Corioamnionitis y funisitis. consecuencias para el neonato. (Chorioamnionitis and funisitis. Implications for the neonate)

1. Corioamnionitis y funisitis:
Consecuencias para el neonato

2. 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.

3. Corioamnionitis y funisitis:
Consecuencias para el Neonato

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

5. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Lee SM, et al. The risk of intra-amniotic infection, inflammation and histologic chorioamnionitis in term pregnant women with intact membranes
and labor. Placenta ©2011 Jul;32(7):516-21.

6. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Hematógena
Contiguidad
Ascendent e
Goldenberg RL, et al. Mechanisms of disease: Intrauterine Infection and Preterm Delivery. NEJM ©2000;342(20):1500-7.

7. Corioamnionitis y funisitis:
Consecuencias para el Neonato
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.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

8. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Gantert M, et al. Chorioamnionitis: a multiorgan disease of the fetus? J Perinatol ©2010;30:S21–S30.

9. Corioamnionitis y funisitis:
Consecuencias para el Neonato

10. Corioamnionitis y funisitis:
Consecuencias para el Neonato
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.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

11. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Síndrome de respuesta inflamatoria sistémica fetal (F/SIRS)
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

12. Corioamnionitis y funisitis:
Consecuencias para el Neonato
CORIOAMNINITIS Y FUNISITIS
CORIOAMNINITIS AGUDA
Actinomyces sp
Escherichia coli Prevotella bivia
Mycoplasma hominis Corynebacterium sp
Ureaplasma urealyticum Escherichia coli
group B Streptococcus Peptostreptococcus magnus
Staphylococcus group B, group D, alpha-
Pseudomonas hemolytic, and anaerobic
Proteus streptococci
Klebsiella Mycoplasma sp
Fusobacterium sp. Ureaplasma urealyticum
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

13. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Candida sp
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 tangential
lighting are helpful in detecting their presence. B. Hematoxylin-eosin (routine) stained section of subamniotic microabscess typical of candidal
funisitis. The lesion is highly characteristic but not specific for the organism. C. Candida pseudohyphae revealed with Gomori methenamine
silver (GMS) stain in subamniotic foci in a low-power photomicrograph of 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.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

14. Corioamnionitis y funisitis:
Consecuencias para el Neonato
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 initially
along the perimeter of the umbilical vein. A hand lens and tangential lighting are helpful in detecting their
presence. B. Hematoxylin-eosin (routine) stained section of subamniotic microabscess typical of candidal
funisitis. The lesion is highly characteristic but not specific for the organism. C. Candida pseudohyphae
revealed with Gomori methenamine silver (GMS) stain in subamniotic foci in a low-power photomicrograph
of 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.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

15. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Respuesta inflamatoria materna:
Mayor riesgo de mortalidad perinatal
y sepsis neonatal:
Corioamnionitis necrotizante.
Microabscesos subcoriónicos.
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 tangential lighting are helpful in detecting their
presence. B. Hematoxylin-eosin (routine) stained section of subamniotic microabscess typical of candidal
funisitis. The lesion is highly characteristic but not specific for the organism. C. Candida pseudohyphae
revealed with Gomori methenamine silver (GMS) stain in subamniotic foci in a low-power photomicrograph
of 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.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

16. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Respuesta fetal de la vasculitis coriónica
y 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.
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 tangential lighting are helpful in detecting their
presence. B. Hematoxylin-eosin (routine) stained section of subamniotic microabscess typical of candidal
funisitis. The lesion is highly characteristic but not specific for the organism. C. Candida pseudohyphae
revealed with Gomori methenamine silver (GMS) stain in subamniotic foci in a low-power photomicrograph
of 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.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

17. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Goldenberg RL, et al. Mechanisms of disease: Intrauterine Infection and Preterm Delivery. NEJM ©2000;342(20):1500-7.

18. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Popowski T, et al. BMC Pregnancy and Childbirth 2011, 11:26.
Goldenberg RL, et al. Mechanisms of disease: Intrauterine Infection and Preterm Delivery. NEJM ©2000;342(20):1500-7.

19. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Tita AT, Andrews WW. Diagnosis and Management of Clinical Chorioamnionitis. Clin Perinatol ©2010 Jun;37(2):339–354.

20. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Síndrome de respuesta inflamatoria sistémica fetal (F/SIRS)
Parto prematuro.
Sepsis neonatal.
Displasia broncopulmonar.
Enterocolitis necrotizante.
Parálisis cerebral (PC).
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

21. Corioamnionitis y funisitis:
Consecuencias para el Neonato

22. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Parálisis cerebral
2.41 1.83
Shatrov JG, et al. Chorioamnionitis and Cerebral Palsy. A Meta-Analysis. Obstet Gynecol ©2010 Aug;116(2):387-392.

23. Corioamnionitis y funisitis:
Consecuencias para el Neonato
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.

24. Corioamnionitis y funisitis:
Consecuencias para el Neonato
Parálisis cerebral
Asfixia al nacimiento.
La creciente evidencia:
Infección e inflamación intrauterina.
*Estudios poblacionales han demostrado que la asfixia aguda periparto es una
causa rara de PC. Este trastorno generalmente se debe a factores prenatales.
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.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.

25. Corioamnionitis y funisitis:
Consecuencias para el Neonato
El estudio anatomopatológico de la placenta proporciona
información de gran relevancia para el neonatólogo en
los casos de sospecha de infección intrauterina y debe
ser solicitada en todos los partos pretérminos.
CAA con vasculitis de la placa coriónica o funisitis tiene
importantes consecuencias para el pronóstico del RN y
puede presagiar los riesgos de un posterior diagnóstico
de PC.
Reilly SD and Faye-Petersen OM. Chorioamnionitis and Funisitis: Their Implications for the Neonate. NeoReviews ©2008;9;e411-e417.