Earliest Warning Sign Indicates Need to Test For Condition Associated With Fetal Deaths

By Lois Baker

Release Date: May 11, 1998

NEW ORLEANS -- Physicians traditionally have looked for the presence of at least three of several known clinical signs of chorioamnionitis before ordering a test for the condition, an inflammation of the fetal membranes that is a risk factor for fetal death.

Researchers at the University at Buffalo are recommending that the presence of only one of the known clinical signs is sufficient reason to conduct a diagnostic test for the condition, which they found present in nearly one-third of perinatal deaths recorded at a regional perinatal center during an eight-year period.

Results of the research were reported here today (May 11, 1998) by Lawrence J. Gugino, M.D., UB associate professor of gynecology and obstetrics and lead author, at the 46th annual clinical meeting of the American College of Obstetricians and Gynecologists.

Chorioamnionitis is associated with premature rupture of the fetal membrane and premature delivery. Both are independent risk factors for fetal death.

Gugino and colleagues reviewed the records of 804 perinatal deaths that occurred in Children's Hospital of Buffalo, a regional perinatal center, between 1988 and 1996. Chorioamnionitis was found to be present in 243, or about one-third of these cases, as determined by analysis of placental tissue.

Perinatal deaths include those that occur in utero and up to a month after birth. Traditionally, at least three of several possible clinical indicators -- including maternal fever, elevated white cell count, uterine tenderness, foul-smelling discharge and increased fetal heartbeat -- were considered necessary to justify screening for chorioamnionitis, Gugino said.

By comparing patient records during the pregnancy with results of the laboratory analysis of placental tissue after the fetal or infant death, Gugino and colleagues found that if only one of these symptoms is present, chorioamnionitis should be suspected and patients should be tested for the condition.

"The presence of one or more clinical signs or symptoms was found to be both a sensitive and specific screening method for suspected chorioamnionitis," Gugino said.

"This finding suggests that it would be prudent to take action to confirm the diagnosis and begin treatment if necessary, based on one indicator," Gugino said. "The likelihood is great that chorioamnionitis is present."

Additional investigators on the study were Paul T. Buerger, M.D.; Jean Wactawski-Wende, Ph.D., and John Fisher, M.D., all of the UB Department of Gynecology-Obstetrics.