The frequency, clinical significance, and pathological features of chronic chorioamnionitis: A lesion associated with spontaneous preterm birth

Chong Jai Kim, Roberto Romero, Juan Pedro Kusanovic, Wonsuk Yoo, Zhong Dong, Vanessa Topping, Francesca Gotsch, Bo Hyun Yoon, Je Geun Chi, Jung Sun Kim

Research output: Contribution to journalArticle

114 Citations (Scopus)

Abstract

Acute chorioamnionitis is a well-established lesion of the placenta in cases with intra-amniotic infection. In contrast, the clinicopathological significance of chronic chorioamnionitis is unclear. This study was conducted to determine the frequency and severity of chronic chorioamnionitis in normal pregnancy and in various pregnancy complications. Placentas from the following patient groups were studied: (1) term not in labor (n=100), (2) term in labor (n=100), (3) preterm labor (n=100), (4) preterm prelabor rupture of membranes (n=100), (5) preeclampsia at term (n=100), (6) preterm preeclampsia (n=100), and (7) small-for-gestational-age at term (n=100). Amniotic fluid CXCL10 concentration was measured in 64 patients. CXCL9, CXCL10, and CXCL11 mRNA expressions in the chorioamniotic membranes were assessed using real-time quantitative reverse transcription-PCR. The frequency of chronic chorioamnionitis in the preterm labor group and the preterm prelabor rupture of membranes group was 34 and 39%, respectively, which was higher than that of normal-term placentas (term not in labor, 19%; term in labor, 8%; Pη0.05 each). The frequency of chronic chorioamnionitis in the preeclampsia at term group, preterm preeclampsia group, and small-for-gestational-age group was 23, 16, and 13%, respectively. Concomitant villitis of unknown etiology was found in 38 and 36% of preterm labor cases and preterm prelabor rupture of membranes cases with chronic chorioamnionitis, respectively. Interestingly, the median gestational age of preterm chronic chorioamnionitis cases was higher than that of acute chorioamnionitis cases (P≤0.05). The median amniotic fluid CXCL10 concentration was higher in cases with chronic chorioamnionitis than in those without, in both the preterm labor group and preterm prelabor rupture of membranes group (P≤0.05 and P≤0.01, respectively). CXCL9, CXCL10, and CXCL11 mRNA expression in the chorioamniotic membranes was also higher in cases with chronic chorioamnionitis than in those without chronic chorioamnionitis (P≤0.05). We propose that chronic chorioamnionitis defines a common placental pathological lesion among the preterm labor and preterm prelabor rupture of membranes groups, especially in cases of late preterm birth. Its association with villitis of unknown etiology and the chemokine profile in amniotic fluid suggests an immunological origin, akin to transplantation rejection and graft-versus-host disease in the chorioamniotic membranes.

Original languageEnglish (US)
Pages (from-to)1000-1011
Number of pages12
JournalModern Pathology
Volume23
Issue number7
DOIs
StatePublished - Jul 1 2010
Externally publishedYes

Fingerprint

Chorioamnionitis
Premature Birth
Premature Obstetric Labor
Membranes
Rupture
Pre-Eclampsia
Amniotic Fluid
Placenta
Gestational Age
Messenger RNA
Pregnancy Complications
Graft Rejection
Graft vs Host Disease
Chemokines
Reverse Transcription

Keywords

  • amniotic fluid
  • chorioamnionitis
  • CXCL10
  • CXCL11
  • CXCL9
  • pregnancy

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

The frequency, clinical significance, and pathological features of chronic chorioamnionitis : A lesion associated with spontaneous preterm birth. / Kim, Chong Jai; Romero, Roberto; Kusanovic, Juan Pedro; Yoo, Wonsuk; Dong, Zhong; Topping, Vanessa; Gotsch, Francesca; Yoon, Bo Hyun; Chi, Je Geun; Kim, Jung Sun.

In: Modern Pathology, Vol. 23, No. 7, 01.07.2010, p. 1000-1011.

