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Pediatrics Jun 2017Chorioamnionitis (CA) has often been linked etiologically to cerebral palsy (CP). (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Chorioamnionitis (CA) has often been linked etiologically to cerebral palsy (CP).
OBJECTIVES
To differentiate association from risk of CA in the development of CP.
DATA SOURCES
PubMed, Cochrane Library, Embase, and bibliographies of original studies were searched by using the keywords (chorioamnionitis) AND ((cerebral palsy) OR brain).
STUDY SELECTION
Included studies had to have: (1) controls, (2) criteria for diagnoses, and (3) neurologic follow-up. Studies were categorized based on: (1) finding incidence of CP in a CA population, or risk of CP; and (2) incidence of CA in CP or association with CP.
DATA EXTRACTION
Two reviewers independently verified study inclusion and extracted data.
RESULTS
Seventeen studies (125 256 CA patients and 5 994 722 controls) reported CP in CA. There was significantly increased CP inpreterm histologic chorioamnionitis (HCA; risk ratio [RR] = 1.34, < .01), but not in clinical CA (CCA). Twenty-two studies (2513 CP patients and 8135 controls) reported CA in CP. There was increased CCA (RR = 1.43, < .01), but no increase in HCA in preterm CP. Increased HCA was found (RR = 4.26, < .05), as well as CCA in term/near-term CP (RR = 3.06, < .01).
CONCLUSIONS
The evidence for a causal or associative role of CA in CP is weak. Preterm HCA may be a risk factor for CP, whereas CCA is not. An association with term and preterm CP was found for CCA, but only with term CP for HCA.
Topics: Cerebral Palsy; Chorioamnionitis; Female; Humans; Pregnancy; Premature Birth; Risk Factors
PubMed: 28814548
DOI: 10.1542/peds.2016-3781 -
Pediatric Research Jan 2020Histologic chorioamnionitis is an inflammatory disorder of the placenta that commonly precedes preterm delivery. Preterm birth related to chorioamnionitis and fetal... (Review)
Review
Histologic chorioamnionitis is an inflammatory disorder of the placenta that commonly precedes preterm delivery. Preterm birth related to chorioamnionitis and fetal inflammation has been associated with a risk for serious inflammatory complications in infancy. In addition, preterm infants exposed to chorioamnionitis may be more susceptible to infection in the neonatal intensive care unit and possibly later in life. A significant body of work has established an association between chorioamnionitis and inflammatory processes. However, the potential consequences of this inflammation on postnatal immunity are less understood. In this review, we will discuss current knowledge regarding the effects of fetal exposure to inflammation on postnatal immune responses.
Topics: Adaptive Immunity; Age Factors; Animals; Chorioamnionitis; Female; Humans; Immune System; Immunity, Innate; Infant, Newborn; Infant, Premature; Inflammation Mediators; Pregnancy; Premature Birth; Risk Assessment; Risk Factors
PubMed: 31537013
DOI: 10.1038/s41390-019-0582-6 -
The Journal of Maternal-fetal &... Mar 2021The criteria for the diagnosis of intra-amniotic infection (IAI) were derived from a study of women at term in labor but is currently used as the main diagnostic tool... (Review)
Review
The criteria for the diagnosis of intra-amniotic infection (IAI) were derived from a study of women at term in labor but is currently used as the main diagnostic tool for clinical chorioamnionitis. Regarding the inconsistent usage of the term, the diagnostic utility of clinical chorioamnionitis needs to be revisited. In this review, we addressed the critical issues on why the diagnostic criteria of suspected clinical chorioamnionitis should be changed. Overall, the accuracy of clinical chorioamnionitis to detect intra-amniotic infection (IAI) is not high, around 50%. The accuracy of each diagnostic criteria to diagnose IAI is, for example, 51.1% with maternal tachycardia, 57.8% with fetal tachycardia, and 55.6% with maternal leukocytosis. However, it needs to be reminded that these diagnostic performances had been obtained from term pregnancies but not from preterm pregnancies. Since there is a difference between clinical chorioamnionitis and histologic chorioamnionitis or even IAI, the diagnostic criteria of clinical chorioamnionitis would be ideal if it could directly predict the development of neonatal infectious outcomes. In fact, multiple definitions of clinical chorioamnionitis either in more lenient or stringent manner are currently used, which is responsible for inconsistent association of clinical chorioamnionitis with long-term neonatal outcomes. Whereas the diagnosis of clinical chorioamnionitis in preterm is followed by expeditious delivery, the diagnosis of clinical chorioamnionitis at term pregnancy is usually conducted in laboring women and requires additional neonatal evaluation for sepsis, which suggests different implications of clinical chorioamnionitis in preterm and term pregnancy. Current diagnostic criteria of clinical chorioamnionitis should be revised, specifically in terms of sensitivity in preterm pregnancy and specificity in term pregnancy.
