Consonni Sara, Salmoiraghi Elettra, Vaglio Tessitore Isadora, Pintucci Armando, Vitale Valentina, Calzi Patrizia, Moltrasio Francesca, Locatelli Anna
Department of Obstetrics and Gynecology, Carate Hospital, ASST Brianza, 20871 Vimercate, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy.
Children (Basel). 2023 Jun 26;10(7):1110. doi: 10.3390/children10071110.
Chorioamnionitis (CA) at term of pregnancy can have an infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (intrauterine inflammation, infection, or both, TI) has been proposed to reduce the overdiagnosis of infection and neonatal overtreatment. The aim of this study is to identify clinical and histological variables that could predict adverse outcomes when TI is suspected and/or confirmed. This retrospective cohort study included 404 pregnancies (gestational age ≥ 37 weeks) that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to the NICHD definition of 2015, and it could be confirmed (TI+) or not confirmed (TI-) via histological examination. Signs of infection/inflammation that did not conform to the definition of TI were classified as "clinical suspicion" and could be supported (CS+) or not supported (CS-) by histology. Cases of histological chorioamnionitis (HCA) without clinical manifestation represented a fifth group. Whole placental involvement (WPLI) was defined as a histological inflammation involving the maternal and fetal sides. There were 113 TI+, 30 TI-, 186 CS+, 35 CS-, and 40 isolated HCA cases. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). Compared with CS+, TI+ was more predictive of CNO ( = 0.001), CMO ( < 0.001), and WPLI ( = 0.005). WPLI was related both to CNO ( < 0.001) and to CMO ( = 0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; = 0.001) and by WPLI (OR 2.23; = 0.001). Compared with CS, TI is a better predictor of CNO and can be useful for the identification of newborns at risk.
足月妊娠时的绒毛膜羊膜炎（CA）可能源于感染和/或炎症，并与不良结局相关。提出三联征I（宫内炎症、感染或两者皆有，即TI）以减少感染的过度诊断和新生儿的过度治疗。本研究的目的是确定在怀疑和/或确诊TI时可预测不良结局的临床和组织学变量。这项回顾性队列研究纳入了404例妊娠（孕周≥37周），分为5个包含所有情况且相互排斥的组。TI根据2015年美国国立儿童健康与人类发展研究所（NICHD）的定义来界定，并且可通过组织学检查确诊（TI+）或未确诊（TI-）。不符合TI定义的感染/炎症体征被归类为“临床怀疑”，并且可得到组织学支持（CS+）或未得到支持（CS-）。无临床表现的组织学绒毛膜羊膜炎（HCA）病例代表第五组。全胎盘受累（WPLI）定义为涉及母侧和胎儿侧的组织学炎症。有113例TI+、30例TI-、186例CS+、35例CS-以及40例孤立的HCA病例。133例（39.2%）诊断为WPLI。114例（28.2%）出现复合新生儿结局（CNO），而192例（47.5%）出现复合母亲结局（CMO）。与CS+相比，TI+对CNO（P = 0.001）、CMO（P < 0.001）和WPLI（P = 0.005）的预测性更强。WPLI与CNO（P < 0.001）和CMO（P = 0.046）均相关。TI+和WPLI在预测CNO时显示出相似的敏感性但特异性不同。在逻辑回归分析中，TI+（比值比[OR] 2.21；P = 0.001）和WPLI（OR 2.23；P = 0.001）可独立预测CNO。与CS相比，TI对CNO的预测性更好，并且可用于识别有风险的新生儿。
