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Part of the book series: Infectious Disease ((ID))

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Abstract

Excellent in-depth discussions of placental pathology in intrauterine infections are found in current placental pathology texts (13). The integrity of the fetal-placentalmaternal unit is key to the prevention of intrauterine infection. Infectious agents must traverse placental barriers to reach the fetus. In most instances, intrauterine infection leaves “footprints” in the placenta, either as direct evidence of infection (organisms) or indirect evidence of infection (inflammation or tissue injury). The placenta acts as a successful barrier to fetal infection. In most cases, despite placental infection, the fetus remains uninfected, although not necessarily unaffected by the infection. Other factors that affect the severity of intrauterine infection include the pathogen load, the virulence of the organism, immunocompetence of both mother and fetus, and gestational age at time of infection.

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References

  1. Fox H. Infections and inflammatory lesions of the placenta. In: Fox H, ed. Pathology of the Placenta, 2nd ed. Philadelphia: Saunders, 1997:294–343.

    Google Scholar 

  2. Hyde SR, Altshuler G. Infectious disorders of the placenta. In: Lewis SH, Perrin E, eds. Pathology of the Placenta, 2nd ed. New York: Churchill-Livingstone, 1999:317–342.

    Google Scholar 

  3. Benirschke K, Kaufmann P. Infectious diseases. In: Benirschke K, Kaufmann P, eds. Pathology of the Human Placenta, 4th ed. New York: Springer, 2000:591–684.

    Google Scholar 

  4. Salafia CM, Mangam HE, Weigl CA, Foye GJ, Silberman L. Abnormal fetal heart rate patterns and placental inflammation. Am J Obstet Gynecol 1989;160:140–147.

    PubMed  CAS  Google Scholar 

  5. Leo MV, Skurnick JH, Ganesh VV, Adhate A, Apuzzio JJ. Clinical chorioamnionitis is not predicted by umbilical artery Doppler velocimetry in patients with premature rupture of the membranes. Obstet Gynecol 1991;79:916–918.

    Google Scholar 

  6. Hyde S, Smotherman J, Moore JI, Altshuler G. A model of bacterially induced umbilical vein spasm, relevant to fetal hypoperfusion. Obstet Gynecol 1989;73:966–970.

    PubMed  CAS  Google Scholar 

  7. Gomez R, Romero R, Gabio G, Yoon BH, Mazor M, Stanley B. The fetal inflammatory response syndrome. Am J Obstet Gynecol 1998;179:194–202.

    Article  PubMed  CAS  Google Scholar 

  8. Baud O, Emile D, Pelletier E, et al. Amniotic fluid concentration of interleukin-1B, interleukin-6 and TNF-α in chorioamnionitis before 32 weeks of gestation: histologic associations and neonatal outcome. Br J Obstet Gynecol 1999;106:72–77.

    CAS  Google Scholar 

  9. Meyer BA, Dickinson JE, Chambers C, Parisi VM. The effect of fetal sepsis on umbilical cord gases. Am J Obstet Gynecol 1992;116:612–617.

    Google Scholar 

  10. Galask RP, Varner MW, Petzold CR, Wilbur SL. Bacterial attachment of the chorioamniotic membranes. Am J Obstet Gynecol 1984;148:915–928.

    PubMed  CAS  Google Scholar 

  11. Epstein FH. Premature rupture of the fetal membranes. N Engl J Med 1998;338:663–670.

    Article  Google Scholar 

  12. van Hoeven KH, Anyaegbunam A, Hochester H, et al. Clinical significance of increasing histologic severity of acute inflammation in the fetal membranes and umbilical cord. Ped Pathol Lab Med 1996;16:731–744.

    Article  Google Scholar 

  13. de Araujo MC, Schultz R, Vaz FA, Massad E, Feferbaum R, Ramos JL. A case-control study of histological chorioamnionitis and neonatal infection. Early Human Dev 1994;16:51–58.

    Article  Google Scholar 

  14. Stallmach T, Karolyi L. Augmentation of fetal granulopoiesis with chorioamnionitis during the second trimester of gestation. Hum Pathol 1994;25:244–247.

    Article  PubMed  CAS  Google Scholar 

  15. de Felice C, Toti P, Laurini RN, et al. Early neonatal brain injury in histologic chorioamnionitis. J Pediatr 2001;138:101–104.

    Article  PubMed  Google Scholar 

  16. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 1984;73:282–289.

