羊膜炎
- 関
- chorioamnionitis、funisitis
Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/30 23:31:12」(JST)
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| Chorioamnionitis |
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Micrograph showing chorioamnionitis. The clusters of blue dots are inflammatory cells (neutrophils, eosinophils and lymphocytes). H&E stain.
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| Classification and external resources |
| Specialty |
pediatrics |
| ICD-10 |
O41.1, P02.7 |
| ICD-9-CM |
658.4, 762.7 |
| DiseasesDB |
31882 |
| eMedicine |
ped/89 |
| MeSH |
D002821 |
Chorioamnionitis also known as intra-amniotic infection (IAI)[1] is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor. The risk of developing chorioamnionitis increases with each vaginal examination that is performed in the final month of pregnancy, including during labor.[3]
Contents
- 1 Background
- 2 Diagnosis
- 2.1 Clinical
- 2.2 Pathologic
- 3 Treatment
- 4 Associations
- 5 See also
- 6 Notes
- 7 References
- 8 External links
Background
The fetal membranes consist of two parts:
- The outer membrane is the chorion. It is closest to the mother and physically supports the much thinner amnion.
- The inner membrane is the amnion. It is in direct contact with the amniotic fluid, which surrounds the fetus.
Diagnosis
Intermediate magnification micrograph of moderate chorioamnionitis. H&E stain.
Clinical
Chorioamnionitis is diagnosed clinically in the setting of Maternal fever (≥100.4º F) and at least two of the following: [2]
- Maternal leukocytosis (>15,000cells/mm3)
- Maternal tachycardia (>100bpm)
- Fetal tachycardia (>160bpm)
- Uterine tenderness
- Foul odor of amniotic fluid[3]
Exclusions:
- maternal upper respiratory infection.
- maternal urinary tract infection.
Pathologic
Chorioamnionitis can be diagnosed from a histologic examination of the fetal membranes.
Infiltration of the chorionic plate by neutrophils is diagnostic of (mild) chorioamnionitis. More severe chorioamnionitis involves subamniotic tissue and may have fetal membrane necrosis and/or abscess formation.
Severe chorioamnionitis may be accompanied by vasculitis of the umbilical blood vessels (due to the fetus' inflammatory cells) and, if very severe, funisitis (inflammation of the umbilical cord's connective tissue).
Treatment
Antibiotic Treatment consists of:
- Standard: Ampicillin 2g IV every 6 hours + Gentamicin 1.5mg/kg every 8 hours
- Alternative: Ampicillin-Sulbactam 3g IV every 5 hours, Ticarcillin-Clavulanate 3.1g IV every 4 hours, Cefoxitine 2g IV every 6 hours
- Cesarean Delivery: Ampicillin 2g IV every 6 hours + Gentamicin 1.5mg/kg every 8 hours + Clindamycin 900mg every 8 hours or Metronidazole 500mg IV every 6 hours
- Penicillin-Allergy: Vancomycin 1g IV every 12 hours + Gentamicin 1.5mg/kg every 8 hours
Completion of treatment/cure is only considered after delivery of the infected products of conception.
[4]
Associations
Chorioamnionitis is a risk factor for periventricular leukomalacia and cerebral palsy.[5]
See also
- Wharton's jelly
- Chronic deciduitis
- Funisitis
Notes
- ^ "Intra–Amniotic Infection". http://www.merckmanuals.com/. Retrieved 20 December 2014.
- ^ Elmar Peter Sakala, MD, MA, MPH, FACOG. Professor of GYNOB, Loma Linda University of medicine, California. Codirector of Student Clerkship. Dept of GYNOB
- ^ http://www.uptodate.com/contents/intraamniotic-infection-chorioamnionitis
- ^ http://www.uptodate.com/contents/intraamniotic-infection-chorioamnionitis
- ^ Wu YW, Colford JM (2000). "Chorioamnionitis as a risk factor for cerebral palsy: A meta-analysis". JAMA 284 (11): 1417–24. doi:10.1001/jama.284.11.1417. PMID 10989405.
References
- Excess Digital Exams Raise Risk of Chorioamnionitis, Ob.Gyn. News, August 15, 1997
- Centers for disease control and prevention (2002) Prevention of perinatal group B Streptococcal disease: revised guidelines from CDC. MMWR 51:RR-11:1–28
External links
- Overview at Cleveland Clinic.
- Cerebral palsy inflammation link (29 November 2003) at BBC.
