Correlation between placental bacterial PCR results and histological chorioamnionitis: a prospective study on 41 placentas


Submitted: August 31, 2023
Accepted: February 21, 2024
Published: April 18, 2024
Abstract Views: 41
PDF: 30
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Authors

  • Hanaa Zaidi Faculty of Medicine and Pharmacy, Mohammed V University, Rabat; Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, Rabat, Morocco. https://orcid.org/0000-0002-7038-8691
  • Laila Lahlou Faculty of Medicine and Pharmacy, Mohammed V University, Rabat; Laboratory of Biostatistics and Clinical Research, Faculty of Medicine and Pharmacy, Rabat, Iran, Islamic Republic of.
  • Mariem Chraybi Faculty of Medicine and Pharmacy, Abdelmalek Essaadi University, Tanger; Laboratory of Pathological Anatomy and Cytology, CHU Mohammed IV, Tanger, Morocco.
  • Amina Barkat Faculty of Medicine and Pharmacy, Mohammed V University, Rabat; Mother and Child Health and Nutrition Research Team, Neonatology Department P5, Children's Hospital, CHU Ibn Sina, Rabat, Morocco.
  • Sabah Elamrani Faculty of Medicine and Pharmacy, Mohammed V University, Rabat; Maternity Souissi, CHU Ibn Sina, Rabat, Morocco.
  • Najat Lamalmi Faculty of Medicine and Pharmacy, Mohammed V University, Rabat; Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, Rabat, Morocco.

Chorioamnionitis or intra-uterine inflammation is considered the most common infection diagnosed in labor and delivery units worldwide. It is a leading cause of maternal morbidity and mortality, as well as neonatal death and sepsis. The heterogeneity of this clinical syndrome has been recently reported. The objectives of this study were to determine: 1) placental microbiology using molecular microbiological techniques; 2) diagnostic accuracy of the clinical criteria used to identify patients with placental bacterial infection; 3) relationship between placental bacterial infection and histological chorioamnionitis. This prospective cross-sectional study included 41 women diagnosed with clinical and histological chorioamnionitis. The presence of microorganisms in the placenta was determined by conducting placental analysis using a broad range of polymerase chain reactions (PCR). Bacterial placental infection (defined as the presence of the 16S gene detected in placental tissue using the molecular technique PCR) was observed in 63% (26/41) of parturients diagnosed with histological chorioamnionitis. The traditional criteria for diagnosing clinical chorioamnionitis exhibit poor diagnostic performance in accurately identifying proven intra-amniotic infection. The molecular analysis (PCR) of the placenta has suggested that acute chorioamnionitis commonly has a bacterial origin.


Redline RW. Placental inflammation. Semin Neonatol 2004;9:265-74. DOI: https://doi.org/10.1016/j.siny.2003.09.005

Report of the National Committee of Experts on Maternal Mortality. INSERM, December 2006.

Baergen RN. The placenta as witness. Clinics Perinatol 2007;34:393-407. DOI: https://doi.org/10.1016/j.clp.2007.03.013

Kim CJ, Romero R, Chaemsaithong P, et al. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 2015;213:S29-S52. DOI: https://doi.org/10.1016/j.ajog.2015.08.040

Cornette L. Fetal and neonatal inflammatory response and adverse outcome. Sem Fetal Neo-nat Med 2004;9:459-70. DOI: https://doi.org/10.1016/j.siny.2004.08.004

Romero R, Gomez-Lopez N, Winters AD, et al. Evidence that intra-amniotic infections are often the result of an ascending invasion - a molecular microbiological study. J Perinat Med 2019;47:915–31 DOI: https://doi.org/10.1515/jpm-2019-0297

Gibbs RS, Duff P. Progress in pathogenesis and management of clinical intraamniotic infec-tion. Am J Obstet Gynecol 1991;164:1317–26. DOI: https://doi.org/10.1016/0002-9378(91)90707-X

Gibbs RS, Blanco JD, St Clair PJ, et al. Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term. J Infect Dis 1982;145:1–8. DOI: https://doi.org/10.1093/infdis/145.1.1

Gilstrap LC 3rd, Cox SM. Acute chorioamnionitis. Obstet Gynecol Clin North Am 1989;16:373–9. DOI: https://doi.org/10.1016/S0889-8545(21)00165-0

Willi MJ, Winkler M, Fischer DC, et al. Chorioamnionitis: elevated interleukin-6 and inter-leukin-8 concentrations in the lower uterine segment. J Perinat Med 2002;30:292–6. DOI: https://doi.org/10.1515/JPM.2002.042