    Google Scholar 

  17. Bendon RW, Faye-Petersen O, Pavlova Z, et al. Histologic features of chorioamnion membrane rupture: development of methodology. Ped Pathol Lab Med 1997;17:27–42.

    Article  CAS  Google Scholar 

  18. Redline RW, Faye-Petersen O, Heller D, et al. Amniotic infection syndrome: nosology and reproducibility of placental reaction patterns. Ped Dev Pathol 2003;6:435–448.

    Article  Google Scholar 

  19. Naeye RL. Disorders of the placenta and decidua. In: Naeye RL, ed. Disorder of the Placenta, Fetus and Neonate: Diagnosis and Clinical Significance. St. Louis: Mosby, 1992:118–247.

    Google Scholar 

  20. Bendon RW. Histopathology of fetal membrane rupture: a review of the literature. Semin Perinatol 1996;20:381–388.

    Article  PubMed  CAS  Google Scholar 

  21. Chellam VG, Rushton DI. Chorioamnionitis and funiculitis in the placentas of 200 births weighing less than 2.5 kg. Br J Obstet Gynaecol 1985;92:808–814.

    PubMed  CAS  Google Scholar 

  22. Romero R, Mazor M. Infection and preterm labor. Clin Obstet Gynecol 1988;31:553–584.

    Article  PubMed  CAS  Google Scholar 

  23. Salafia C. Chorioamnionitis. Path Case Rev 1997;2:250–255.

    Google Scholar 

  24. Egger G, Spendel S, Porta S. Characteristics of ingress and life span of neutrophils at a site of acute inflammation, determined with the Sephades model in rats. Exp Pathol 1988;35:209–281.

    PubMed  CAS  Google Scholar 

  25. Svensson L, Ingemarsson I, Mardh PA. Chorioamnionitis and the isolation of microorganisms from the placenta. Obstet Gynecol 1986;67:403–409.

    PubMed  CAS  Google Scholar 

  26. Romero R, Salafia CM, Athanassiadis AP, et al. The relationship between acute inflammatory lesions of the preterm placenta and amniotic fluid microbiology. Am J Obstet Gynecol 1992;166:1382–1388.

    PubMed  CAS  Google Scholar 

  27. Hillier SL, Martius J, Krohn MJ, Kiviat N, Holmes KK, Eschenback DA. A case-control study of chorioamnionic infection and histologic chorioamnionitis in prematurity. N Engl J Med 1988;319:972–978.

    Article  PubMed  CAS  Google Scholar 

  28. Novak RW, Platt MS. Significance of placental findings in early-onset group B streptococcal neonatal sepsis. Clin Pediatr 1985;24:256–258.

    CAS  Google Scholar 

  29. Vollman JH, Smith WL, Ballard ET, et al. Early onset group B streptococcal disease: clinical, roentgenographic and pathologic features. J Pediatr 1976;89:199–204.

    Article  PubMed  CAS  Google Scholar 

  30. Craig JM. Group B β hemolytic streptococcal sepsis in the newborn. Perspect Pediatr Pathol 1981;6:139–151.

    PubMed  CAS  Google Scholar 

  31. Cassell GH, Hauth JC, Andrews WW, et al. Chorioamnion colonization: correlation with gestational age in women following spontaneous vs induced delivery. Am J Obstet Gynecol 1993;168:425.

    Google Scholar 

  32. Salafia CM, Weigl C, Silberman L. The prevalence and distribution of acute placental inflammation in uncomplicated term pregnancies. Obstet Gynecol 1989;73:383–389.

    PubMed  CAS  Google Scholar 

  33. Keski-Nisula L, Aalto M-L, Katila M-L, Kirkinen P. Intrauterine inflammation at term: a histopathologic study. Hum Pathol 2000;31:841–846.

    Article  PubMed  CAS  Google Scholar 

  34. Andrews WW, Hauth JC, Goldenberg RL. Infection and preterm birth. Am J Perinatol 2000;17:357–365.

    Article  PubMed  CAS  Google Scholar 

  35. de Araujo MC, Schultz R, Latorre RDO, Ramos JL, Vaz FA. A risk factor of early-onset infection in premature newborns: invasion of chorioamnionic tissues by leukocytes. Early Hum Dev 1999;56:1–15.

    Article  Google Scholar 

  36. Naeye RL, Peters EC. Causes and consequences of premature rupture of fetal membranes. Lancet 1980;1:192–194.

    Article  PubMed  CAS  Google Scholar 

  37. Romero R, Sirouri M, Oyarzun E, et al. Prevalence, microbiology and clinical significance of intra amniotic infection in women with preterm labor and intact membranes. Am J Obstet Gynecol 1989;161:817–824.

