Volume 10, Issue 4 (2025)
SJMR 2025, 10(4): 197-202 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Alijani L, Mohammadian H, Sanaye Naderi M, Nateghi M R. Management of Acute Necrotizing Chorioamnionitis Associated with Umbilical Cord Panvasculitis: A Case Report. SJMR 2025; 10 (4) : 5
URL: http://saremjrm.com/article-1-383-en.html
URL: http://saremjrm.com/article-1-383-en.html
1- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
3- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
4- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
2- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran.
3- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Sciences, Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
4- Sarem Gynecology, Obstetrics and Infertility Research Center, Sarem Women’s Hospital, Iran University of Medical Science (IUMS), Tehran, Iran. & Sarem Cell Research Center (SCRC), Sarem Women’s Hospital, Tehran, Iran.
Abstract: (29 Views)
Background and Objective: Chorioamnionitis is a serious infectious complication of pregnancy associated with significant maternal and fetal morbidity and mortality. Acute necrotizing chorioamnionitis, particularly when accompanied by umbilical cord panvasculitis, represents a severe inflammatory process indicating fetal inflammatory response. This report aims to describe the diagnostic and therapeutic challenges in managing a case of acute necrotizing chorioamnionitis with panvasculitis in a high-risk pregnancy.
Case Presentation: A 29-year-old pregnant woman (G2P0Ab1) at 24 weeks of gestation, with a history of cervical cerclage and recurrent genital tract infections, was admitted with abdominal pain and vaginal bleeding. Despite the absence of classical signs of intra-amniotic infection, preterm premature rupture of membranes occurred, followed by worsening symptoms, leading to an emergency cesarean section. Intraoperative findings suggested severe intrauterine infection. Microbiological cultures revealed Enterobacter cloacae complex resistant to initial empirical antibiotics. Histopathological examination of the placenta and umbilical cord confirmed acute necrotizing chorioamnionitis with panvasculitis. Following antibiotic modification based on antibiogram results, the patient showed clinical improvement and was discharged in good condition.
Conclusion: This case highlights the importance of close surveillance of high-risk pregnancies after cervical cerclage, awareness of atypical presentations of intra-amniotic infection, and the critical role of placental pathology and targeted antibiotic therapy. Early recognition and timely multidisciplinary management are essential to reduce adverse maternal and fetal outcomes.
Case Presentation: A 29-year-old pregnant woman (G2P0Ab1) at 24 weeks of gestation, with a history of cervical cerclage and recurrent genital tract infections, was admitted with abdominal pain and vaginal bleeding. Despite the absence of classical signs of intra-amniotic infection, preterm premature rupture of membranes occurred, followed by worsening symptoms, leading to an emergency cesarean section. Intraoperative findings suggested severe intrauterine infection. Microbiological cultures revealed Enterobacter cloacae complex resistant to initial empirical antibiotics. Histopathological examination of the placenta and umbilical cord confirmed acute necrotizing chorioamnionitis with panvasculitis. Following antibiotic modification based on antibiogram results, the patient showed clinical improvement and was discharged in good condition.
Conclusion: This case highlights the importance of close surveillance of high-risk pregnancies after cervical cerclage, awareness of atypical presentations of intra-amniotic infection, and the critical role of placental pathology and targeted antibiotic therapy. Early recognition and timely multidisciplinary management are essential to reduce adverse maternal and fetal outcomes.
