Bacterial intrauterine infection and acute inflammatory changes of the placenta, fetal membranes and umbilical cord
Journal
Acta Morphologica
Date Issued
2019
Author(s)
Lazarova-Stojoska, Aleksandra
Abstract
Introduction: Preterm delivery is a clinical syndrome with multifactorial etiology and it is
considered to be one of the most challenging issues of contemporary perinatology. Intrauterine
infections play one of the leading roles in the development of this clinical entity, but the
prevalence of microbial invasion and the type of microorganisms associated with this condition
are still a subject of debate.
Material and methods: We conducted a cross-sectional study at the University clinic for
obstetrics and gynecology in Skopje. One hundred and fifty (150) patient with clinical signs of
preterm delivery between 24+0-37+0 g.w. were included. For microbiological analysis, samples
were taken using standard cotton swab, from the maternal side of the placenta at the border
between the placental disk and fetal membranes. For histopathologic analysis, placentas were
collected in transport container and sent to Institute of pathology. Samples for histopathologic
analysis were provided from the following zones: border amnion-chorion, chorionic plate,
umbilical cord and fetal membranes. The results were considered statistically significant if
p<.05.
Results: Microbiological analysis of provided samples showed a presence of bacteria in
61/150 (40.7%) of the patients. Results from the analysis of the inflammatory changes of the
placenta, fetal membranes and umbilical cord showed a higher frequency of maternal and fetal
inflammatory response of any stage or grade in patients with positive microbiological findings.
No statistically significant difference was found for the maternal inflammatory response of any
stage or grade (p=.09), but the difference in the distribution of the fetal inflammatory response
of any stage or grade was found to be statistically significant (p=.006). Intensity of the fetal
inflammatory response was higher in patients with positive cultures, and there was a
statistically significant association between the positive microbiological findings and the stages
and grades of fetal inflammatory response.
Conclusion: Positive microbiological findings increase the risk for histopathologically
proven acute chorioamnionitis in patients with preterm delivery. In this category of patients
there is a significantly higher frequency of acute inflammatory changes of the umbilical cord,
with higher frequency of the higher stages and grades of fetal inflammatory response and
statistically significant association between the positive culture and the intensity of the fetal
inflammatory response.
considered to be one of the most challenging issues of contemporary perinatology. Intrauterine
infections play one of the leading roles in the development of this clinical entity, but the
prevalence of microbial invasion and the type of microorganisms associated with this condition
are still a subject of debate.
Material and methods: We conducted a cross-sectional study at the University clinic for
obstetrics and gynecology in Skopje. One hundred and fifty (150) patient with clinical signs of
preterm delivery between 24+0-37+0 g.w. were included. For microbiological analysis, samples
were taken using standard cotton swab, from the maternal side of the placenta at the border
between the placental disk and fetal membranes. For histopathologic analysis, placentas were
collected in transport container and sent to Institute of pathology. Samples for histopathologic
analysis were provided from the following zones: border amnion-chorion, chorionic plate,
umbilical cord and fetal membranes. The results were considered statistically significant if
p<.05.
Results: Microbiological analysis of provided samples showed a presence of bacteria in
61/150 (40.7%) of the patients. Results from the analysis of the inflammatory changes of the
placenta, fetal membranes and umbilical cord showed a higher frequency of maternal and fetal
inflammatory response of any stage or grade in patients with positive microbiological findings.
No statistically significant difference was found for the maternal inflammatory response of any
stage or grade (p=.09), but the difference in the distribution of the fetal inflammatory response
of any stage or grade was found to be statistically significant (p=.006). Intensity of the fetal
inflammatory response was higher in patients with positive cultures, and there was a
statistically significant association between the positive microbiological findings and the stages
and grades of fetal inflammatory response.
Conclusion: Positive microbiological findings increase the risk for histopathologically
proven acute chorioamnionitis in patients with preterm delivery. In this category of patients
there is a significantly higher frequency of acute inflammatory changes of the umbilical cord,
with higher frequency of the higher stages and grades of fetal inflammatory response and
statistically significant association between the positive culture and the intensity of the fetal
inflammatory response.
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