    PubMed  CAS  Google Scholar 

  38. Bendon RW, Faye-Petersen O, Pavlova Z, et al. Fetal membrane histology in preterm premature rupture of membranes: comparison to controls, and between antibiotic and placebo treatment. Pediatr Dev Pathol 1999;2:552–558.

    Article  PubMed  CAS  Google Scholar 

  39. Ghidini A, Salafia CM, Minior VK. Lack of relationship between histologic chorioamnionitis and duration of the latency period in preterm rupture of membranes. J Matern Fetal Med 1998;7:238–242.

    Article  PubMed  CAS  Google Scholar 

  40. McGregor JA, French JI, Lawellin D, Branco-Buff A, Smith C, Todd JK. Bacterial protease-induced reduction of chorioamnionic membrane strength and elasticity. Obstet Gynecol 1987;69:167–174.

    PubMed  CAS  Google Scholar 

  41. Hillier SL, Witkin SS, Krohn MA, Watta DH, Kiviat NB, Eschenback DA. The relationship of amniotic fluid cytokines and preterm delivery, amniotic fluid infection, histologic chorioamnionitis and chorioamnion infection. Obstet Gynecol 1993;81:941–948.

    PubMed  CAS  Google Scholar 

  42. Spiegel CA, Amsel R, Eschenbach D, Cshoenknecht F, Holmes KK. Anaerobic bacteria in nonspecific vaginitis. N Engl J Med 1980;303:601–607.

    Article  PubMed  CAS  Google Scholar 

  43. Martius J, Eschenbach DA. The role of bacterial vaginosis as a cause of amniotic fluid infection, chorioamnionitis and prematurity-a review. Arch Gynecol Obstet 1990;247:1–13.

    Article  PubMed  CAS  Google Scholar 

  44. Llahi-Camp JM, Rai R, Iscon C, Regan L, Taylor-Robinson D. Association of bacterial vaginosis with a history of second trimester miscarriage. Hum Reprod 1996;11:1575–1578.

    PubMed  CAS  Google Scholar 

  45. Hauth JC, Goldenberg RL, Andrews WW, DuBard MB, Cooper RL. Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. N Engl J Med 1995;33:1732–1736.

    Article  Google Scholar 

  46. Wen TS, Erikensen NL, Blanco JD, Graham JM, Oshiro BT, Prieto JA. Association of clinical intra-amniotic infection and meconium. Am J Perinatol 1993;10:438–440.

    PubMed  CAS  Google Scholar 

  47. Romero R, Hanaoka S, Mazor M, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991;164:859–862.

    PubMed  CAS  Google Scholar 

  48. Kaspar HG, Abu-Musa A, Hannoun A, Seoud M, Shammas M, Usta I, Khalili A. The placenta in meconium staining: lesions and early neonatal outcome. Clin Exp Obstet Gynecol 2000;27:63–66.

    PubMed  CAS  Google Scholar 

  49. de Beaufort AJ, Pelikan DMV, Elferink JG, Berger HM. Effect of interleukin 8 in meconium on in-vitro neutrophil chemotaxis. Lancet 1998;352:102–105.

    Article  PubMed  Google Scholar 

  50. Shen-Schwarz S, Ruchelli E, Brown D. Villous oedema of the placenta: a clinicopathological study. Placenta 1989;10:297–307.

    PubMed  CAS  Google Scholar 

  51. Darby MJ, Caritis SN, Shen-Schwarz S. Placental abruption in the preterm gestation: an association with chorioamnionitis. Obstet Gynecol 1989;74:88–92.

    PubMed  CAS  Google Scholar 

  52. Ohyama M, Itani Y, Yamanaha M, et al. Re-evaluation of chorioamnionitis and funisitis with a special reference to subacute chorioamnionitis. Hum Pathol 2003;33:183–190.

    Article  Google Scholar 

  53. Altshuler G. Pathogenesis of congenital herpes virus infection: case report including a description of the placenta. Am J Dis Child 1974;127:427–429.

    PubMed  CAS  Google Scholar 

  54. Garcia AGP, Marques RLS, Lobato YY, Fonseca ME, Wigg MD. Placental pathology in congenital rubella. Placenta 1985;6:281–295.