Research output: Contribution to journalArticle

Kim, Chong Jai ; Romero, Roberto ; Kusanovic, Juan Pedro ; Yoo, Wonsuk ; Dong, Zhong ; Topping, Vanessa ; Gotsch, Francesca ; Yoon, Bo Hyun ; Chi, Je Geun ; Kim, Jung Sun. / The frequency, clinical significance, and pathological features of chronic chorioamnionitis : A lesion associated with spontaneous preterm birth. In: Modern Pathology. 2010 ; Vol. 23, No. 7. pp. 1000-1011.
@article{68e983caab5b40ecb3c99bfac4bd7e2b,
title = "The frequency, clinical significance, and pathological features of chronic chorioamnionitis: A lesion associated with spontaneous preterm birth",
abstract = "Acute chorioamnionitis is a well-established lesion of the placenta in cases with intra-amniotic infection. In contrast, the clinicopathological significance of chronic chorioamnionitis is unclear. This study was conducted to determine the frequency and severity of chronic chorioamnionitis in normal pregnancy and in various pregnancy complications. Placentas from the following patient groups were studied: (1) term not in labor (n=100), (2) term in labor (n=100), (3) preterm labor (n=100), (4) preterm prelabor rupture of membranes (n=100), (5) preeclampsia at term (n=100), (6) preterm preeclampsia (n=100), and (7) small-for-gestational-age at term (n=100). Amniotic fluid CXCL10 concentration was measured in 64 patients. CXCL9, CXCL10, and CXCL11 mRNA expressions in the chorioamniotic membranes were assessed using real-time quantitative reverse transcription-PCR. The frequency of chronic chorioamnionitis in the preterm labor group and the preterm prelabor rupture of membranes group was 34 and 39{\%}, respectively, which was higher than that of normal-term placentas (term not in labor, 19{\%}; term in labor, 8{\%}; Pη0.05 each). The frequency of chronic chorioamnionitis in the preeclampsia at term group, preterm preeclampsia group, and small-for-gestational-age group was 23, 16, and 13{\%}, respectively. Concomitant villitis of unknown etiology was found in 38 and 36{\%} of preterm labor cases and preterm prelabor rupture of membranes cases with chronic chorioamnionitis, respectively. Interestingly, the median gestational age of preterm chronic chorioamnionitis cases was higher than that of acute chorioamnionitis cases (P≤0.05). The median amniotic fluid CXCL10 concentration was higher in cases with chronic chorioamnionitis than in those without, in both the preterm labor group and preterm prelabor rupture of membranes group (P≤0.05 and P≤0.01, respectively). CXCL9, CXCL10, and CXCL11 mRNA expression in the chorioamniotic membranes was also higher in cases with chronic chorioamnionitis than in those without chronic chorioamnionitis (P≤0.05). We propose that chronic chorioamnionitis defines a common placental pathological lesion among the preterm labor and preterm prelabor rupture of membranes groups, especially in cases of late preterm birth. Its association with villitis of unknown etiology and the chemokine profile in amniotic fluid suggests an immunological origin, akin to transplantation rejection and graft-versus-host disease in the chorioamniotic membranes.",
keywords = "amniotic fluid, chorioamnionitis, CXCL10, CXCL11, CXCL9, pregnancy",
author = "Kim, {Chong Jai} and Roberto Romero and Kusanovic, {Juan Pedro} and Wonsuk Yoo and Zhong Dong and Vanessa Topping and Francesca Gotsch and Yoon, {Bo Hyun} and Chi, {Je Geun} and Kim, {Jung Sun}",
year = "2010",
month = "7",
day = "1",
doi = "10.1038/modpathol.2010.73",
language = "English (US)",
volume = "23",
pages = "1000--1011",
journal = "Modern Pathology",
issn = "0893-3952",
publisher = "Nature Publishing Group",
number = "7",

}

TY - JOUR

T1 - The frequency, clinical significance, and pathological features of chronic chorioamnionitis

