Clinical and subclinical chorioamnionitis in preterm births and late miscarriages: a prospective cohort study

Anju Krishna R. P.; Vidyalekshmy Ranganayaki; Rajalakshmi Ananthanarayanan

doi:10.18203/2320-1770.ijrcog20263989

Authors

Anju Krishna R. P. Department of High-Risk Pregnancy and Perinatology, Kimshealth, Trivandrum, Kerala, India
Vidyalekshmy Ranganayaki Department of High-Risk Pregnancy and Perinatology, Kimshealth, Trivandrum, Kerala, India
Rajalakshmi Ananthanarayanan Department of Infectious Diseases, Kimshealth, Trivandrum, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263989

Keywords:

Clinical chorioamnionitis, Early onset neonatal sepsis, Preterm births, Subclinical chorioamnionitis

Abstract

Background: Preterm birth is the leading cause of neonatal mortality worldwide and is associated with long-term neurodevelopmental morbidity. Nearly 40-50% of preterm births and up to two-thirds of late miscarriages are infection-related. Chorioamnionitis, a common intrauterine infection, significantly contributes to early-onset neonatal sepsis and maternal complications. Clinical chorioamnionitis is diagnosed using Gibb’s criteria, whereas subclinical chorioamnionitis is confirmed only on histopathology and is more prevalent. This study aimed to determine the incidence of clinical and subclinical chorioamnionitis in spontaneous preterm deliveries, preterm premature rupture of membranes (PPROM) and late miscarriages.

Methods: This prospective cohort study was conducted over one year at a tertiary care center. One hundred antenatal women between 16 and 36+6 weeks with preterm labour, PPROM, or late miscarriage were enrolled. Clinical features, laboratory parameters like white blood cell count (WBC), C-reactive protein (CRP), high vaginal swab, urine culture, and neonatal outcomes were recorded. Placental tissues were examined for histopathology, and neonatal sepsis, if present, was documented.

Results: Fifty seven percent had PPROM, 42% spontaneous preterm labour, and 1% late miscarriage. Elevated WBC (>15,000) was seen in 38%, and 52% had CRP levels twice normal. Positive high vaginal swabs were noted in 39%. 10% had positive urine culture. Incidence of clinical, microbiological, and histopathological chorioamnionitis was 7%, 11%, and 34%, respectively. Four cases met criteria for triple I, and six neonates developed early-onset sepsis.

Conclusions: Clinical criteria showed high specificity but low sensitivity, missing 79.4% of histological cases. WBC and CRP had moderate predictive value. Early diagnosis remains crucial to balance prematurity risks against infection-related morbidity. Better diagnostic tools are needed to identify underlying intrauterine inflammation.

References

Allanson B, Jennings B, Jacques A, Charles AK, Keil AD, Dickinson JE. Infection and fetal loss in the mid-second trimester of pregnancy. Aust N Z J Obstet Gynaecol. 2010;50(3):221-5.

Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010;37:339-54.

ACOG Committee Opinion. Prevention of Group B Streptococcal early onset disease in newborns. Obstet Gynecol. 2019;134:e19e40.

Gibbs RS, Dinsmoor MJ, Newton ER, Ramamurthy RS. A randomized trial of intrapartum versus immediate postpartum treatment of women with intra-amniotic infection. Obstet Gynecol. 1988;72(6):823-8.

Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intraamniotic infection. Am J Obstet Gynecol. 1991;164(5 Pt 1):1317-26.

Higgins RD, Saade G, Polin RA, Grobman WA, Buhimschi IA, Watterberg K, et al. Evaluation and management of women and newborns with a maternal diagnosis of chorioamnionitis: summary of a workshop. Obstet Gynecol. 2016;127(3):426-36.

Aljerian K. Chorioamnionitis: establishing a correlation between clinical and histological diagnosis. Indian J Pathol Microbiol. 2020;63(1):44-48.

Jung E, Romero R, Suksai M, Gotsch F, Chaemsaithong P, Erez O, Conde-Agudelo A, Gomez-Lopez N, Berry SM, Meyyazhagan A, Yoon BH. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. American journal of obstetrics and gynecology. 2024 Mar 1;230(3):S807-40.

Wu HC, Shen CM, Wu YY, Yuh YS, Kua KE. Subclinical histologic chorioamnionitis and related clinical and laboratory parameters in preterm deliveries. Pediatr Neonatol. 2009;50(5):217-21.

Arias-Peláez C, Gallego-Betancourt CX, Mera-Ijaji GA, Ortiz-Martínez RA, Chagüendo-García JE. Prevalence of histologic chorioamnionitis in patients with spontaneous pre-term labour in Popayán, Colombia, 2014-2016. Revi Colomb Obstet Ginecol. 2017;68(2):102-11.

Palmsten K, Nelson KK, Laurent LC, Park S, Chambers CD, Parast MM. Subclinical and clinical chorioamnionitis, fetal vasculitis, and risk for preterm birth: a cohort study. Placenta. 2018;67:54-60.

Cataño Sabogal CP, Fonseca J, García-Perdomo HA. Validation of diagnostic tests for histologic chorioamnionitis: Systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;228:13-26.

Sharma J, Tiwari S, Thapa D, Yadav R. Vaginal microflora in high vaginal swab in prelabour rupture of membrane: a descriptive cross-sectional study. JNMA J Nepal Med Assoc. 2024;62(276):532-5.

Ambalpady PA, Samantroy S, Mishra A, Panda J, Pattnaik D, Jena P. Microbiome diversity in vaginal fluid and sensitivity patterns in preterm premature rupture of membrane cases. Cureus. 2022;14(1):e20999.

Tanshen K, Goshwami P, Tribedi S, Haider S. The bacteriological assessment of urine in patients with premature rupture of membranes. Int J Reprod Contracept Obstet Gynecol. 2023;12:3226-31.

Berezowsky A, Krispin E, Danieli HT, Chen R, Hadar E, Wiznitzer A. 837: Chorioamnionitis in preterm delivery-what is the correlation between placental pathology and placental microbiology? Am J Obstet Gynecol. 2018;218(1):S499-500.

Soraisham AS, Singhal N, McMillan DD, Sauve RS, Lee SK, Canadia Neonatal Network. A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol. 2009;200(4):372.e1-6.

Zaharie GC, Hăşmăşanu MG, Haralambous E, Zaharie FA, Jakab AD, Matyas M. Chorioamnionitis and neonatal morbidity and mortality in extremely preterm infants born at 23-28 weeks: a single-centre retrospective study. J Clin Med. 2026;15(12):4406.