Histologic Funisitis and Likelihood of Intrauterine Inflammation or Infection: A Case-Control Study

Morgen S. Doty; Carolyn Salafia; Susan Shen-Schwarz; Edwin Guzman; George R. Saade; Suneet P. Chauhan

doi:10.1055/s-0037-1620232

American Journal of Perinatology, Table of Contents

Am J Perinatol 2018; 35(09): 858-864
DOI: 10.1055/s-0037-1620232

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Histologic Funisitis and Likelihood of Intrauterine Inflammation or Infection: A Case-Control Study

Authors

Morgen S. Doty

¹Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas
Carolyn Salafia

²Department of Research and Development, Placental Analytics, Larchmont, New York
Susan Shen-Schwarz

³Department of Pathology, Saint Peter's University Hospital, New Brunswick, New Jersey
Edwin Guzman

⁴Department of Obstetrics and Gynecology, Saint Peter's University Hospital, New Brunswick, New Jersey
George R. Saade

⁵Division of Maternal-Fetal Medicine, University of Texas Medical Branch, Galveston, Texas
Suneet P. Chauhan

⁶Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas

Abstract

Objective The objective of this study was to ascertain the likelihood of isolated maternal fever and suspected intrauterine inflammation or infection or both (Triple I) among cases of histologic chorioamnionitis with funisitis (HCF) at term.

Study Design In this case-control study, placental pathology records were reviewed to identify term singleton laboring patients with HCF. Controls (1:1) were matched for gestational age.

Results During the 6-month period, there were 2,399 term deliveries of laboring women. Of 1,552 (65%) term placentas examined, 4% (n = 60) had HCF.

Features of Triple I were significantly more common among cases than controls: (1) isolated maternal fever of ≥100.4°F, twice, at least 30 minutes apart (p = 0.014); (2) fever with fetal tachycardia (p = 0.029); 3) fever with either fetal tachycardia or white blood cell count greater than 15,000 per mm³ (p = 0.034). The feature of Triple I with the highest sensitivity at 10% (95% confidence intervals [CI] 4–21%) was isolated maternal fever using ≥100.4°F on two occasions. The specificity for all features was consistently 100% (95% CI 91–100%).

Conclusion To our knowledge, this is the first report on HCF and Triple I features. Though the sensitivity of Triple I to identify HCF is low, specificity is excellent.

Keywords

triple I - intrauterine inflammation or infection - histologic chorioamnionitis with funisitis

Full Text

References

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