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Prelabor rupture of the membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Lami Yeo, Francesca Gotsch, Eleazar Soto, Sonia S. Hassan, Juan Pedro Kusanovic, Ray Bahado-Singh
Pathologic examination of the umbilical cord is an easy approach to determine whether fetal inflammation was present before birth. Funisitis and chorionic vasculitis are the histopathologic hallmarks of FIRS (103). Funisitis is associated with endothelial activation, a key mechanism in the development of organ damage (104), and neonates with funisitis are at increased risk for neonatal sepsis (105) and long-term complications, such as bronchopulmonary dysplasia (BPD) (99) and cerebral palsy (101). Indeed, newborns with funisitis are at more than a twofold increased risk for intraventricular hemorrhage (IVH) (106) and have an 11-fold risk for the development of periventricular echolucencies (107). In the context of FIRS, the combination of inflammatory changes in the brain and fetal systemic hypotension may increase the likelihood of brain injury (108). Collectively, these observations suggest that a subset of fetuses presenting with preterm PROM have bacteremia and/or FIRS that may contribute to fetal organ damage.
Pathologic abnormalities of placental structure and function in diabetes
Published in Moshe Hod, Lois G. Jovanovic, Gian Carlo Di Renzo, Alberto de Leiva, Oded Langer, Textbook of Diabetes and Pregnancy, 2018
Rhonda Bentley-Lewis, Maria Rosaria Raspollini, Drucilla Roberts
Fungal placentitis, a relatively uncommon finding, is also increased in the setting of maternal diabetes.55–61 This pathology includes brisk funisitis or umbilical cord vasculitis with peripheral umbilical cord abscesses (Figure 11.4).59 The presence of invasive hyphae within the Wharton’s jelly of the umbilical cord is thought to represent an increased risk for disseminated disease in the fetus, but even deeply invasive hyphae are usually benign.3 Consequently, it usually does not have significant sequelae for the fetus, although rarely fungal placentitis can lead to overwhelming sepsis.62,63
The Vaginal Microbiome
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Shahriar Mowla, Phillip R. Bennett, David A. MacIntyre
Recent work from our laboratories has further explored the relationship between the vaginal microbiota and a specific sub-group of preterm birth, namely preterm pre-labor rupture of the fetal membranes (PPROM) (125,126). PPROM proceeds around 30–40% of preterm birth cases (127) and is associated with increased risk of poor maternal and neonatal outcomes as the uterine cavity and fetus become exposed to potentially pathogenic vaginal bacteria (128–134). Our findings showed that vaginal dysbiosis characterized by Lactobacillus species' depletion increased bacterial diversity and presence of potential pathogens is significantly more prevalent in women who subsequently experience PPROM (29). Moreover, the event of membrane rupture itself additionally promotes sub-optimal vaginal microbiota colonization, which may be further exacerbated by specific antibiotic treatment (erythromycin) widely used clinically in an attempt to prolong pregnancy and reduce neonatal morbidity following PPROM (50). This seems to have consequences for the mother and neonate following delivery. In this study cohort, the vaginal microbiota of women with chorioamnionitis with funisitis were enriched for Prevotella, Sneathia, Peptostreptococcus, and Catonella species, and had raised C-reactive protein (a systemic marker of inflammation) and white blood cell counts. Moreover, in cases developing early onset neonatal sepsis, maternal vaginal swabs collected closest to the time of delivery were enriched for Streptococcus agalactiae, Fusobacterium nucleatum, Escherichia coli, Catonella, and Sneathia species. Interestingly, maternal colonization by Lactobacillus crispatus was associated with protection against early onset neonatal sepsis following PPROM.