    Article  PubMed  CAS  Google Scholar 

  55. Garcia AGP. Congenital toxoplasmosis in two successive sibs. Arch Dis Child 1968;43:705–710.

    PubMed  CAS  Google Scholar 

  56. Jacques SM, Qureshi F. Chronic chorioamnionitis: a clinicopathologic and immunohistochemical study. Hum Pathol 1998;29:1457–1461.

    Article  PubMed  CAS  Google Scholar 

  57. Gersell DJ, Phillips NJ, Beckerman K. Chronic chorioamnionitis: a clinicopathologic study of 17 cases. Int J Gynecol Pathol 1991;10:217–229.

    Article  PubMed  CAS  Google Scholar 

  58. Navarro C, Blanc WA. Chronic viral funisitis. J Pediatr 1977;91:967–973.

    Article  PubMed  CAS  Google Scholar 

  59. Reyes C, Popek E. Funisitis: where does it begin? [abstract]. Pediatr Dev Pathol 2000;3:311.

    Article  Google Scholar 

  60. Fojaco RM, Hensley GT, Moskowitz L. Congenital syphilis and necrotizing funisitis. JAMA 1989;261:1788–1790.

    Article  PubMed  CAS  Google Scholar 

  61. Heifetz SA, Bauman M. Necrotizing funisitis and herpes simplex infection of placental and decidual tissues: study of four cases. Hum Pathol 1994;25:715–722.

    Article  PubMed  CAS  Google Scholar 

  62. Jacques SM, Quershi F. Necrotizing funisitis. A study of 45 cases. Hum Pathol 1992;23:1278–1283.

    Article  PubMed  CAS  Google Scholar 

  63. Craver RD, Baldwin VJ. Necrotizing funisitis. Obstet Gynecol 1992;79:64–70.

    PubMed  CAS  Google Scholar 

  64. Hood IC, DeSa DJ, Whyte RK. The inflammatory response in candidal chorioamnionitis. Hum Pathol 1983;14:984–990.

    Article  PubMed  CAS  Google Scholar 

  65. Schwartz DA, Reef S. Candida albicans placentitis and funisitis: early diagnosis of congenital candidemia by histopathologic examination of the umbilical cord vessel. Pediatr Infect Dis J 1990;9:661–665.

    PubMed  CAS  Google Scholar 

  66. Altshuler G, Hyde S. Meconium-induced vasoconstriction: a potential cause of cerebral and other fetal hypoperfusion and of poor pregnancy outcome. Child Neurol 1989;4:137–142.

    Article  CAS  Google Scholar 

  67. Burgess AM, Hutchins GM. Inflammation of the lungs, umbilical cord and placenta associated with meconium passage in utero, a review of 123 autopsied cases. Pathol Res Pract 1996;192;1121–1128.

    PubMed  CAS  Google Scholar 

  68. Bendon RW, Miller M. Letter to the editor: plasma cells in the decidua. Placenta 1990;11:369–370.

    Article  PubMed  CAS  Google Scholar 

  69. Khong TY, Bendon RW, Qureshi F, et al. Chronic deciduitis in the placental basal plate: definition and interobserver reliability. Hum Pathol 2000;31:292–295.

    Article  PubMed  CAS  Google Scholar 

  70. Russell P. Inflammatory lesions of the human placenta. III: the histopathology of villitis of unknown aetiology. Placenta 1980;1:227–244.

    Article  PubMed  CAS  Google Scholar 

  71. Kaplan C. The placenta and viral infection. Semin Diagn Pathol 1993;10:232–250.

    PubMed  CAS  Google Scholar 

  72. Knox WF, Fox H. Villitis of unknown aetiology: its incidence and significance in placentae from a British population. Placenta 1984;5:395–402.

    Article  PubMed  CAS  Google Scholar 

  73. Altshuler G, Russell P. The human placental villitides, a review of chronic intrauterine infection. In: Münster EG, Kirsten WH, eds. Current Topics in Pathology. New York: Springer-Verlag, 1975:64–112.

    Google Scholar 

  74. Redline R, Patterson P. Chronic villitis is associated with major infiltration of fetal tissues by maternal calls [abstract]. Mod Pathol 1993;6:7P

    Google Scholar 

  75. Schwartz DA, Khan R, Stoll B. Characterization of the fetal inflammatory response to cytomegalovirus placentitis. An immunohistochemical study. Arch Pathol Lab Med 1992;116:21–27.

    PubMed  CAS  Google Scholar 

  76. Labarrere CA, McIntyre JA, Faulk WP. Immunohistologic evidence that villitis in human normal term placenta is an immunologic lesion. Am J Obstet Gynecol 1990;162:515–522.

