Obstet Gynecol Sci.  2020 Mar;63(2):126-132. 10.5468/ogs.2020.63.2.126.

Subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis in women with spontaneous preterm delivery

• Kim NK
• Choi YJ
• Hong S
• Park JY
• Oh KJ
• Hong JS

• KMID: 2471749
• DOI: http://doi.org/10.5468/ogs.2020.63.2.126

Abstract

OBJECTIVE
To compare subsequent pregnancy outcomes according to the presence of acute histologic chorioamnionitis (HCA) in women with spontaneous preterm delivery (SPTD).
METHODS
Among 1,706 women who gave birth twice or more at our institution, 138 women delivered spontaneously at preterm (<37.0 weeks). Subsequent deliveries occurred at our institution and placental biopsy results were available. The study population was categorized into 2 groups based on the presence of acute HCA at the time of SPTD: HCA group (n=52) and non-HCA group (n=86). The primary outcome measures were gestational age at delivery, birthweight, and frequency of preterm delivery in subsequent pregnancies.
RESULTS
The median gestational age at the time of SPTD was 34.0 weeks (interquartile range [IQR], 28.9-35.3 weeks), and the frequency of acute HCA was 52/138 (38%). There were no differences in gestational age at delivery, birthweight, and frequency of preterm delivery between the HCA group and non-HCA group (median gestational age at delivery, 38.0 weeks (IQR, 36.7-38.8 weeks) in the HCA group vs. 37.9 weeks (IQR, 35.7-39.0 weeks) in the non-HCA group; frequency of preterm delivery, 14/52 (27%) in the HCA group vs. 33/86 (38%) in the non-HCA group; and median birthweight, 3.14 kg (IQR, 2.64-3.45 kg) in the HCA group vs. 2.95 kg (IQR, 2.44-3.36 kg) in the non-HCA group; P>0.1 for all.
CONCLUSION
The presence of acute HCA in women at prior SPTD did not significantly affect their subsequent pregnancy outcomes.

Keyword

Acute histologic chorioamnionitis; Preterm delivery; Recurrent preterm delivery; Placenta; Funisitis

MeSH Terms

Biopsy
Chorioamnionitis*
Female
Gestational Age
Humans
Outcome Assessment (Health Care)
Parturition
Placenta
Pregnancy
Pregnancy Outcome*
Pregnancy*

Figure

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  Fig. 1 Patient flow diagram.

Reference

1. Kazemier BM, Buijs PE, Mignini L, Limpens J, de Groot CJ, Mol BW, et al. Impact of obstetric history on the risk of spontaneous preterm birth in singleton and multiple pregnancies: a systematic review. BJOG. 2014; 121:1197–1208. PMID: 24899245.

2. Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol. 2015; 213:S29–52. PMID: 26428501.

3. Menon R, Taylor RN, Fortunato SJ. Chorioamnionitis--a complex pathophysiologic syndrome. Placenta. 2010; 31:113–120. PMID: 20031205.

4. Pugni L, Pietrasanta C, Acaia B, Merlo D, Ronchi A, Ossola MW, et al. Chorioamnionitis and neonatal outcome in preterm infants: a clinical overview. J Matern Fetal Neonatal Med. 2016; 29:1525–1529. PMID: 26135227.

5. Yoon BH, Romero R, Kim CJ, Jun JK, Gomez R, Choi JH, et al. Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and prediction of perinatal morbidity. Am J Obstet Gynecol. 1995; 172:960–970. PMID: 7892891.

6. Romero R, Miranda J, Chaemsaithong P, Chaiworapongsa T, Kusanovic JP, Dong Z, et al. Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes. J Matern Fetal Neonatal Med. 2015; 28:1394–1409. PMID: 25190175.

7. Shim SS, Romero R, Hong JS, Park CW, Jun JK, Kim BI, et al. Clinical significance of intra-amniotic inflammation in patients with preterm premature rupture of membranes. Am J Obstet Gynecol. 2004; 191:1339–1345. PMID: 15507963.

8. Romero R, Miranda J, Chaiworapongsa T, Korzeniewski SJ, Chaemsaithong P, Gotsch F, et al. Prevalence and clinical significance of sterile intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Reprod Immunol. 2014; 72:458–474. PMID: 25078709.

9. Yoon BH, Romero R, Moon JB, Shim SS, Kim M, Kim G, et al. Clinical significance of intra-amniotic inflammation in patients with preterm labor and intact membranes. Am J Obstet Gynecol. 2001; 185:1130–1136. PMID: 11717646.

10. Lee SM, Park JW, Kim BJ, Park CW, Park JS, Jun JK, et al. Acute histologic chorioamnionitis is a risk factor for adverse neonatal outcome in late preterm birth after preterm premature rupture of membranes. PLoS One. 2013; 8:e79941. PMID: 24324586.

11. Oh KJ, Romero R, Park JY, Hong JS, Yoon BH. The earlier the gestational age, the greater the intensity of the intra-amniotic inflammatory response in women with preterm premature rupture of membranes and amniotic fluid infection by Ureaplasma species. J Perinat Med. 2019; 47:516–527. PMID: 31141489.

12. Ghidini A, Salafia CM. Histologic placental lesions in women with recurrent preterm delivery. Acta Obstet Gynecol Scand. 2005; 84:547–550. PMID: 15901265.

13. Himes KP, Simhan HN. Risk of recurrent preterm birth and placental pathology. Obstet Gynecol. 2008; 112:121–126. PMID: 18591317.

14. Park CW, Yoon BH, Kim SM, Park JS, Jun JK. The frequency and clinical significance of intra-amniotic inflammation defined as an elevated amniotic fluid matrix metalloproteinase-8 in patients with preterm labor and low amniotic fluid white blood cell counts. Obstet Gynecol Sci. 2013; 56:167–175. PMID: 24327997.

15. Park CW, Yoon BH, Kim SM, Park JS, Jun JK. Which is more important for the intensity of intra-amniotic inflammation between total grade or involved anatomical region in preterm gestations with acute histologic chorioamnionitis? Obstet Gynecol Sci. 2013; 56:227–233. PMID: 24328007.

16. Ananth CV, Getahun D, Peltier MR, Salihu HM, Vintzileos AM. Recurrence of spontaneous versus medically indicated preterm birth. Am J Obstet Gynecol. 2006; 195:643–650. PMID: 16949395.

17. Meis PJ, Klebanoff M, Thom E, Dombrowski MP, Sibai B, Moawad AH, et al. Prevention of recurrent preterm delivery by 17 alpha-hydroxyprogesterone caproate. N Engl J Med. 2003; 348:2379–2385. PMID: 12802023.

18. Committee on Practice Bulletins—Obstetrics, The American College of Obstetricians and Gynecologists. Practice bulletin no. 130: prediction and prevention of preterm birth. Obstet Gynecol. 2012; 120:964–973. PMID: 22996126.

19. Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996; 334:567–572. PMID: 8569824.

20. Grobman WA, Lai Y, Iams JD, Reddy UM, Mercer BM, Saade G, et al. Prediction of spontaneous preterm birth among nulliparous women with a short cervix. J Ultrasound Med. 2016; 35:1293–1297. PMID: 27151903.

21. Goldenberg RL, Iams JD, Das A, Mercer BM, Meis PJ, Moawad AH, et al. The preterm prediction study: sequential cervical length and fetal fibronectin testing for the prediction of spontaneous preterm birth. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Am J Obstet Gynecol. 2000; 182:636–643. PMID: 10739521.