Association between interleukin-6 levels in amniotic fluid after rupture of membranes during labour at term pregnancy and successful vaginal delivery: a prospective cohort study
Published in Journal of Obstetrics and Gynaecology, 2022
Min Jung Lee, Min Kyung Kim, Hyo Jin Lee, Kwang Hee Ahn, Hyeon Ji Kim, Jee Yoon Park
Amniotic fluid was immediately obtained from vaginal canal after spontaneous ROM. With the assistance of a sterile speculum, the pooled fluid was obtained through a syringe at the posterior fornix. IL-6 concentration was measured using commercially available enzyme-linked immunosorbent assays (R&D Systems, Minneapolis, MN, USA). The sensitivity of the test was <1.0 pg/mL, and the inter-assay and intra-assay coefficients of variation were <10%. Maternal serum was obtained at the beginning of active labour and umbilical cord venous blood was obtained during delivery before removal of the placenta. Complete blood cell (CBC) counts and C-reactive protein (CRP) levels were evaluated from both maternal serum and cord blood by the laboratory department of our institution. The placenta was evaluated by pathologists for the detection of histologic chorioamnionitis and funisitis. Histologic chorioamnionitis was defined as the presence of inflammatory changes on the amniotic membranes and chorionic plates, and funisitis was defined as the presence of neutrophilic infiltration into the umbilical vessel walls or Wharton’s jelly (Kim et al. 2015).
Combined Use of Magnesium Sulfate and Fingolimod for Antenatal Neuroprotection against Inflammation-Mediated Experimental Preterm Brain Injury in a Rat Model
Published in Fetal and Pediatric Pathology, 2022
Serenat Eris Yalcin, Mekin Sezik, And Yavuz, Mehtap Savran, Halil Asci, Ozlem Ozmen
Every year, more than 15 million babies are born prematurely worldwide, with >1 million dying. Preterm delivery is currently the leading cause of neonatal mortality, occurring in up to 11% of all pregnancies [1, 2]. A significant proportion of infant survivors of preterm birth have long-term neurological morbidity. Recent evidence suggests that intrauterine infection and inflammation are important factors leading to cerebral injury in this population [3]. Locally, intra-amniotic infection is manifested by increased cytokine concentrations in amniotic fluid, particularly in the preterm fetal brain [4]. This local inflammatory response may be indicative of fetal inflammatory response syndrome (FIRS), a systemic activation of the fetal immune system. Clinically, FIRS is defined by the presence of high levels of cytokines, such as IL-6, which are associated with funisitis and fetal brain injury [5]. Preterm infants with funisitis have higher levels of IL-10, an anti-inflammatory cytokine, which is likely owing to a compensatory anti-inflammatory response [6]. S100 calcium-binding protein β (S100β) is a marker with high sensitivity for predicting premature brain injury in cord blood and amniotic fluid [7]. In addition, S100β expression increases in brain tissue in fetal brain damage [8].
Paths of causal influence from prenatal inflammation and preterm gestation to childhood asthma symptoms
Published in Journal of Asthma, 2019
Nada Sindičić Dessardo, Elvira Mustać, Srdjan Banac, Sandro Dessardo
Placental histological examination included a minimum of three cross sections of the umbilical cord taken from its foetal and placental side, three membrane rolls, and a sample of the chorionic plate and three samples from the maternal side of the placenta. The inflammatory findings at histology were recorded and accounted for the worst area scored, according to the classification proposed by Redline [17]. Newborns were classified as having FIRS if severe HCA and funisitis were confirmed to be present [18]. Respiratory distress syndrome was defined as the need for oxygen supplementation or mechanical ventilatory support for at least 48 h. Patent ductus arteriosus was defined by clinical signs and the presence of typical echocardiographic findings. CLD of prematurity was defined as the need for mechanical ventilation or supplemental oxygen beyond 36 weeks of postconceptional age [19]. The newborns were considered to have early and/or late onset sepsis if there was either a positive culture or clinical signs of infection accompanied by concurrent antibiotic treatment for at least 7 days. Post-natal follow-up included regular visits at 6 and 12 months of age, and once a year visits following the first year of life, in order to collect additional clinical data of relevance for the study. For the purpose of the study, the criteria for the definition of ECW were the presence of three or more episodes of wheezing per year for which a bronchodilator had been prescribed [20]. The assessment of ECW prevalence was made at the age of 3 years for all the enrolled infants.