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dc.contributor.authorRoberts, Drucilla Jane
dc.contributor.authorCeli, Ann Catherine
dc.contributor.authorRiley, Laura E.
dc.contributor.authorOnderdonk, Andrew Bruce
dc.contributor.authorBoyd, Theonia Kamman
dc.contributor.authorJohnson, Lise Carolyn
dc.contributor.authorLieberman, Ellice S.
dc.date.accessioned2012-12-18T19:21:34Z
dc.date.issued2012
dc.identifier.citationRoberts, Drucilla J., Ann C. Celi, Laura E. Riley, Andrew B. Onderdonk, Theonia K. Boyd, Lise Carolyn Johnson, and Ellice Lieberman. 2012. Acute histologic chorioamnionitis at term: nearly always noninfectious. PLoS ONE 7(3): e31819.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10060086
dc.description.abstractBackground: The link between histologic acute chorioamnionitis and infection is well established in preterm deliveries, but less well-studied in term pregnancies, where infection is much less common. Methodology/Principal Findings We conducted a secondary analysis among 195 low-risk women with term pregnancies enrolled in a randomized trial. Histologic and microbiologic evaluation of placentas included anaerobic and aerobic cultures (including mycoplasma/ureaplasma species) as well as PCR. Infection was defined as ≥1,000 cfu of a single known pathogen or a ≥2 log difference in counts for a known pathogen versus other organisms in a mixed culture. Placental membranes were scored and categorized as: no chorioamnionitis, Grade 1 (subchorionitis and patchy acute chorioamnionitis), or Grade 2 (severe, confluent chorioamnionitis). Grade 1 or grade 2 histologic chorioamnionitis was present in 34% of placentas (67/195), but infection was present in only 4% (8/195). Histologic chorioamnionitis was strongly associated with intrapartum fever >38°C [69% (25/36) fever, 26% (42/159) afebrile, P<.0001]. Fever occurred in 18% (n = 36) of women. Most febrile women [92% (33/36)] had received epidural for pain relief, though the association with fever was present with and without epidural. The association remained significant in a logistic regression controlling for potential confounders (OR = 5.8, 95% CI = 2.2,15.0). Histologic chorioamnionitis was also associated with elevated serum levels of interleukin-8 (median = 1.3 pg/mL no histologic chorioamnionitis, 1.5 pg/mL Grade 1, 2.1 pg/mL Grade 2, P = 0.05) and interleukin-6 (median levels = 2.2 pg/mL no chorioamnionitis, 5.3 pg/mL Grade 1, 24.5 pg/mL Grade 2, P = 0.02) at admission for delivery as well as higher admission WBC counts (mean = 12,000cells/mm\(^3\) no chorioamnionitis, 13,400cells/mm\(^3\) Grade 1, 15,700cells/mm\(^3\) Grade 2, P = 0.0005). Conclusion/Significance: Our results suggest histologic chorioamnionitis at term most often results from a noninfectious inflammatory process. It was strongly associated with fever, most of which was related to epidural used for pain relief. A more ‘activated’ maternal immune system at admission was also associated with histologic chorioamnionitis.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0031819en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296706/pdf/en_US
dash.licenseLAA
dc.subjectmedicineen_US
dc.subjectepidemiologyen_US
dc.subjectinfection diseasesen_US
dc.subjectobstetrics and gynecologyen_US
dc.titleAcute Histologic Chorioamnionitis at Term: Nearly Always Noninfectiousen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorOnderdonk, Andrew Bruce
dc.date.available2012-12-18T19:21:34Z
dc.identifier.doi10.1371/journal.pone.0031819*
dash.contributor.affiliatedRiley, Laura
dash.contributor.affiliatedCeli, Ann
dash.contributor.affiliatedBoyd, Theonia
dash.contributor.affiliatedRoberts, Drucilla
dash.contributor.affiliatedOnderdonk, Andrew
dash.contributor.affiliatedLieberman, Ellice
dash.contributor.affiliatedJohnson, Lise


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