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Pathology of pregnancy, childbirth and the puerperium (O, 630–679)
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| Pregnancy |
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Pregnancy with
abortive outcome
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- Ectopic pregnancy
- Abdominal pregnancy
- Cervical pregnancy
- Interstitial pregnancy
- Ovarian pregnancy
- Molar pregnancy
- Miscarriage
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Oedema, proteinuria and
hypertensive disorders
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- Gestational hypertension
- Pre-eclampsia
- Eclampsia
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|
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Other, predominantly
related to pregnancy
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Digestive system
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- Acute fatty liver of pregnancy
- Gestational diabetes
- Hepatitis E
- Hyperemesis gravidarum
- Intrahepatic cholestasis of pregnancy
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|
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Integumentary system /
dermatoses of pregnancy
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- Gestational pemphigoid
- Impetigo herpetiformis
- Intrahepatic cholestasis of pregnancy
- Linea nigra
- Prurigo gestationis
- Pruritic folliculitis of pregnancy
- Pruritic urticarial papules and plaques of pregnancy (PUPPP)
- Striae gravidarum
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Nervous system
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Blood
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- Gestational thrombocytopenia
- Pregnancy-induced hypercoagulability
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Maternal care related to the
fetus and amniotic cavity
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- amniotic fluid
- Oligohydramnios
- Polyhydramnios
- Braxton Hicks contractions
- chorion / amnion
- Amniotic band syndrome
- Chorioamnionitis
- Chorionic hematoma
- Monoamniotic twins
- Premature rupture of membranes
- Obstetrical hemorrhage
- placenta
- Circumvallate placenta
- Monochorionic twins
- Placenta praevia
- Placental abruption
- Twin-to-twin transfusion syndrome
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| Labor |
- Amniotic fluid embolism
- Cephalopelvic disproportion
- Dystocia
- Fetal distress
- Locked twins
- Obstetrical hemorrhage
- placenta
- Preterm birth
- Postmature birth
- Umbilical cord prolapse
- Uterine rupture
- Vasa praevia
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| Puerperal |
- Breastfeeding difficulties
- Lactation failure
- Galactorrhea
- Fissure of the nipple
- Breast engorgement
- Diastasis symphysis pubis
- Peripartum cardiomyopathy
- Postpartum depression
- Postpartum thyroiditis
- Puerperal fever
- Puerperal mastitis
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| Other |
- Concomitant conditions
- Diabetes mellitus
- Systemic lupus erythematosus
- Thyroid disorders
- Maternal death
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Index of obstetrics
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| Description |
- Pregnancy
- Development
- Anatomy
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| Disease |
- Pregnancy and childbirth
- Placenta and neonate
- Infections
- Symptoms and signs
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| Treatment |
- Procedures
- Drugs
- oxytocins
- labor repressants
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Certain conditions originating in the perinatal period / fetal disease (P, 760–779)
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Maternal factors and
complications of pregnancy,
labour and delivery |
| placenta: |
- Placenta praevia
- Placental insufficiency
- Twin-to-twin transfusion syndrome
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| chorion/amnion: |
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| umbilical cord: |
- Umbilical cord prolapse
- Nuchal cord
- Single umbilical artery
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Length of gestation
and fetal growth |
- Small for gestational age/Large for gestational age
- Preterm birth/Postmature birth
- Intrauterine growth restriction
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| Birth trauma |
- scalp
- Cephalhematoma
- Chignon
- Caput succedaneum
- Subgaleal hemorrhage
- Brachial plexus lesion
- Erb's palsy
- Klumpke paralysis
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| By system |
| Respiratory |
- Intrauterine hypoxia
- Infant respiratory distress syndrome
- Transient tachypnea of the newborn
- Meconium aspiration syndrome
- pleural disease
- Pneumothorax
- Pneumomediastinum
- Wilson–Mikity syndrome
- Bronchopulmonary dysplasia
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| Cardiovascular |
- Pneumopericardium
- Persistent fetal circulation
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Haemorrhagic and
hematologic disease |
- Vitamin K deficiency
- Haemorrhagic disease of the newborn
- HDN
- ABO
- Anti-Kell
- Rh c
- Rh D
- Rh E
- Hydrops fetalis
- Hyperbilirubinemia
- Kernicterus
- Neonatal jaundice
- Velamentous cord insertion
- Intraventricular hemorrhage
- Germinal matrix hemorrhage
- Anemia of prematurity
