Diagnostic Accuracy of Histological Chorioamnionitis and Funisitis in Neonatal Sepsis

Abstract

Background Histological chorioamnionitis (HCA) is present not only in women with clinical chorioamnionitis (CCA) but also in a large subset with silent chorioamnionitis which has a risk of developing complications of preterm labor, fetal, and maternal infection. Objectives To assess HCA and funisitis, and their correlation with the early neonatal outcome. Methods Of 778 preterm babies born over a period of 1 year at ≤34 weeks gestation, 100 placentae were analyzed as per the inclusion criteria in this prospective study. Sections from the placenta, membranes, and umbilical cord were examined for histopathology. Clinical parameters in mother and neonate were recorded and correlation with HCA was estimated. Results The incidence of HCA, funisitis, CCA was 35%, 7%, and 24%, respectively. Sixteen of 24 (66.7%) CCA had HCA and 19/35 (54%) of HCA had no CCA. History of preterm premature rupture of membranes was there in 73/100 cases, of which 41 had HCA. HCA cases having duration of rupture of membranes (DROM) <24 h were 22/41 (53.6%), 77.2% of which developed early onset neonatal sepsis (EONS). Odds of EONS with DROM <12 and 24 h was 1.3 and 2.9, respectively. EONS was suspected in 28/35 (80%) of HCA versus 13/24 (54%) of CCA. Culture positive sepsis was seen in (9/28) 32% cases with HCA and funisitis. In the absence of HCA, EONS was suspected in 30.7% cases. Conclusion HCA has a better diagnostic ability to detect EONS. Sepsis screen on the basis of CCA alone can miss about 50% of cases.