Lee SE, Romero R, Kim CJ, et al. Funisitis in term pregnancy is associated with microbial invasion of the amniotic cavity and intra-amniotic inflammation. J Matern Fetal Neonatal Med 2006;19:693–7. DOI: https://doi.org/10.1080/14767050600927353

Redline RW. Inflammatory response in acute chorioamnionitis. Semin Fetal Neonatal Med 2012;17:20–5. DOI: https://doi.org/10.1016/j.siny.2011.08.003

Schiano MA, Hauth JC, Gilstrap LC III. Second-stage fetal tachycardia and neonatal infec-tion. Am J Obstet Gynecol 1984;148:779–81. DOI: https://doi.org/10.1016/0002-9378(84)90566-0

Coulter J, Turner M. Maternal fever in term labour in relation to fetal tachycardia, cord ar-tery acidaemia and neonatal infection. Br J ObstetGynaecol 1998;105:242. DOI: https://doi.org/10.1111/j.1471-0528.1998.tb10062.x

Chaiworapongsa T, Romero R, Kim JC, et al. Evidence for fetal involvement in the patho-logic process of clinical chorioamnionitis. Am J Obstet Gynecol 2002;186:1178–82. DOI: https://doi.org/10.1067/mob.2002.124042

Buhimschi CS, Abdel-Razeq S, Cackovic M, et al. Fetal heart rate monitoring patterns in women with amniotic fluid proteomic profiles indicative of inflammation. Am J Perinatol 2008;25:359–72. DOI: https://doi.org/10.1055/s-2008-1078761

Romero R, Pacora P, Kusanovic JP, et al. Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, neonatal bacteremia, and implications for clinical care. J Perinat Med 2021;49:275–98 DOI: https://doi.org/10.1515/jpm-2020-0297

Romero R, Miranda J, Kusanovic JP, et al. Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques. J Perinat Med 2015;43:19–36. DOI: https://doi.org/10.1515/jpm-2014-0249

Hauth JC, Gilstrap LC 3rd, Hankins GD, et al. Term maternal and neonatal complications of acute chorioamnionitis. Obstet Gynecol 1985;66:59–62.

Gibbs RS, Dinsmoor MJ, Newton ER, et al. A randomized trial of intrapartum versus im-mediate postpartum treatment of women with intra-amniotic infection. Obstet Gynecol 1988;72:823–8. DOI: https://doi.org/10.1097/00006250-198812000-00001

Newton ER. Chorioamnionitis and intraamniotic infection. Clin Obstet Gynecol 1993;36:795–8 DOI: https://doi.org/10.1097/00003081-199312000-00004

Soper DE, Mayhall CG, Dalton HP. Risk factors for intraamniotic infection: a prospective epidemiologic study. Am J Obstet Gynecol 1989;161:562–6; discussion 6-8. DOI: https://doi.org/10.1016/0002-9378(89)90356-6

Newton ER, Prihoda TJ, Gibbs RS. Logistic regression analysis of risk factors for intra-amniotic infection. Obstet Gynecol 1989;73:571–5.

Curtin WM, Katzman PJ, Florescue H, et al. Accuracy of signs of clinical chorioamnionitis in the term parturient. J Perinatol 2013;33:422–8. DOI: https://doi.org/10.1038/jp.2012.135

Zaidi H, Lamalmi N, Lahlou L, et al. Clinical predictive factors of histological chorioamni-onitis: case-control study. Heliyon 2020;6:e05698. DOI: https://doi.org/10.1016/j.heliyon.2020.e05698

Khong TY, Eoghan EM, Ilana A, et al. Sampling and definitions of placental lesions: Amsterdam Placental Workshop Group Consensus Statement. Arch Pathol Lab Med 2016;140:698‑713. DOI: https://doi.org/10.5858/arpa.2015-0225-CC

Khong TY, Mooney EE, Nikkels PGJ, et al. Pathology of the Placenta. A practical guide. Springer Cham; 2019. DOI: https://doi.org/10.1007/978-3-319-97214-5

Gardella C, Riley DE, Hitti J, et al. Identification and sequencing of bacterial rDNAs in cul-ture-negative amniotic fluid from women in premature labour. Am J Perinatol 2004;21:319-23. DOI: https://doi.org/10.1055/s-2004-831884

Han YW, Shen T, Chung P, et al. Uncultivated bacteria as etiologic agents of intra-amniotic inflammation leading to preterm birth. J Clin Micro 2009;47:38-47. DOI: https://doi.org/10.1128/JCM.01206-08

Romero R, Quintero R, Oyarzun E, et al. Intraamniotic infection and the onset of labor in preterm premature rupture of the membranes. Am J Obstet Gynecol 1988;159:661-6. DOI: https://doi.org/10.1016/S0002-9378(88)80030-9