T2 - A lesion associated with spontaneous preterm birth

AU - Kim, Chong Jai

AU - Romero, Roberto

AU - Kusanovic, Juan Pedro

AU - Yoo, Wonsuk

AU - Dong, Zhong

AU - Topping, Vanessa

AU - Gotsch, Francesca

AU - Yoon, Bo Hyun

AU - Chi, Je Geun

AU - Kim, Jung Sun

PY - 2010/7/1

Y1 - 2010/7/1

N2 - Acute chorioamnionitis is a well-established lesion of the placenta in cases with intra-amniotic infection. In contrast, the clinicopathological significance of chronic chorioamnionitis is unclear. This study was conducted to determine the frequency and severity of chronic chorioamnionitis in normal pregnancy and in various pregnancy complications. Placentas from the following patient groups were studied: (1) term not in labor (n=100), (2) term in labor (n=100), (3) preterm labor (n=100), (4) preterm prelabor rupture of membranes (n=100), (5) preeclampsia at term (n=100), (6) preterm preeclampsia (n=100), and (7) small-for-gestational-age at term (n=100). Amniotic fluid CXCL10 concentration was measured in 64 patients. CXCL9, CXCL10, and CXCL11 mRNA expressions in the chorioamniotic membranes were assessed using real-time quantitative reverse transcription-PCR. The frequency of chronic chorioamnionitis in the preterm labor group and the preterm prelabor rupture of membranes group was 34 and 39%, respectively, which was higher than that of normal-term placentas (term not in labor, 19%; term in labor, 8%; Pη0.05 each). The frequency of chronic chorioamnionitis in the preeclampsia at term group, preterm preeclampsia group, and small-for-gestational-age group was 23, 16, and 13%, respectively. Concomitant villitis of unknown etiology was found in 38 and 36% of preterm labor cases and preterm prelabor rupture of membranes cases with chronic chorioamnionitis, respectively. Interestingly, the median gestational age of preterm chronic chorioamnionitis cases was higher than that of acute chorioamnionitis cases (P≤0.05). The median amniotic fluid CXCL10 concentration was higher in cases with chronic chorioamnionitis than in those without, in both the preterm labor group and preterm prelabor rupture of membranes group (P≤0.05 and P≤0.01, respectively). CXCL9, CXCL10, and CXCL11 mRNA expression in the chorioamniotic membranes was also higher in cases with chronic chorioamnionitis than in those without chronic chorioamnionitis (P≤0.05). We propose that chronic chorioamnionitis defines a common placental pathological lesion among the preterm labor and preterm prelabor rupture of membranes groups, especially in cases of late preterm birth. Its association with villitis of unknown etiology and the chemokine profile in amniotic fluid suggests an immunological origin, akin to transplantation rejection and graft-versus-host disease in the chorioamniotic membranes.

AB - Acute chorioamnionitis is a well-established lesion of the placenta in cases with intra-amniotic infection. In contrast, the clinicopathological significance of chronic chorioamnionitis is unclear. This study was conducted to determine the frequency and severity of chronic chorioamnionitis in normal pregnancy and in various pregnancy complications. Placentas from the following patient groups were studied: (1) term not in labor (n=100), (2) term in labor (n=100), (3) preterm labor (n=100), (4) preterm prelabor rupture of membranes (n=100), (5) preeclampsia at term (n=100), (6) preterm preeclampsia (n=100), and (7) small-for-gestational-age at term (n=100). Amniotic fluid CXCL10 concentration was measured in 64 patients. CXCL9, CXCL10, and CXCL11 mRNA expressions in the chorioamniotic membranes were assessed using real-time quantitative reverse transcription-PCR. The frequency of chronic chorioamnionitis in the preterm labor group and the preterm prelabor rupture of membranes group was 34 and 39%, respectively, which was higher than that of normal-term placentas (term not in labor, 19%; term in labor, 8%; Pη0.05 each). The frequency of chronic chorioamnionitis in the preeclampsia at term group, preterm preeclampsia group, and small-for-gestational-age group was 23, 16, and 13%, respectively. Concomitant villitis of unknown etiology was found in 38 and 36% of preterm labor cases and preterm prelabor rupture of membranes cases with chronic chorioamnionitis, respectively. Interestingly, the median gestational age of preterm chronic chorioamnionitis cases was higher than that of acute chorioamnionitis cases (P≤0.05). The median amniotic fluid CXCL10 concentration was higher in cases with chronic chorioamnionitis than in those without, in both the preterm labor group and preterm prelabor rupture of membranes group (P≤0.05 and P≤0.01, respectively). CXCL9, CXCL10, and CXCL11 mRNA expression in the chorioamniotic membranes was also higher in cases with chronic chorioamnionitis than in those without chronic chorioamnionitis (P≤0.05). We propose that chronic chorioamnionitis defines a common placental pathological lesion among the preterm labor and preterm prelabor rupture of membranes groups, especially in cases of late preterm birth. Its association with villitis of unknown etiology and the chemokine profile in amniotic fluid suggests an immunological origin, akin to transplantation rejection and graft-versus-host disease in the chorioamniotic membranes.

KW - amniotic fluid

KW - chorioamnionitis

KW - CXCL10

KW - CXCL11

KW - CXCL9

KW - pregnancy

UR - http://www.scopus.com/inward/record.url?scp=77954243739&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77954243739&partnerID=8YFLogxK

U2 - 10.1038/modpathol.2010.73

DO - 10.1038/modpathol.2010.73

M3 - Article

C2 - 20348884

AN - SCOPUS:77954243739

VL - 23

SP - 1000

EP - 1011

JO - Modern Pathology

JF - Modern Pathology

SN - 0893-3952

IS - 7

ER -