Unexplained Fever in Obstetrics
Benedict Isaac, Serge Kernbaum, Michael Burke in Unexplained Fever, 2019
In modern obstetric preterm delivery, this remains the single most important factor in neonatal mortality. Chorioamnionitis must be looked for in any women with premature rupture of membranes (PROM) even though it may occur in patients with intact membranes. In the latter, occult genital tract infection is the cause, predisposing to preterm delivery with many pathogens being responsible. Studies have shown the close relationship of vaginal colonization by Streptococcus B hemolyticus and chorioamnionitis, with subsequent severe neonatal disease. The classical signs of amnionitis are maternal and fetal tachycardia, maternal fever, purulent or foul-smelling vaginal discharge, and leukocytosis. When all of these are present, we are already dealing with a severe disease. The infection may be fatal to the fetus and a source of severe morbidity to the mother, without previous warning. In a recent study only 27 of 333 cases of histopathologic chorioamnionitis of 8.1% had maternal fever. The authors estimated that approximately 25% of the preterm deliveries were statistically attributable to chroioamnionitis. A high suspicion of amnionitis should be entertained in any woman with PROM presenting with fever without any apparent cause.
The Role of Mesenchymal Stem Cells in the Functions and Pathologies of the Human Placenta
Ornella Parolini, Antonietta Silini in Placenta, 2016
The presence of a vascularized allogeneic placenta, the developing fetus, and its membranes in the maternal uterus poses significant challenges for the maternal and fetal immune systems. Pathologies associated with immune response or inflammatory lesions include chorioamnionitis, chronic intervillositis, and chronic deciduitis. The term chorioamnionitis refers to acute inflammation of the placental membranes (amnion and chorion) and is a leading cause of maternal and fetal complications, including preterm birth and neonatal infection (Romero et al. 2002; Ogunyemi et al. 2003). The inflammatory process is generally regarded as a continuum. During the early stage, the neutrophils involved in this inflammatory response are usually maternal (migrating from intervillous sac, decidual vessels, or both) in origin. During later stages, fetal neutrophils (migrating from fetal surface vessels of the chorionic plate or umbilical cord) are involved. Chronic intervillositis is characterized by an intervillous infiltrate of mononuclear cells (monocytes, lymphocytes, and histiocytes) of maternal origin, and the infiltration is frequently associated with either villous or intervillous fibrinoid deposition (Contro et al. 2010). Chronic deciduitis is characterized by abundant lymphocyte infiltration within the decidua (Khong et al. 2000).
Low Birthweight and Fetal Growth Retardation: Some Preventable Aspects
Asim Kurjak, John M. Beazley in Fetal Growth Retardation: Diagnosis and Treatment, 2020
After malnutrition, infection is likely to be the second most important cause of both fetal growth retardation and preterm delivery throughout the world.11 The infection may just involve the mother with a knock-on effect on the fetus through her illness (e.g., malnutrition, pyrexia, drugs, etc.). Alternatively the infection may involve the fetus and/or placenta as with blood-born organisms such as syphilis, rubella, and malaria. Or infection, usually bacterial, may pass up the birth canal to cause chorion-amnionitis, a condition being increasingly recognized in association with both premature labor and fetal growth retardation, especially in developing countries.12,13 It has been suggested that coitus may on occasion precipitate such infection by dislodging the cervical plug of mucus and permitting organisms to reach the amniotic mambranes. Most vaginal organisms will metabolize prostaglandin precursors in the amnion into prostaglandins. Chorion-amnionitis, rupture of the membranes, placental infection, and premature labor are among the complications which may ensue.14 A similar train of events may be precipitated by the examining finger of the obstetrician or midwife. Indeed the “membrane sweep” used to be a popular method of inducing labor. Trainee obstetricians are now usually taught not to insert a finger into the cervix before the time for delivery has arrived.
