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37 Chorioamnionitis W.J. Ledger The high perinatal mortality figures in women with chorioamnionitis have led to Obstetrical judgments in the United States, which may not be justified. Because of the concern about these survival figures, many Obstetrical Services set short time limits when chorioamnionitis occurs and have the infant delivered by cesarean section i£ necessary. Based upon animal studies, there is an additional concern about the stress in utero to the fetus of the febrile mother. Because of our interest in intra-partum monitoring at the University of

J. Perinat. Med. 39 (2011) 731–736 • Copyright by Walter de Gruyter • Berlin • Boston. DOI 10.1515/JPM.2011.078 2011/0007 Article in press - uncorrected proof NICU admission hypothermia, chorioamnionitis, and cytokines Karen D. Fairchild1,*, Chen-Chih J. Sun2, George C. Gross3, Adora C. Okogbule-Wonodi4, Rose M. Chasm4 and Rose M. Viscardi4 1 Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA 2 Department of Pathology, University of Maryland School of Medicine, Baltimore, MD, USA 3 Department of Radiology, University of

References 1 De Felice C, P Toti, R Santopietro, M Stumpo, L Pecciarini, F Bagnoli: Small thymus in very low birth weight infants born to mothers with subclinical chorioamnionitis. J Pediatr 135 ( 1999 ) 384 2 De Felice C, P Toti, RN Laurini, M Stumpo, E Picciolini, T Todros, P Tanganelli, G Buonocore, R Bracci: Early neonatal brain injury in histologic chorioamnionitis. J Pediatr 138 ( 2001 ) 101 3 De Felice C, P Vacca, A Del Vecchio, M Criscuolo, A Lozupone, G Latini: Early postnatal skin color changes in term newborns with subclinical histological

Introduction Clinical chorioamnionitis is defined by the presence of maternal fever and at least two or more of the following clinical criteria: maternal or fetal tachycardia; maternal leukocytosis; uterine tenderness; or foul-smelling amniotic fluid (AF) [1–12]. The standard clinical treatment of this condition is the administration of antibiotics because the diagnosis is considered to represent evidence of intra-amniotic bacterial infection [8, 13–19]. This intervention is expected to reduce the rate of complications in both mother and neonate [8, 13–16]. A

Introduction Clinical chorioamnionitis is characterized by maternal fever accompanied by at least two of the following signs: maternal or fetal tachycardia, maternal leukocytosis, uterine tenderness, or foul-smelling amniotic fluid [1–13]. This pregnancy complication is associated with adverse maternal [14–19], fetal, and neonatal/infant outcomes [20–40]. Most of the signs of clinical chorioamnionitis (except for fetal tachycardia and foul-smelling amniotic fluid) are thought to reflect a maternal inflammatory response to microbial invasion of the amniotic cavity

Introduction Current obstetric interventions to reduce early-onset newborn infections, including intrapartum antibiotic prophylaxis for mothers colonized with group B Streptococcus (GBS) and treatment of clinically diagnosed chorioamnionitis, are effective [ 1 ], [ 2 ]. However, accurate identification of newborns who will develop early-onset sepsis despite these interventions remains a major challenge. For this reason, the American Academy of Pediatrics and the Centers for Disease Control recommend treating asymptomatic infants born to mothers with clinically

Introduction Chorioamnionitis or infection of the fetal membranes is defined as an inflammation or infection in the placenta, amnion and/or chorion [ 1 ]. About 1–4% of the deliveries in the United States are complicated by chorioamnionitis. Chorioamnionitis is found as a complication in 40–70% of preterm deliveries with preterm premature rupture of membranes and is found in 1–13% of term deliveries [ 2 ], [ 3 ]. The risk factors of chorioamnionitis are young age, a longer duration of preterm rupture of membranes, nulliparity, low socioeconomic status, multiple

Introduction Clinical chorioamnionitis is a heterogeneous syndrome [1] characterized by maternal fever accompanied by at least two of the following signs: maternal or fetal tachycardia, maternal leukocytosis, uterine tenderness, or foul-smelling amniotic fluid [2–14]. This syndrome is associated with proven intra-amniotic infection in almost 60% of cases, and is a major risk factor for neonatal sepsis [12, 15–23]. The rapid and accurate diagnosis of maternal intra-amniotic infection is important to guide the management of neonates exposed to intrapartum fever [24

Introduction Mycoplasmas represent the smallest self-replicating organisms, capable of a cell-free existence [ 1 ]. Among them, Ureaplasma urealyticum and Mycoplasma hominis are often found in vulvovaginal flora, therefore they are also known as genital mycoplasmas [ 2 ]. Polymerase chain reaction (PCR) based methods allowed to distinguish the formerly known species U. urealyticum into two new species, namely, Ureaplasma parvum (previously U. urealyticum biovar 1) and U. urealyticum (previously U. urealyticum biovar 2) [ 3 ]. Acute chorioamnionitis

-hemolytic streptococcus cause different pulmonary and systemic responses in conscious neonatal lambs. Pediatr Res 33 ( 1993 ) 373 5 Dammann O, KC Kuban, A Leviton: Perinatal infection, fetal inflammatory response, white matter damage, and cognitive limitations in children born preterm. Ment Retard Dev Disabil Res Rev 8 ( 2002 ) 46 6 De Felice C, P Toti, RN Laurini, M Stumpo, E Picciolini, T Todros, P Tanganelli, G Buonocore, R Bracci: Early brain injury in histologic chorioamnionitis. J Pediatr 138 ( 2001 ) 101 7 Garland SM, F Ni Chuileannain, C Satzke, R Robins