corioamnionitis y funisitis. consecuencias para el neonato

Corioamnionitis y funisitis:Consecuencias para el neonato

Corioamnionitis y funisitis: Consecuencias para el Neonato

Lahra MM. A fetal response to chorioamnionitis is associated with early survival after preterm birth. Am J Obstet Gynecol ©2004;190:147–51.


Mi Lee S, et al. The frequency and risk factors of funisitis and histologic chorioamnionitis in pregnant women at term who delivered after thespontaneous onset of labor. J Matern Fetal Neonatal Med. ©2011 Jan;24(1):37-42.


Goldenberg RL, et al. Mechanisms of disease: Intrauterine Infection and Preterm Delivery. NEJM ©2000;342(20):1500-7.

Hematógena

Contiguidad

Ascendente


Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

Fiebre intraparto >37.8ºC.

Taquicardia materna >120 lpm.

Taquicardia fetal >160-180 lpm.

Secreción vaginal o LA turbio, purulento y/o fétido.

Sensibilidad uterina.

Leucocitosis materna >15,000-18,000 cells/μL.


Figure 1. Acute chorioamnionitis (ACA). Contrast the normal placenta (A) with the placenta with acute chorioamnionitis (B) that shows clouding and greenish-yellow discoloration of the membranes and cord.




Síndrome de respuesta inflamatoria sistémica fetal (F/SIRS)


CORIOAMNINITIS AGUDA

Escherichia coliMycoplasma hominisUreaplasma urealyticumgroup B StreptococcusStaphylococcusPseudomonasProteusKlebsiellaFusobacterium sp.

CORIOAMNINITIS Y FUNISITIS

Actinomyces spPrevotella biviaCorynebacterium spEscherichia coliPeptostreptococcus magnusgroup B, group D, alpha-hemolytic, and anaerobic streptococciMycoplasma spUreaplasma urealyticum




Figure 3. A. Necrotizing funisitis due to Candida funisitis. Candida funisitis is seen as punctate, 1- to 2-mm, yellow-white nodules on the cord.They generally track the coils of the cord vessels and are noted initially along the perimeter of the umbilical vein. A hand lens and tangentiallighting are helpful in detecting their presence. B. Hematoxylin-eosin (routine) stained section of subamniotic microabscess typical of candidalfunisitis. The lesion is highly characteristic but not specific for the organism. C. Candida pseudohyphae revealed with Gomori methenaminesilver (GMS) stain in subamniotic foci in a low-power photomicrograph of an umbilical cord with subamniotic microabscesses. Figure 3A isreprinted with permission from Faye-Petersen OM, Heller DS, Joshi VV. Handbook of Placental Pathology. 2nd ed. Oxford, United Kingdom:Taylor & Francis;2006:93–115.

Candida sp



Fuertemente asociados a:

Mayor riesgo de sepsis neonatal.

Mayor riesgo de resultados adversos neonatales: DBP, ECN y PC.

Figure 3. A. Necrotizing funisitis due to Candida funisitis. Candida funisitis is seen as punctate, 1- to 2-mm,yellow-white nodules on the cord. They generally track the coils of the cord vessels and are noted initiallyalong the perimeter of the umbilical vein. A hand lens and tangential lighting are helpful in detecting theirpresence. B. Hematoxylin-eosin (routine) stained section of subamniotic microabscess typical of candidalfunisitis. The lesion is highly characteristic but not specific for the organism. C. Candida pseudohyphaerevealed with Gomori methenamine silver (GMS) stain in subamniotic foci in a low-power photomicrographof an umbilical cord with subamniotic microabscesses. Figure 3A is reprinted with permission from Faye-Petersen OM, Heller DS, Joshi VV. Handbook of Placental Pathology. 2nd ed. Oxford, United Kingdom: Taylor& Francis; 2006:93–115.



Respuesta inflamatoria materna:

Mayor riesgo de mortalidad perinatal y sepsis neonatal:

Corioamnionitis necrotizante.Microabscesos subcoriónicos.




Respuesta fetal de la vasculitis coriónicay umbilical intensas, con daño de la pa-red vascular o perivasculitis concéntrica de los vasos umbilicales se asocia con:

Infección intrauterina.Parto pretérmino.Muerte perinatal.



Síndrome de respuesta inflamatoria sistémica fetal (F/SIRS)

Parto prematuro.Sepsis neonatal.Displasia broncopulmonar.Enterocolitis necrotizante.Parálisis cerebral (PC).



Parálisis cerebral

Shatrov JG, et al. Chorioamnionitis and Cerebral Palsy. A Meta-Analysis. Obstet Gynecol ©2010 Aug;116(2):387-392.

2.41 1.83


Parálisis cerebral

>50% RN con PC son de término.

PC: 2 x 1,000 nv.

Disfunción motora no progresiva congénita caracterizada por espasticidad, rigidez o coreoatetosis.

Racinet C, Hoffmann P. Perinatal asphyxia and cerebral palsy: medicolegal implications. Bull Acad Natl Med. ©2010 Jun;194(6):891-901.Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.


Parálisis cerebral

Asfixia al nacimiento.

La creciente evidencia:

Infección e inflamación intrauterina.

Boog G. Cerebral palsy and perinatal asphyxia (II--Medicolegal implications and prevention). Gynecol Obstet Fertil. 2011 Mar;39(3):146-73.Racinet C, Hoffmann P. Perinatal asphyxia and cerebral palsy: medicolegal implications. Bull Acad Natl Med. ©2010 Jun;194(6):891-901.


*Estudios poblacionales han demostrado que la asfixia aguda periparto es unacausa rara de PC. Este trastorno generalmente se debe a factores prenatales.


El estudio anatomopatológico de la placenta proporcionainformación de gran relevancia para el neonatólogo enlos casos de sospecha de infección intrauterina y debeser solicitada en todos los partos pretérminos.

CAA con vasculitis de la placa coriónica o funisitis tieneimportantes consecuencias para el pronóstico del RN ypuede presagiar los riesgos de un posterior diagnósticode PC.


corioamnionitis y funisitis. consecuencias para el neonato

Health & Medicine

corioamnionitis y funisitis

candida funisitis

necrotizing funisitis

consecuencias para

risk factors of funisitis

histologic chorioamnionitis

ecn y pc

fayepetersen om