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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/01/17 22:15:46」(JST)

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Chorioamnionitis 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]

Background[edit]

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[edit]

Intermediate magnification micrograph of moderate chorioamnionitis. H&E stain.

Clinical[edit]

Chorioamnionitis is diagnosed clinically in the setting of:^[1]

maternal fever.
uterine tenderness in the presence of confirmed premature rupture of membranes (PROM).

Exclusions:

maternal upper respiratory infection.
maternal urinary tract infection.

Pathologic[edit]

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[edit]

Treatment consists of:

antibiotics (amoxicillin + gentamicin + metronidazole) for the mother, and
quickly delivering the baby.

Associations[edit]

Chorioamnionitis is a risk factor for periventricular leukomalacia and cerebral palsy.^[2]

References[edit]

^ Elmar Peter Sakala, MD, MA, MPH, FACOG. Professor of GYNOB, Loma Linda University of medicine, California. Codirector of Student Clerkship. Dept of GYNOB
^ 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.

3. Excess Digital Exams Raise Risk of Chorioamnionitis, Ob.Gyn. News, August 15, 1997

4. 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[edit]

Overview at Cleveland Clinic.
Cerebral palsy inflammation link (29 November 2003) at BBC.

UpToDate Contents

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1. 羊水感染症（絨毛膜羊膜炎） intraamniotic infection chorioamnionitis
2. 分娩時発熱 intrapartum fever
3. 妊娠中の女性および産後の女性における腹痛および急性腹症に対するアプローチ approach to abdominal pain and the acute abdomen in pregnant and postpartum women
4. 胎盤病理組織報告 the placental pathology report
5. B群レンサ球菌に対する化学的予防投与を受けている母親を持つ幼児のマネージメント management of the infant whose mother has received group b streptococcal chemoprophylaxis

English Journal

Histopathological Findings in Spontaneous Hematoma of the Umbilical Cord: Severe Hypoxic-Ischemic Encephalopathy in a Term Survived Newborn.

Tonni G1, Bonasoni MP, De Felice C, Rossi A, Tonni S.
The American journal of forensic medicine and pathology.Am J Forensic Med Pathol.2015 Dec;36(4):254-6. doi: 10.1097/PAF.0000000000000195.
BACKGROUND: Spontaneous hematoma of the umbilical cord is a rare, unpreventable, and dramatic event mainly due to a disruption of the vascular wall, often resulting in adverse perinatal outcome.CASE: We describe a case of a term fetus with acute hemorrhage in the cord occurred intrapartum during spo
PMID 26334189

Long-term outcomes of antenatal corticosteroids treatment in very preterm infants after chorioamnionitis.

Miyazaki K1, Furuhashi M2, Ishikawa K3, Tamakoshi K4, Hayashi K5, Kai A6, Ishikawa H7, Murabayashi N8, Ikeda T8, Kono Y9, Kusuda S10, Fujimura M11.
Archives of gynecology and obstetrics.Arch Gynecol Obstet.2015 Dec;292(6):1239-46. doi: 10.1007/s00404-015-3762-6. Epub 2015 May 20.
PURPOSE: To evaluate the effect of antenatal corticosteroids (AC) therapy on short- and long-term outcomes among very low birth weight preterm infants after histologic chorioamnionitis (HCA).METHODS: We performed a retrospective analysis of 5240 single very low birth weight (VLBW) infants born at 22
PMID 25990481

Compartmentalization of acute phase reactants Interleukin-6, C-Reactive Protein and Procalcitonin as biomarkers of intra-amniotic infection and chorioamnionitis.

Dulay AT1, Buhimschi IA2, Zhao G3, Bahtiyar MO4, Thung SF5, Cackovic M5, Buhimschi CS6.
Cytokine.Cytokine.2015 Dec;76(2):236-43. doi: 10.1016/j.cyto.2015.04.014. Epub 2015 May 6.
BACKGROUND: The arsenal of maternal and amniotic fluid (AF) immune response to local or systemic infection includes among others the acute-phase reactants IL-6, C-Reactive Protein (CRP) and Procalcitonin (PCT). If these molecules can be used as non-invasive biomarkers of intra-amniotic infection (IA
PMID 25957466

Japanese Journal

症例報告前期破水から絨毛膜羊膜炎,常位胎盤早期剥離,ならびにMRSA敗血症を発症した1例

祝井麻希,小田英之,佐藤善啓 [他]
東京産科婦人科学会会誌 64(2), 185-189, 2015-04
NAID 40020542766

症例報告無症状で経過し常位胎盤早期剝離に至った重度絨毛膜羊膜炎の1例

角田陽平,林瑞成,松井遼子 [他]
東京産科婦人科学会会誌 64(1), 42-46, 2015-01
NAID 40020542055

Perinatal outcomes of pregnancies complicated by preterm premature rupture of the membranes before 34 weeks of gestation in a tertiary center in China: A retrospective review

Yu Haiyan,Wang Xiaodong,Gao Haocheng,You Yong,Xing Aiyun
BioScience Trends 9(1), 35-41, 2015
… Clinical chorioamnionitis occurred in 17.8% of the pregnancies. …
NAID 130005054678

Related Pictures

★リンクテーブル★

リンク元	「絨毛膜羊膜炎」「CAM」「funisitis」「amnionitis」

「絨毛膜羊膜炎」

Chorioamnionitis
	Classification and external resources
	; Micrograph showing chorioamnionitis. The clusters of blue dots are inflammatory cells (neutrophils, eosinophils and lymphocytes). H&E stain.
ICD-10	O41.1, P02.7
ICD-9	658.4, 762.7
DiseasesDB	31882
eMedicine	ped/89
MeSH	D002821

　　[★]

英: chorioamnionitis
同: 絨毛羊膜炎、羊膜絨毛膜炎、羊膜炎、臍帯炎

[show details]

絨毛膜羊膜炎 : 約 3,910 件
絨毛羊膜炎 : 約 2,970 件

概念

妊娠子宮において腟内細菌の上行性感染により、胎児面の羊膜ならびにその下の絨毛膜に炎症を及ぼす状態。
切迫早産の原因とされているらしい

参考

1. C．産科疾患の診断・治療・管理 13．産科感染症の診断と治療 - 日産婦誌５４巻１０号

http://www.jsog.or.jp/PDF/54/5410-457.pdf

2. D．産科疾患の診断・治療・管理 18．産科感染症の管理と治療 - 日産婦誌60巻6 号

http://www.jsog.or.jp/PDF/60/6006-117.pdf

「CAM」

　　[★]

「funisitis」

　　[★]

臍帯炎

関: amnionitis、chorioamnionitis

「amnionitis」

　　[★]

羊膜炎

関: chorioamnionitis、funisitis

[1] Elmar Peter Sakala, MD, MA, MPH, FACOG. Professor of GYNOB, Loma Linda University of medicine, California. Codirector of Student Clerkship. Dept of GYNOB

[pmid10989405-2] 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.

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案内

chorioamnionitis