Histologic chorioamnionitis and preterm delivery in different patient populations

Article Abstract:

Because of its possible association with preterm birth (the main cause of neonatal mortality), the prevalence of chorioamnionitis (inflammation of the membranes of the sac that holds the fetus) was investigated in 1,843 women (1,432 white, 255 black, and 18 of other groups). Diagnosis of this condition was based on histological examination of the placentas by a pathologist who rated severity as mild, moderate, or severe. Data from medical records relevant to the pregnancy and delivery were obtained and correlated with the histopathologic results. Approximately 80 percent of the patients were private patients, 18 percent were clinic patients, and the remainder were maternal transport patients. Of the 138 cesarean deliveries, 7.5 percent were associated with chorioamnionitis. The condition was present in 32 percent of the preterm deliveries, and was severe in almost three-quarters of these cases. By contrast, chorioamnionitis was detected in only 18 percent of term deliveries. More women who experienced preterm delivery also had premature rupture of the membranes (surrounding the fetus); a higher rate of chorioamnionitis occurred in this group. Black patients had a higher rate of preterm delivery than whites (19 versus 9 percent), and indigent clinic patients had higher rates of preterm delivery than private ones. No differences in the rate of chorioamnionitis were found between black and white women, but black women with term deliveries had more severe degrees of this condition than whites. Overall, strong associations between histologic chorioamnionitis and preterm labor were found in this large-scale study. In evaluating the presence of this condition, assessment of severity is essential to accurately estimate the incidence. The fact that blacks, indigent clinic patients, and whites had an equal incidence of chorioamnionitis indicates that this condition is not the cause of the higher rate of preterm births among black women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Placenta, Chorioamnionitis

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Evaluation of blunt abdominal trauma in the third trimester of pregnancy: maternal and fetal considerations

Article Abstract:

Since the modern, healthy pregnant woman usually remains physically active during her pregnancy, the frequency of traumatic injuries late in gestation has increased in recent years; one out of every fourteen pregnant women will suffer some form of trauma, according to one estimate. To better understand the effects of one type of injury (those that affect the mother relatively little, but may affect the fetus considerably), a retrospective study of hospital records covering a two and one-half year period at one institution was carried out. The study included women more than 25 weeks pregnant who suffered potentially major trauma to the uterus from motor vehicle accidents, falls, assaults, or similar causes. They underwent a variety of tests, including electronic monitoring of the fetal heart rate, ultrasonography, and blood tests. Results showed that 84 patients (out of a total of 13,416 deliveries during the study period) met the criteria for major abdominal trauma and were admitted for observation, an admission rate of one pregnant trauma patient every 10 days. Falls accounted for 39 percent of the cases; motor vehicle accidents, for 35 percent; and assaults, for 26 percent. Of the 16 women who were delivered during their admission, 15 had good neonatal outcomes. Placental abruption (detachment) was the most serious complication, while the most common complication (28 percent) was preterm labor (before the thirty-seventh week of pregnancy). When blunt abdominal trauma occurred prior to the 37th week of gestation, preterm labor began in slightly more than one fourth of the cases. Treatment with tocolytic agents (which stop uterine contractions) was successful in 15 of the 17 preterm labors. None of the fetuses was injured in the traumatic event. Women who suffer major trauma to the abdomen during the last third of pregnancy should be evaluated for signs of preterm labor and placental abruption. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Pregnant women, Blunt trauma

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The fingerprint, a false-positive fern test

Article Abstract:

Ferning is the appearance of a fernlike pattern in a dried specimen of cervical mucus, an indication of the presence of the female sex hormone estrogen. Ferning from a 32-week old fetus was confirmed after the specimen was examined on a glass slide under a microscope, indicating the possibility of a premature rupture of the fetal membranes. No fluid from the membrane surrounding the fetus (amniotic fluid) was seen in the vagina, but an abnormal ferning pattern was detected when examined microscopically. The authors outline guidelines to recognize and avoid the source of diagnostic error.

Case studies, Abnormalities, Testing, Fetal membranes, Dermatoglyphics, Vaginal smears

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