Perinatal outcomes of twin emergency cerclage: comparison with expectant treatment and singleton emergency cerclage
Published in Journal of Obstetrics and Gynaecology, 2023
Yuanfan Lu, Jing Zhu, Xiaoting Yu, Zhenyao Li, Tong Zhou, Jiajia Chen, Xianping Huang, Huiqiu Xiang, Jiale Bao, Zhangye Xu
The present retrospective cohort study included data recorded at The Second Affiliated Hospital of Wenzhou Medical University (Wenzhou, Zhejiang, China) between January 2015 and December 2021. The study protocol was reviewed and approved by the Ethics and Research Committee of The Second Affiliated Hospital of Wenzhou Medical University (approval no. 2022-K-44-01). The study included data from pregnant patients with cervical dilatation ≥1cm and bulging of the amniotic sac who did not feel uterine contractions during the second trimester. The patients were divided into three groups according to treatment: (i) Group A (twin emergency cerclage, n = 26); (ii) group B (singleton emergency cerclage, n = 77); and (iii) group C (twin expectant treatment, n = 17). Informed consent was signed by all patients for emergency cerclage or expectant treatment. The inclusion criteria were as follows: (i) No evidence to suggest a high risk of aneuploidy or foetal malformation; (ii) no obvious lower abdominal pain or heavy vaginal bleeding; (iii) no amniotic membrane rupture; (iv) no evidence of chorioamnionitis, such as fever (>38 °C), abdominal pain, uterine tenderness, malodorous vaginal discharge, maternal tachycardia (>100 times/min), foetal tachycardia (>160 times/min) and increase in white blood cell count (>15×109/l) (Can et al.2022). Patients with pregnancy complications, including cardiac disease, hepatic disease, renal insufficiency and abnormal haematopoietic system, were excluded.
Identification of preterm birth in women with threatened preterm labour between 34 and 37 weeks of gestation
Published in Journal of Obstetrics and Gynaecology, 2018
Cenk Gezer, Atalay Ekin, Ulas Solmaz, Alkim Gulsah Sahingoz Yildirim, Askin Dogan, Mehmet Ozeren
Gestational age was calculated on the basis of the last menstrual period and confirmed by ultrasonographic measurements in the first or second trimester. Exclusion criteria were women with multiple gestations, cervical dilatation >3 cm at presentation, cervical cerclage, major uterine anomaly, acute or chronic inflammatory diseases, systemic diseases, history of prior preterm birth, short cervix at mid trimester ultrasound (<25 mm), pregnancies complicated by placenta previa, oligohydramnios, polyhydramnios, stillbirth, major foetal or chromosomal anomalies and those who underwent indicated delivery before 370/7 weeks of gestation. Short cervix at midtrimester was defined as the transvaginal measurement of cervical length between 16 and 24 weeks, according to a standardised technique (To et al. 2001). Patients who had significant obstetric or medical complications mandating early delivery, such as non-reassuring foetal status, clinical chorioamnionitis, placental abruption, significant antepartum haemorrhage and intrauterine growth restriction (estimated birth weight is < 10th percentile for gestational age) were also excluded from the study. Clinical chorioamnionitis was defined as presence of maternal fever (≥ 38 °C) with two of the following signs in the absence of other potential infectious sources: maternal tachycardia (>100 beats/min), maternal leukocytosis (15000 cells/mm3), uterine tenderness, foetal tachycardia (>160 beats/min) and foul odour of amniotic fluid.
An infant of 26 weeks gestation with congenital miliary tuberculosis complicated by chronic lung disease requiring CPAP was diagnosed on Day 104 of life: congenital tuberculosis was confirmed by detection of calcified ovaries in his mother
Published in Paediatrics and International Child Health, 2022
Akina Matsuda, Naoto Nishizaki, Hanako Abe, Akira Mizutani, Takahiro Niizuma, Kaoru Obinata, Kyoko Oguma, Shintaro Makino, Makoto Ishitate, Toshiaki Shimizu
Generally, TB is diagnosed in mothers following suspicion of the disease in their infants and almost all mothers who deliver an infant with congenital TB are diagnosed after their infants [14]. In this case, pregnancy was achieved via IVF-ET [7,15,16]. Genital TB, a major cause of infertility in women from endemic countries or those of high-risk ethnic groups, is also a risk factor for congenital TB, particularly among those with increasing access to assisted reproductive technology including IVF-ET. Only a few cases of congenital TB after IVF-ET have been detected [7]. Furthermore, in this case, routine placental pathology did not identify acid-fast bacilli. Routine placental pathology is primarily aimed at assessing chorio-amnionitis. Therefore, Ziehl–Neelsen staining is needed to identify acid-fast bacilli. In this case, detailed examination of the placental pathology after the infant developed TB symptoms revealed findings indicative of congenital TB, i.e. necrotising granulomatous deciduitis and sub-chorionitis, with acid-fast bacilli detected on Ziehl–Neelsen staining.
Related Knowledge Centers
- Amnion
- Bacteria
- Chorion
- Inflammation
- Metalloproteinase
- Prostaglandin
- Infection
- Preterm Birth
- Fetal Membranes
- Pap Test