Accuracy of signs of clinical chorioamnionitis in the term parturient

• Published in: Journal of perinatology Vol. 33; no. 6; pp. 422 - 428
• Main Authors: Curtin, W M, Katzman, P J, Florescue, H, Metlay, L A
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01.06.2013; Nature Publishing Group
• Subjects: 692/1807/1490; 692/420/256; 692/699/75/29; 692/700/1720; Accuracy; Adult; Amniotic fluid; Antibiotics; Cardiac arrhythmia; Care and treatment; Childbirth & labor; Chorioamnionitis; Chorioamnionitis - classification; Chorioamnionitis - diagnosis; Chorioamnionitis - pathology; Classification; Cohort analysis; Cohort Studies; Dentistry; Diagnosis; Diagnosis, Differential; Female; Fetuses; Fever; Fever of Unknown Origin - etiology; Guideline Adherence; Guidelines; Gynecology; Health aspects; Hospitals, University; Humans; Induced labor; Infant, Newborn; Infants (Newborn); Medical examination; Medicine; Medicine & Public Health; New York; Obstetrics; original-article; Pathology; Pediatric Surgery; Pediatrics; Placenta; Placenta - pathology; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, Third; Retrospective Studies; Risk factors; Sensitivity; Tachycardia; Tachycardia - etiology; New York; United States; United States > US; specificity; accuracy; guidelines; sensitivity; histologic chorioamnionitis; clinical chorioamnionitis
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2012.135

Objective: Uniform histopathologic guidelines were applied to diagnose chorioamnionitis and estimate the accuracy of clinical signs in term parturients. Study Design: A retrospective cohort study utilized slides from term parturient placentas with Amniotic Fluid Infection Nosology Committee guidelines as the gold standard. Sensitivity, specificity and accuracy for fever, maternal tachycardia and fetal tachycardia were calculated. Result: Of 641 placentas, 367 (57.3%) had histologic chorioamnionitis and 274 (42.7%) were negative. Fever had a sensitivity of 42%, specificity of 86.5% and accuracy of 61%. Fever, maternal tachycardia and fetal tachycardia had a sensitivity of 18.3%, specificity of 98.2% and accuracy of 52.4%. Conclusion: Histologic chorioamnionitis, frequently asymptomatic, is a common finding in placentas examined from term parturients. Clinical signs are not accurate in the diagnosis. Adoption of uniform pathologic guidelines will facilitate research into the clinical significance of these lesions in the future.