impact factor: 2.716