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The relationship between acute inflammatory lesions of the preterm placenta and amniotic fluid microbiology

  • Author Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
    Roberto Romero
    Correspondence
    Reprint requests: Roberto Romero, MD, Department of Obstetrics and Gynecology, Wayne State University, 4707 St. Antoine Blvd., Detroit, MI 48201.
    Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
    Carolyn M. Salafia
    Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
    Apostolos P. Athanassiadis
    Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
    Shuichi Hanaoka
    Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
    Moshe Mazor
    Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
    Waldo Sepulveda
    Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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  • Author Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
    Michael B. Bracken
    Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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  • Author Footnotes
    1 From the Departments of Obstetrics and Gynecology and Epidemiology and Public Health, Yale University School of Medicine, the Department of Obstetrics and Gynecology, Wayne State University, and the Department of Laboratory Medicine, Danbury Hospital.
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      Objective: Our objective was to determine the relationship between microbial invasion of the amniotic cavity and the presence and severity of acute inflammatory lesions in the placenta. Study Design: Placental histologic and amniotic fluid microbiologic studies were performed in 92 consecutive patients who were admitted with preterm labor and intact membranes and delivered within 48 hours after amniocentesis.
      Results: The prevalence of a positive amniotic fluid culture was 38% (35 of 92). There was a strong association between the presence and severity of inflammation in the amnion, chorion-decidua, umbilical cord, and chorionic plate and the results of the amniotic fluid culture (p < 0.0001 for each tissue section). Three patterns of inflammation of the chorion-decidua were identified: marginating, nonmarginating, and a mixed pattern. The marginating and the mixed patterns of inflammation were strongly associated with the presence of a positive amniotic fluid culture. Acute inflammation of the chorionic plate was the most sensitive indicator of a microbial invasion of the amniotic cavity (sensitivity 96.6%), and funisitis and umbilical vasculitis had the highest specificity (85.7%).
      Conclusion: The presence of acute inflammatory lesions of the chorioamniotic membranes can serve as a marker of microbial invasion of the amniotic cavity.

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