Consonni, S.; Salmoiraghi, E.; Vaglio Tessitore, I.; Pintucci, A.; Vitale, V.; Calzi, P.; Moltrasio, F.; Locatelli, A. Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term. Preprints2023, 2023030550. https://doi.org/10.20944/preprints202303.0550.v1
APA Style
Consonni, S., Salmoiraghi, E., Vaglio Tessitore, I., Pintucci, A., Vitale, V., Calzi, P., Moltrasio, F., & Locatelli, A. (2023). Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term. Preprints. https://doi.org/10.20944/preprints202303.0550.v1
Chicago/Turabian Style
Consonni, S., Francesca Moltrasio and Anna Locatelli. 2023 "Intra-Amniotic Inflammation or Infection: Suspected and Confirmed Diagnosis of “Triple I” at Term" Preprints. https://doi.org/10.20944/preprints202303.0550.v1
Abstract
Chorioamnionitis (CA) at term of pregnancy can have infectious and/or inflammatory origin and is associated with adverse outcomes. Triple I (Intrauterine Inflammation, Infection or both, TI) has been proposed to reduce the overdiagnosis of infection and the neonatal overtreatment. The aim of the study is to identify clinical and histological variables predicting adverse outcomes when TI has been suspected and/or confirmed. This retrospective cohort study included 404 pregnancies ≥37 g.a. that were divided into 5 all-inclusive and mutually exclusive groups. TI was defined according to NICHD definition of 2015 and it could be confirmed (TI+) or not (TI-) by histological examination. Signs of infection/inflammation not respecting the definition of TI were classified as “Clinical suspicion”, supported (CS+) or not (CS-) by histology. Histological chorioamnionitis (HCA) without clinical manifestation represented fifth group. Whole Placental Involvement (WPLI), was defined as a histological inflammation involving maternal and fetal side. There were 113 TI+, 30 TI-, 186 CS+, 35 CS- and 40 isolated HCA. WPLI was diagnosed in 133 cases (39.2%). Composite neonatal outcome (CNO) occurred in 114 cases (28.2%) while composite maternal outcome (CMO) occurred in 192 cases (47.5%). TI+ compared to CS+ was more predictive of CNO (p=0.001), CMO (p<0.001) and WPLI (p=0.005). WPLI was related both to CNO (p<0.001) and CMO (p=0.046). TI+ and WPLI showed similar sensitivity but different specificity in predicting CNO. At logistic regression, CNO was independently predicted by TI+ (OR 2.21; p=0.001) and by WPLI (OR 2.23; p=0.001). TI, compared to CS, is a better predictor of CNO and can be useful for the identification of newborns at risk.
Medicine and Pharmacology, Obstetrics and Gynaecology
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