Gauthier DW, Meyer WJ, Bieniarz A. Correlation of amniotic fluid glucose concentration and intraamniotic infection in patients with preterm labor or premature rupture of mem-branes. Am J Obstet Gynecol 1991;165:1105-10. DOI: https://doi.org/10.1016/0002-9378(91)90480-F

Onderdonk AB, Delaney ML, DuBois AM, et al. Detection of bacteria in placental tissues obtained from extremely low gestational age neonates. Am J Obstet Gynecol 2008;198:110.e1-110.e7. DOI: https://doi.org/10.1016/j.ajog.2007.05.044

DiGiulio DB, Romero R, Kusanovic JP, et al. Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with pre-term pre-labor rupture of membranes. Am J Reprod Immunol 2010;64:38-57. DOI: https://doi.org/10.1111/j.1600-0897.2010.00830.x

Cahill RJ, Dougan G, O’Gaora P, et al. Universal DNA primers amplify bacterial DNA from human fetal membranes and link Fusobacterium nucleatum with prolonged preterm membrane rupture. Mol Hum Reprod 2005;11:761-65. DOI: https://doi.org/10.1093/molehr/gah234

Gomez R, Romero R, Nien JK, et al. Antibiotic administration to patients with preterm premature rupture of membranes does not eradicate intra amniotic infection. J Maternal-Fetal Neo Med 2007;20:167-73. DOI: https://doi.org/10.1080/14767050601135485

Seong HS, Lee SE, Kang JH, et al. The frequency of microbial invasion of the amniotic cav-ity and histological chorioamnionitis in women at term with intact membranes in the pres-ence or absence of labor. Am J Obstet Gynecol 2008;199:375.e1-375.e5. DOI: https://doi.org/10.1016/j.ajog.2008.06.040

Steel JH, Malatos S, Kennea N, et al. Bacteria and inflammatory cells in fetal membranes do not always cause preterm labour. Ped Res 2005;57:404-11. DOI: https://doi.org/10.1203/01.PDR.0000153869.96337.90

Jones HE, Harris KA, Azizia M, et al. Differing prevalence and diversity of bacterial species in fetal membranes from very preterm and term labor. PLoS ONE 2009;4:e8205. DOI: https://doi.org/10.1371/journal.pone.0008205

DiGiulio DB, Romero R, Amogan HP, et al. Microbial prevalence, diversity and abundance in amniotic fluid during preterm labor: a molecular and culture-based investigation. PLoS ONE 2008;3:e3056. DOI: https://doi.org/10.1371/journal.pone.0003056

Hill AB. The environment and disease: association or causation? Proc R Soc Med 1965;58:295-300. DOI: https://doi.org/10.1177/003591576505800503

Fredericks DN, Relman DA. Sequence-based identification of microbial pathogens: a recon-sideration of Koch’s postulates. Clin Microbiol Rev 1996;9:18-33. DOI: https://doi.org/10.1128/CMR.9.1.18

Romero R, Gomez R, Chaiworapongsa T, et al. The role of infection in preterm labour and delivery. Paediatr Perinat Epidemiol 2001;15:41-56. DOI: https://doi.org/10.1046/j.1365-3016.2001.00007.x

De Felice C, Toti P, Santopietro R, et al. Small thymus in very low birth weight infants born to mothers with subclinical chorioamnionitis. J Pediatr 1999;135:384-86. DOI: https://doi.org/10.1016/S0022-3476(99)70140-X

Romero R, Jezid M, Tinnakorn C, et al. A novel molecular microbiologic technique for the rapid diagnosis of microbial invasion of the amniotic cavity and intra‐amniotic infection in preterm labor with intact membranes. Am J Reprode Immunol 2014;71:330-58. DOI: https://doi.org/10.1111/aji.12189

Boutaga K, van Winkelhoff AJ, Vandenbroucke-Grauls CM, et al. Periodontal pathogens: A quantitative comparison of anaerobic culture and real time PCR. FEMS Immunol Med Micro 2005;45:191-9. DOI: https://doi.org/10.1016/j.femsim.2005.03.011

Fredricks DN, Fiedler TL, Thomas KK, et al. Targeted PCR detection of vaginal bacteria as-sociated with bacterial vaginosis. J Clin Micro 2007;45:3270-76. DOI: https://doi.org/10.1128/JCM.01272-07

Zaidi, H., Lahlou, L., Chraybi, M., Barkat, A., Elamrani, S., & Lamalmi, N. (2024). Correlation between placental bacterial PCR results and histological chorioamnionitis: a prospective study on 41 placentas. Journal of Biological Research - Bollettino Della Società Italiana Di Biologia Sperimentale. https://doi.org/10.4081/jbr.2024.11700

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