Topics: Amniotic Fluid; Chorioamnionitis; Female; Humans; Infant, Newborn; Labor, Obstetric; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third
PubMed: 31084245
DOI: 10.1080/14767058.2019.1618822 -
Romanian Journal of Morphology and... 2017Amniotic membrane (AM) transplantation has been used successfully worldwide in ophthalmology plastic surgery for over 100 years. This review presents the histological... (Review)
Review
Amniotic membrane (AM) transplantation has been used successfully worldwide in ophthalmology plastic surgery for over 100 years. This review presents the histological and the immunohistochemical features of AM compared to those of the conjunctiva and discusses the techniques of processing and preservation, its mechanism of action in ocular reconstruction, its clinical ophthalmic indications, but also advantages and limitations of grafting with this biomaterial.
Topics: Amnion; Eye; Humans; Immunohistochemistry; Plastic Surgery Procedures
PubMed: 28730219
DOI: No ID Found -
Obstetrics and Gynecology Mar 2024To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions.
OBJECTIVE
To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions.
METHODS
This was a case-control study using electronic health record data, including vital signs and laboratory results, for all delivery admissions of patients with sepsis from 59 nationally distributed hospitals. Patients with sepsis were matched by gestational age at delivery in a 1:4 ratio with patients without sepsis to create a comparison group. Patients with chorioamnionitis and sepsis were compared with a complete cohort of patients with chorioamnionitis without sepsis. Multiple screening criteria for sepsis were evaluated: the CMQCC (California Maternal Quality Care Collaborative), SIRS (Systemic Inflammatory Response Syndrome), the MEWC (the Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System), and the MEWT (Maternal Early Warning Trigger Tool). Sensitivity, false-positive rates, and C-statistics were reported for each screening tool. Analyses were stratified into cohort 1, which excluded patients with chorioamnionitis-endometritis, and cohort 2, which included those patients.
RESULTS
Delivery admissions at 59 hospitals were extracted for patients with sepsis. Cohort 1 comprised 647 patients with sepsis, including 228 with end-organ injury, matched with a control group of 2,588 patients without sepsis. Cohort 2 comprised 14,591 patients with chorioamnionitis-endometritis, of whom 1,049 had sepsis and 238 had end-organ injury. In cohort 1, the CMQCC and the UKOSS pregnancy-adjusted criteria had the lowest false-positive rates (6.9% and 9.6%, respectively) and the highest C-statistics (0.92 and 0.91, respectively). Although other screening criteria, such as SIRS and the MEWC, had similar sensitivities, it was at the cost of much higher false-positive rates (21.3% and 38.3%, respectively). In cohort 2, including all patients with chorioamnionitis-endometritis, the highest C-statistics were again for the CMQCC (0.67) and UKOSS (0.64). All screening tools had high false-positive rates, but the false-positive rates for the CMQCC and UKOSS were substantially lower than those for SIRS and the MEWC.
CONCLUSION
During delivery admissions, the CMQCC and UKOSS pregnancy-adjusted screening criteria have the lowest false-positive results while maintaining greater than 90% sensitivity rates. Performance of all screening tools was degraded in the setting of chorioamnionitis-endometritis.
Topics: Pregnancy; Female; Humans; Chorioamnionitis; Case-Control Studies; Retrospective Studies; Endometritis; Sepsis; Systemic Inflammatory Response Syndrome
PubMed: 38086055
DOI: 10.1097/AOG.0000000000005477 -
Frontiers in Immunology 2020Chorioamnionitis, a potentially serious inflammatory complication of pregnancy, is associated with the development of an inflammatory milieu within the amniotic fluid... (Review)
Review
Chorioamnionitis, a potentially serious inflammatory complication of pregnancy, is associated with the development of an inflammatory milieu within the amniotic fluid surrounding the developing fetus. When chorioamnionitis occurs, the fetal lung finds itself in the unique position of being constantly exposed to the consequent inflammatory meditators and/or microbial products found in the amniotic fluid. This exposure results in significant changes to the fetal lung, such as increased leukocyte infiltration, altered cytokine, and surfactant production, and diminished alveolarization. These alterations can have potentially lasting impacts on lung development and function. However, studies to date have only begun to elucidate the association between such inflammatory exposures and lifelong consequences such as lung dysfunction. In this review, we discuss the pathogenesis of and fetal immune response to chorioamnionitis, detail the consequences of chorioamnionitis exposure on the developing fetal lung, highlighting the various animal models that have contributed to our current understanding and discuss the importance of fetal exposures in regard to the development of chronic respiratory disease. Finally, we focus on the clinical, basic, and therapeutic challenges in fetal inflammatory injury to the lung, and propose next steps and future directions to improve our therapeutic understanding of this important perinatal stress.
