Chorioamnionitis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Adnan Ezici, M.D[2]
Overview
Chorioamnionitis is an inflammatory condition of fetal membranes which is usually caused by infectious etiology. The opaque appearance of fetal membranes is a characteristic gross pathologic finding of chorioamnionitis. neutrophilic infiltration of the amniotic cavity and/or chorionic plate is the characteristic microscopic finding of chorioamnionitis.
Pathophysiology
Pathogenesis
Chorioamnionitis is an inflammatory condition of fetal membranes which is usually caused by infectious etiology. The pathogenesis can be further divided into 4 categories based on the anatomical route of the introduction of the microorganism:[1]
- Ascending infection might originate from the maternal genital tract (the most common route).
- Vaginal and enteric flora are usually transmitted via the ascending route to the fetal membranes.
- Iatrogenic infection might be caused by invasive procedures (e.g., amniocentesis).
- Maternal infections such as listeria monocytogenes, might infect fetal membranes through the placenta by the hematogenous route.
- In mothers with hepatic or renal diseases, the infection of fetal membranes might be originated by peritoneal infections via the route of fallopian tubes.
Genetics
Genes involved in the pathogenesis of chorioamnionitis include:[2][3]
- Placental IL-6 (minor C allele at the IL6 SNP)
- IL10
- MBL2
- TNFRSF6
- TGFB1
Gross Pathology
On gross pathology, the opaque appearance of fetal membranes is a characteristic finding of chorioamnionitis.[4]
- The presence of opaque fetal membranes might indicate an increased risk of complications of chorioamnionitis in newborns.
Microscopic Pathology
On microscopic histopathological analysis, neutrophilic infiltration of the amniotic cavity and/or neutrophilic infiltration of the chorionic plate are characteristic findings of chorioamnionitis.[5]
- Decidua of the placenta is originated from the mother which might include the neutrophils of mother.
- Chorioamnionic membranes are originated from the fetus which do not include neutrophils in physiologic settings. However, in case of chorioamnionitis, maternal neutrophils migrate into these membranes in the presence of chemotaxis.
References
- ↑ Ericson JE, Laughon MM (March 2015). "Chorioamnionitis: implications for the neonate". Clin Perinatol. 42 (1): 155–65, ix. doi:10.1016/j.clp.2014.10.011. PMC 4331454. PMID 25678002.
- ↑ Konwar C, Del Gobbo GF, Terry J, Robinson WP (February 2019). "Association of a placental Interleukin-6 genetic variant (rs1800796) with DNA methylation, gene expression and risk of acute chorioamnionitis". BMC Med Genet. 20 (1): 36. doi:10.1186/s12881-019-0768-0. PMC 6387541. PMID 30795743.
- ↑ Annells MF, Hart PH, Mullighan CG, Heatley SL, Robinson JS, McDonald HM (February 2005). "Polymorphisms in immunoregulatory genes and the risk of histologic chorioamnionitis in Caucasoid women: a case control study". BMC Pregnancy Childbirth. 5 (1): 4. doi:10.1186/1471-2393-5-4. PMC 554771. PMID 15723707.
- ↑ Horikoshi Y, Yaguchi C, Furuta-Isomura N, Itoh T, Kawai K, Oda T, Matsumoto M, Kohmura-Kobayashi Y, Tamura N, Uchida T, Kanayama N, Itoh H (2020). "Gross appearance of the fetal membrane on the placental surface is associated with histological chorioamnionitis and neonatal respiratory disorders". PLoS One. 15 (11): e0242579. doi:10.1371/journal.pone.0242579. PMC 7704006 Check
|pmc=value (help). PMID 33253176 Check|pmid=value (help). - ↑ Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM (October 2015). "Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance". Am J Obstet Gynecol. 213 (4 Suppl): S29–52. doi:10.1016/j.ajog.2015.08.040. PMC 4774647. PMID 26428501.