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| Funisitis |
| Etiology •mostly bacteria •low virulence organisms , normal flora of vagina or •obvious pathogens such as E.Coli, Mycoplasma, Ureaplasma |
| Pathogenesis • bacteria ascending from vagina, breaching cervical defenses (mucus plug etc.) • bacterial colonization of intrauterine space through intact or ruptured membranes • maternal and fetal acute inflammatory response, |
| Epidemiology •clinically evident in 0.5-10% of pregnancies |
| General Gross Description •membranes and chorionic plate appear cloudy and occasionally have a yellow or green tint •in severe cases the umbilical cord may have small yellow round lesions on its surface which represent foci of PMN's (small abscesses) |
| General Microscopic Description •Chorioamnionitis: membranes (amnion and chorion + parietal decidua) show neutrophilic infiltrate. PMN's originate from maternal vessels in parietal decidua and migrate into chorion and then amnion. •Chorionitis: chorionic plate shows neutrophilic infiltrate. PMN's orginate from maternal intervillous space and migrate into subchorionic fibrin, chorion itself and then amnion •Funisitis: umbilical cord shows neutrophilic infiltrate. PMN's orginate in the fetal vessels of the umbilical cord and migrate sequentially through the muscular layers of the vessel and then into the Wharton's jelly. •Chorionic vasculitis: chorionic vessels show neutrophils in wall. PMN's originate in the fetal vessels of the chorionic plate and migrate through the walls of the fetal vessels toward the amniotic fluid |
| Clinical Correlation •associated with preterm birth •only 8-25% of mothers have symptoms such as fever, chills •fetus may have decreased biophysical profile score or abnormal heart rate pattern •can lead to congenital pneumonia, gastroenteritis, menigitis, sepsis although most infants do not have sepsis even with umbilical cord inflammation |
| References •Gibbs and Sweet "Maternal and Fetal Infections" (chapter 42) in Creasy and Resnik, Maternal Fetal Medicine: Principles and Practices 3rd edition; Philadelphia: WB Saunders, 1994, p644-646. |
| Funisitis |
| Synopsis by: Linda Ernst (T88800M41000)[226] |
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