Timing of Histologic Progression from Chorio-Deciduitis to Chorio-Deciduo-Amnionitis in the Setting of Preterm Labor and Preterm Premature Rupture of Membranes with Sterile Amniotic FluidReport as inadecuate




Timing of Histologic Progression from Chorio-Deciduitis to Chorio-Deciduo-Amnionitis in the Setting of Preterm Labor and Preterm Premature Rupture of Membranes with Sterile Amniotic Fluid - Download this document for free, or read online. Document in PDF available to download.

Background

Histologic chorio-deciduitis and chorio-deciduo-amnionitis amnionitis in extra-placental membranes are known to represent the early and advanced stages of ascending intra-uterine infection. However, there are no data in humans about the time required for chorio-deciduitis to develop and for chorio-deciduitis without amnionitis to progress to chorio-deciduitis with amnionitis, and the effect of prolongation of pregnancy on the development of chorio-deciduitis and amnionitis in patients with preterm labor and intact membranes PTL and preterm premature rupture of membranes preterm-PROM. We examined these issues in this study.

Methods

The study population consisted of 289 women who delivered preterm 133 cases with PTL, and 156 cases with preterm-PROM and who had sterile amniotic fluid AF defined as a negative AF culture and the absence of inflammation as evidenced by a matrix metalloproteinase-8 MMP-8 level <23 ng-ml. We examined the association between amniocentesis-to-delivery interval and inflammatory status in the extra-placental membranes i.e., inflammation-free extra-placental membranes, choroi-deciduitis only, and chorio-deciduitis with amnionitis in patients with PTL and preterm-PROM.

Results

Amniocentesis-to-delivery interval was longer in cases of chorio-deciduitis with amnionitis than in cases of chorio-deciduitis only in both PTL median interquartile-range IQR; 645.4 319.5 vs. 113.9 526.9 hours; P = 0.005 and preterm-PROM 131.3 135.4 vs. 95.2 140.5 hours; P<0.05. Amniocentesis-to-delivery interval was an independent predictor of the development of both chorio-deciduitis and amnionitis after correction for confounding variables such as gestational age at delivery in the setting of PTL, but not preterm-PROM.

Conclusions

These data confirm for the first time that, in cases of both PTL and preterm-PROM with sterile AF, more time is required to develop chorio-deciduitis with amnionitis than chorio-deciduitis alone in extra-placental membranes. Moreover, prolongation of pregnancy is an independent predictor of the development of both chorio-deciduitis and amnionitis in cases of PTL with sterile AF.



Author: Chan-Wook Park, Joong Shin Park , Errol R. Norwitz, Kyung Chul Moon, Jong Kwan Jun, Bo Hyun Yoon

Source: http://plos.srce.hr/



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