351: Effect of chorionic-vasculitis on intraamniotic and maternal inflammatory-responses with the progression of inflammation in umbilical-cord

Abstract

Both vasculitis in chorionic plate(CP) and phlebitis in umbilical cord(UC) have been regarded as the same stage 1 of fetal inflammatory response(FIR) in ascending intrauterine infection(AIUI). However, there is no information about the intensity of intra-amniotic inflammatory response(IAIR) and the frequency of maternal inflammatory response(MIR) in AIUI according to the presence or absence of chorionic vasculitis(CV) in the context of the progression of inflammation in UC. The objective of current study is to examine this issue. Study population included 293singleton preterm birth(≤35wks) due to either PTL or preterm PROM with amniotic fluid(AF) obtained within 4days of delivery. We examined the intensity of IAIR and the frequency of MIR in AIUI according to the presence or absence of CV in the context of the progression of inflammation in UC(i.e., inflammation-free UC; inflammation restricted to umbilical vessels without extension into Wharton’s jelly[WJ]; and inflammation extended into WJ). IAIR was determined by AF MMP-8 concentrations, and the frequency of MIR in AIUI was assessed by the presence of either amnionitis or severe grade amnionitis. CV was present in 0%, 8% and 27% in the context of inflammation-free UC, inflammation restricted to umbilical vessels, and inflammation extended into WJ. Median AF MMP-8 level was higher in cases with CV than in those without CV in the context of inflammation restricted to umbilical vessels(Fig.1[a]), but not inflammation extended into WJ(Fig.1[b]). Severe grade amnionitis was more frequent in cases with CV than in those without CV in the context of both inflammation restricted to umbilical vessels(Fig.2[a]) and inflammation extended into WJ(Fig.2[b]) although the frequency of amnionitis was not different between two groups. CV is rare but associated with more intense IAIR and frequent severe grade MIR in AIUI in the context of inflammation restricted to umbilical vessels. This finding may lead to the reconsideration of current classification that CV and umbilical phlebitis are treated on an equal stage of FIR in AIUI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)