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| Digestive |
- Ileus
- Necrotizing enterocolitis
- Meconium peritonitis
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Integument and
thermoregulation |
- Erythema toxicum
- Sclerema neonatorum
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| Nervous system |
- Periventricular leukomalacia
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| Musculoskeletal |
- Gray baby syndrome
- muscle tone
- Congenital hypertonia
- Congenital hypotonia
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| Infectious |
- Vertically transmitted infection
- Congenital rubella syndrome
- Neonatal herpes simplex
- Mycoplasma hominis infection
- Omphalitis
- Neonatal sepsis
- Group B streptococcal infection
- Neonatal conjunctivitis
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| Other |
- Perinatal mortality
- Stillbirth
- Infant mortality
- Neonatal withdrawal
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Index of developmental medicine
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| Description |
- Embryology
- Cell lines
- Stem cells
- endoderm
- mesoderm
- ectoderm
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| Disease |
- Due to toxins
- Syndromes
- Chromosomal
- Neonate
- Twins
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Index of obstetrics
|
|
| Description |
- Pregnancy
- Development
- Anatomy
|
|
| Disease |
- Pregnancy and childbirth
- Placenta and neonate
- Infections
- Symptoms and signs
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| Treatment |
- Procedures
- Drugs
- oxytocins
- labor repressants
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Inflammation
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| Acute |
| Plasma derived mediators |
- Bradykinin
- complement
- coagulation
- Factor XII
- Plasmin
- Thrombin
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| Cell derived mediators |
| preformed: |
- Lysosome granules
- biogenic amines
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| synthesized on demand: |
- cytokines
- eicosanoids
- Leukotriene B4
- Prostaglandins
- Nitric oxide
- Kinins
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| Chronic |
- Macrophage
- Epithelioid cell
- Giant cell
- Granuloma
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| Processes |
| Traditional: |
- Rubor
- Calor
- Tumor
- Dolor (pain)
- Functio laesa
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| Modern: |
- Acute-phase reaction/Fever
- Vasodilation
- Increased vascular permeability
- Exudate
- Leukocyte extravasation
- Chemotaxis
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| Specific locations |
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UpToDate Contents
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English Journal
- Perinatal inflammation: a common factor in the early origins of cardiovascular disease?
- Nguyen MU1, Wallace MJ1, Pepe S2, Menheniott TR2, Moss TJ3, Burgner D4.
- Clinical science (London, England : 1979).Clin Sci (Lond).2015 Oct 1;129(8):769-84. doi: 10.1042/CS20150045.
- Cardiovascular disease continues to be the leading cause of global morbidity and mortality. Traditional risk factors account for only part of the attributable risk. The origins of atherosclerosis are in early life, a potential albeit largely unrecognized window of opportunity for early detection and
- PMID 26223841
- Automated auditory brainstem response in preterm newborns with histological chorioamnionitis.
- Smit AL1, Been JV, Zimmermann LJ, Kornelisse RF, Andriessen P, Vanterpool SF, Bischoff MP, Stokroos RJ, de Krijger RR, Kremer B, Kramer BW.
- The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2015 Oct;28(15):1864-9. doi: 10.3109/14767058.2014.971747. Epub 2014 Nov 6.
- OBJECTIVE: We investigated whether histological chorioamnionitis is associated with an adverse neonatal hearing outcome.METHODS: Two cohorts of very preterm newborns (n = 548, gestational age ≤ 32.0 weeks) were linked to placental histology and automated auditory brainstem response (AABR) outc
- PMID 25294170
- Do maternal factors influence neonatal thyroid status in the extreme premature infant?
- Ng SM1, Watson G, Turner MA, Newland P, Weindling AM.
- The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2015 Oct;28(15):1846-9. doi: 10.3109/14767058.2014.970158. Epub 2014 Oct 13.
- BACKGROUND: In early pregnancy, maternal transfer of thyroxine (T4) significantly contributes to the foetal T4 requirements. Interruption of the maternal transfer of T4 may lead to inadequate T4 exposure, potentially leading to neurodevelopmental deficits.AIM: To determine if maternal factors are as
- PMID 25260130
Japanese Journal
- Systemic Mycobacteriosis in an Aborted Thoroughbred Fetus in Japan
- Systemic Mycobacteriosis in an Aborted Thoroughbred Fetus in Japan
Related Links
- Amnionitis is an infection of the uterus, the amniotic sac, and in some cases, of the fetus. Amnionitis is very rare, occurring in only about 5% of pregnancies. ... Symptoms of amnionitis are variable. One of the earliest signs can be ...
- amnionitis [am″ne-o-ni´tis] inflammation of the amnion, a manifestation of an intrauterine infection, often associated with prolonged membrane rupture and long labor. am·ni·o·ni·tis (am'nē-ō-nī'tis), Inflammation resulting from infection of ...
Related Pictures
★リンクテーブル★
[★]
臍帯炎
- 関
- amnionitis、chorioamnionitis