    PubMed  CAS  Google Scholar 

  77. Greco MA, Wieczorek RM, Sachdev R, Kaplan C, Nuovo GJ, Demopoulos RI. Phenotype of villous stromal cells in placentas with cytomegalovirus, syphilis and nonspecific villitis. Am J Pathol 1992;141:835–842.

    PubMed  CAS  Google Scholar 

  78. Xiao J, Garcia-Lloret M, Winkler-Lowen B, Miller R, Simpson K, Guilbert LJ. ICMA-1 mediated adhesion of peripheral blood monocytes to the maternal surface of placental syncytiotrophoblasts. Implications for placental villitis. Am J Pathol 1997;150:1845–1860.

    PubMed  CAS  Google Scholar 

  79. Salafia CM, Silberman L, Herrera NE, Mahoney MJ. Placental pathology at term associated with elevated mid-trimester maternal serum α-fetoprotein concentration. Am J Obstet Gynecol 1988;158:1064–1066.

    PubMed  CAS  Google Scholar 

  80. Gersell DJ. Chronic villitis, chronic chorioamniontis and maternal floor infarction. Semin Diagn Pathol 1993;10:251–266.

    PubMed  CAS  Google Scholar 

  81. Doss BJ, Greene MF, Hill J, Heffner LJ, Bieber FR, Genest DR. Massive chronic intervillositis associated with recurrent abortion. Hum Pathol 1995;26:1245–1251.

    Article  PubMed  CAS  Google Scholar 

  82. Jacques SM, Qureshi F. Chronic intervillositis of the placental. Arch Pathol Lab Med 1993;17:1032–1035.

    Google Scholar 

  83. Ismail MR, Ordi J, Menendez C, et al. Placental pathology in malaria: histological, immunohistochemical and quantitative study. Hum Pathol 2000;31:85–93.

    Article  PubMed  CAS  Google Scholar 

  84. Mitchell PS, Persing DH. Current trends in molecular microbiology. Lab Med 1999;30:263–270.

    Google Scholar 

  85. Euscher E, Davis J, Holtzman I, Nuovo GJ. Coxsackie virus infection of the placenta associated with neurodevelopmental delays in the newborn. Obstet Gynecol 2001;98:1019–1026.

    Article  PubMed  CAS  Google Scholar 

  86. Sheikh AU, Polliotti BM, Miller RK. Human immunodeficiency virus infection: in situ polymerase chain reaction localization in human placentas after in utero and in vitro infection. Am J Obstet Gynecol 2000;182:207–213.

    Article  PubMed  CAS  Google Scholar 

  87. Ozono K, Mushiake S, Takeshima T, Nakayama M. Diagnosis of congenital cytomegalovirus infection by examination of placenta: application of polymerase chain reaction and in situ hybridization. Pediatr Path Lab Med 1997;17:249–258.

    Article  CAS  Google Scholar 

  88. Muhlemann K, Miller RK, Metlay L, Menegus MA. CMV infection of the human placenta: an immunocytochemical study. Hum Pathol 1992;23:1234–1237.

    Article  PubMed  CAS  Google Scholar 

  89. Schwarz TF, Nerlich A, Hottentrager B, et al. Parvovirus B19 infection of the fetus histology and in situ hybridization. Am J Clin Pathol 1991;96:121–126.

    PubMed  CAS  Google Scholar 

  90. Tsai MM, O’Leary TJ. Identification of Toxoplasma gondii in formalin-fixed, paraffinembedded tissue by polymerase chain reaction. Mod Pathol 1 1993;6:185–188.

    CAS  Google Scholar 

  91. Guarner J, Greer PW, Bartlett J, et al. Congenital syphilis in a newborn: an immunopathologic study. Mod Pathol 1999;12:82–87.

    PubMed  CAS  Google Scholar 

  92. Genest DR, Choi-Hong SR, Tate JE, Qureshi F, Jacques SM, Crum C. Diagnosis of congenital syphilis from placental examination: comparison of histopathology, Steiner stain, and polymerase chain reaction for Treponema pallidum DNA. Hum Pathol 1996;27:366–372.

    Article  PubMed  CAS  Google Scholar 

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Popek, E.J. (2006). Placental Histopathology. In: Hutto, C. (eds) Congenital and Perinatal Infections. Infectious Disease. Humana Press. https://doi.org/10.1385/1-59259-965-6:037

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  • DOI: https://doi.org/10.1385/1-59259-965-6:037

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