Amniotic Infection Syndrome: Nosology and Reproducibility of Placental Reaction Patterns

SAGE Publications - Tập 6 Số 5 - Trang 435-448 - 2003
Raymond W. Redline1, Ona Faye-Petersen2, Debra S. Heller3, Faisal Qureshi4, Van H. Savell5, Carole Vogler6
1Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
2University of Alabama at Birmingham, Birmingham, AL
3University of Medicine and Dentistry of New Jersey‐New Jersey Medical School, Newark, NJ
4Hutzel Site and Wayne State University, Detroit, MI
5Driscoll Children’s Hospital, Corpus Christie, TX
6St. Louis University School of Medicine, St. Louis, MO

Tóm tắt

Clinically responsive placental examination seeks to provide useful information regarding the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to assemble and validate a complete set of the placental reaction patterns seen with amniotic fluid infection in the hope that this might provide a standardized diagnostic framework useful for practicing pathologists. Study cases (14 with amniotic fluid infection, 6 controls) were reviewed blindly by six pathologists after agreement on a standard set of diagnostic criteria. After analysis of initial results, criteria were refined and a second, overlapping set of cases were reviewed. Majority vote served as the gold standard. Grading and staging of maternal and fetal inflammatory responses was found to be more reproducible using a two- versus three-tiered grading system than a three-versus five-tiered staging system (overall agreement 81% vs. 71%). Sensitivity, specificity, and efficiency for individual observations ranged from 67–100% (24/30 > 90%). Reproducibility was measured by unweighted kappa values and interpreted as follows: < 0.2, poor; 0.2–0.6, fair/moderate; > 0.6, substantial. Kappa values for the 12 lesions evaluated in 20 cases by the six pathologists were: acute chorioamnionitis/maternal inflammatory response (any, 0.93; severe 0.76; advanced stage, 0.49); chronic (subacute) chorioamnionitis (0.25); acute chorioamnionitis/fetal inflammatory response (any, 0.90; severe, 0.55; advanced stage, 0.52); chorionic vessel thrombi (0.37); peripheral funisitis (0.84); acute villitis (0.90); acute intervillositis/intervillous abscesses (0.65), and decidual plasma cells (0.30). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a framework for future clinical research.

Từ khóa


Tài liệu tham khảo

10.1097/00003081-195902030-00010

Naeye RL, 1992, Diagnosis and Clinical Significance, 174

Navarro C, 1974, A variant of cord inflammation with a high rate of perinatal infection. J. Pediatr., 85, 689

10.1001/archpedi.1977.02120240042009

10.1016/S0046-8177(83)80178-6

10.1016/S0002-9378(88)80084-X

Mueller-Heubach E, 1990, Obstet. Gynecol., 75, 622

10.1097/00004347-199107000-00001

10.1080/15513819609169300

Leviton A, 1999, Developmental Epidemiology Network Investigators. Pediatr. Res., 46, 566

Redline RW, 2000, Arch. Pathol. Lab. Med., 124, 1785, 10.5858/2000-124-1785-PLAWCP

10.1016/S0002-9378(98)70272-8

10.1097/00001703-199402000-00003

Sun CC, 2002, Arch. Pathol. Lab. Med., 126, 706, 10.5858/2002-126-0706-DIPDOP

10.1136/jcp.48.5.420

10.1046/j.1365-3016.2000.00253.x

Langston C, 1997, Arch. Pathol. Lab. Med., 121, 449

10.2307/2529310

Redline RW, 1998, Arch. Pathol. Lab. Med., 122, 1091

10.1056/NEJM200005183422007

10.1111/j.1471-0528.1985.tb03050.x

10.1016/S0002-9378(12)90420-2

10.1016/0002-9378(93)90341-F

10.1016/S0002-9378(99)70225-5

Pankuch GA, 1984, Obstet. Gynecol., 64, 802

10.1097/00004347-198501000-00001

10.1056/NEJM198810133191503

10.1016/0002-9378(92)91609-E

Blanc W., 1980, Perinatal Infections, CIBA Foundation Symposium 77, 17, 10.1002/9780470720608.ch3

10.1203/00006450-200211000-00017

DiSalvo D., 1998, The Developmental Epidemiology Network Investigators. Pediatr. Res., 43, 15

10.1053/hupa.2001.24992

10.1067/mob.2001.116689

10.1053/hupa.2002.32214

10.1016/S0002-9378(97)70082-6

Spong C, 1996, Am. J. Obstet. Gynecol., 174, 490

10.1007/s100249900014

Driscoll SG, 1962, Obstet. Gynecol, 216

10.1016/S0143-4004(83)80009-5

10.3109/15513819609168723

Lachapelle MH, 1996, J. Immunol., 156, 4027, 10.4049/jimmunol.156.10.4027

10.1016/S0046-8177(99)90307-6

10.1016/S0046-8177(85)80159-3

10.1016/S0015-0282(16)43448-5

10.1097/00001703-199507010-00003

10.1097/00004347-199107000-00001

10.1016/S0046-8177(98)90016-8

10.1053/hupa.2002.31291

10.1097/00125480-200211000-00011

10.1016/S0046-8177(00)80241-5

10.1046/j.1365-3016.1999.00214.x

Thông tin
Thông tin xuất bản

SAGE Publications

Tập 6 Số 5

435-448

Thông tin tác giả