Topics: Animals; Chorioamnionitis; Female; Fetus; Humans; Lung; Pregnancy; Prenatal Exposure Delayed Effects
PubMed: 32636848
DOI: 10.3389/fimmu.2020.01285 -
Expert Opinion on Biological Therapy Jan 2019: In reconstructive urology, autologous tissues such as intestinal segments, skin, and oral mucosa are used. Due to their limitations, reconstructive urologists are... (Review)
Review
: In reconstructive urology, autologous tissues such as intestinal segments, skin, and oral mucosa are used. Due to their limitations, reconstructive urologists are waiting for a novel material, which would be suitable for urinary tract wall replacement. Human amniotic membrane (AM) is a naturally derived biomaterial with a capacity to support reepithelization and inhibit scar formation. AM has a potential to become a considerable asset for reconstructive urology, i.e., reconstruction of ureters, urinary bladder, and urethrae. : This review aims to discuss the potential application of human AM in reconstructive urology. The environment for urinary tract healing is particularly unfavorable due to the presence of urine. Due to its fetal origin, the bioactivity of AM is orientated to induce intrinsic regeneration mechanisms and inhibit scarring. This review introduces the concept of applying human AM in reconstructive urology procedures to improve their outcomes and future tissue engineering based strategies. : Many fields of medicine that have accomplished translational research have proven the usefulness of AM in clinical practice. There is an urgent need for studies to be conducted on large animal models that might convincingly demonstrate the underestimated potential of AM to urologists around the world.
Topics: Amnion; Animals; Biocompatible Materials; Extracellular Matrix; Humans; Regeneration; Regenerative Medicine; Tissue Embedding; Urinary Tract; Urothelium
PubMed: 30521409
DOI: 10.1080/14712598.2019.1556255 -
The Journal of Clinical Endocrinology... Apr 2017Biochemical weakening of the amnion is a major factor preceding preterm premature rupture of membranes (PPROMs), leading to preterm birth. Activation of matrix...
CONTEXT
Biochemical weakening of the amnion is a major factor preceding preterm premature rupture of membranes (PPROMs), leading to preterm birth. Activation of matrix metalloproteinases (MMPs) is known to play a key role in collagen degradation of the amnion; however, epithelial to mesenchymal transition (EMT) that is also induced by MMP activation has not been investigated as a mechanism for amnion weakening.
OBJECTIVE
To measure amniotic EMT associated with vaginal delivery (VD) compared with unlabored cesarean sections (CSs), and to assess changes in amniotic mechanical strength with pharmacologic inhibitors and inducers of EMT, thus testing the hypothesis that EMT is a key biochemical event that promotes amniotic rupture.
FINDINGS
(1) Amnions taken from VD contained a significantly increased number of mesenchymal cells relative to epithelial cells compared with unlabored CS by fluorescence-activated cell sorting analysis (60% vs 10%); (2) tumor necrosis factor (TNF)-α stimulation of amniotic epithelial cells increased expression of the mesenchymal marker vimentin after 2 days; (3) EMT inhibitor, etodolac, significantly increased the time and mechanical pressure required to rupture the amnion; and (4) TNF-α and another pharmacologic EMT inducer, ethacridine, decreased the time and mechanical pressure required for amnion rupture, further confirming that the mesenchymal phenotype significantly weakens the amnion.
CONCLUSIONS
This work demonstrated amniotic cell EMT was associated with labor and EMT decreased the tensile strength of the amnion. These findings suggest a role for EMT in the pathophysiology of PPROM and may provide a basis for development of therapies to prevent preterm labor.
Topics: Amnion; Cyclooxygenase 2 Inhibitors; Epithelial-Mesenchymal Transition; Etodolac; Female; Fetal Membranes, Premature Rupture; Humans; Matrix Metalloproteinases; Pregnancy; Tensile Strength; Tumor Necrosis Factor-alpha
PubMed: 28388726
DOI: 10.1210/jc.2016-3150 -
Annals of Diagnostic Pathology Feb 2022The histologic diagnosis of acute ascending intrauterine infection permits a higher-efficacy identification of both subclinical infection and clinical chorioamnionitis,...
The histologic diagnosis of acute ascending intrauterine infection permits a higher-efficacy identification of both subclinical infection and clinical chorioamnionitis, but procedures for placental pathology need to adopt a unified approach and work toward reproducible grading and staging systems. We conducted a retrospective chart review of 696 placental records from single and multiple deliveries between January 2011 and February 2020. Then, we compared original diagnoses with diagnoses based on Redline criteria, which is an internationally recognized system of staging and grading. Of the 696 cases available for review, 255 had complete medical records. Findings showed a strong degree of agreement (90%-100%) between original investigators' histological diagnoses of acute ascending intrauterine infection and a review by researchers using Redline criteria. Although interobserver agreement was good, more education is needed on Redline criteria to avoid missed cases (primarily Stage 1), support protocols for pathologists and obstetricians/gynecologists in determining which cases need to be investigated, and the development of reporting standards for acute ascending intrauterine infection and feedback mechanisms during follow-up.
Topics: Chorioamnionitis; Female; Humans; Observer Variation; Pathologists; Pregnancy; Retrospective Studies
PubMed: 34894434
DOI: 10.1016/j.anndiagpath.2021.151874 -
MCN. the American Journal of Maternal... 2018
Topics: Adult; Chorioamnionitis; Female; Humans; Postnatal Care; Pregnancy
PubMed: 29215424
DOI: 10.1097/NMC.0000000000000396