Article number: 5
Article Type: Case Report |
Subject:
Pregnancy Care
Received: 2026/02/21 | Accepted: 2026/02/21 | Published: 2026/02/21
Received: 2026/02/21 | Accepted: 2026/02/21 | Published: 2026/02/21
References
1. 1. Jung E, Romero R, Suksai M, Gotsch F, Chaemsaithong P, Erez O et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. Am J Obstet Gynecol 2024;230:S807-s40. [DOI:10.1016/j.ajog.2023.02.002] [PMID] []
2. Romero R, Pacora P, Kusanovic JP, Jung E, Panaitescu B, Maymon E et al. Clinical chorioamnionitis at term X: microbiology, clinical signs, placental pathology, and neonatal bacteremia - implications for clinical care. Journal of perinatal medicine 2021;49:275-98. [DOI:10.1515/jpm-2020-0297] [PMID] []
3. Zaki D, Balayla J, Beltempo M, Gazil G, Nuyt AM, Boucoiran I. Interaction of chorioamnionitis at term with maternal, fetal and obstetrical factors as predictors of neonatal mortality: a population-based cohort study. BMC pregnancy and childbirth 2020;20:454. [DOI:10.1186/s12884-020-03142-0] [PMID] []
4. Boskabadi H, Zakerihamidi M. Evaluation of Maternal Risk Factors, Delivery, and Neonatal Outcomes of Premature Rupture of Membrane: A Systematic Review Study. Journal of Pediatrics Review 2019;7:77-88. [DOI:10.32598/jpr.7.2.77]
5. Zullo F, Di Mascio D. Management of cervical cerclage after preterm premature rupture of membranes: an argument for removal. American journal of obstetrics & gynecology MFM 2025;7:101570. [DOI:10.1016/j.ajogmf.2024.101570] [PMID]
6. van Dijk CE, Breuking SH, Jansen S, Limpens JCEJM, Kazemier BM, Pajkrt E. Perioperative complications of a transvaginal cervical cerclage in singleton pregnancies: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology 2023;228:521-34.e19. [DOI:10.1016/j.ajog.2022.10.026] [PMID]
7. Cappelletti M, Presicce P, Kallapur S. Immunobiology of Acute Chorioamnionitis. Frontiers in Immunology 2020;11:649. [DOI:10.3389/fimmu.2020.00649] [PMID] []
8. Ducey J, Owen A, Coombs R, Cohen M. Vasculitis as part of the fetal response to acute chorioamnionitis likely plays a role in the development of necrotizing enterocolitis and spontaneous intestinal perforation in premature neonates. European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie 2015;25:284-91. [DOI:10.1055/s-0034-1373849] [PMID]
9. Villamor-Martinez E, Fumagalli M, Mohammed Rahim O, Passera S, Cavallaro G, Degraeuwe P et al. Chorioamnionitis Is a Risk Factor for Intraventricular Hemorrhage in Preterm Infants: A Systematic Review and Meta-Analysis. Frontiers in physiology 2018;9:1253. [DOI:10.3389/fphys.2018.01253] [PMID] []
10. Tita AT, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clinics in perinatology 2010;37:339-54. [DOI:10.1016/j.clp.2010.02.003] [PMID] []
11. Carter SWD, Neubronner S, Su LL, Dashraath P, Mattar C, Illanes SE et al. Chorioamnionitis: An Update on Diagnostic Evaluation. Biomedicines 2023;11:2922. [DOI:10.3390/biomedicines11112922] [PMID] []
12. Intra J, Carcione D, Sala RM, Siracusa C, Brambilla P, Leoni V. Antimicrobial Resistance Patterns of Enterobacter cloacae and Klebsiella aerogenes Strains Isolated from Clinical Specimens: A Twenty-Year Surveillance Study. Antibiotics (Basel, Switzerland) 2023;12: [DOI:10.3390/antibiotics12040775] [PMID] []
13. Rallis D, Giapros V, Serbis A, Kosmeri C, Baltogianni M. Fighting Antimicrobial Resistance in Neonatal Intensive Care Units: Rational Use of Antibiotics in Neonatal Sepsis. Antibiotics 2023;12:508. [DOI:10.3390/antibiotics12030508] [PMID] []
14. Derese TN, Wondafrash MD, Teka AM, Mideksa HS, Mario LD, Hundie TG et al. Chorioamnionitis and its associated factors among women admitted to the maternity unit of Public Hospitals in Addis Ababa, Ethiopia. PLOS global public health 2025;5:e0004467. [DOI:10.1371/journal.pgph.0004467] [PMID] []
15. Aljerian K. Chorioamnionitis: Establishing a correlation between clinical and histological diagnosis. Indian Journal of Pathology and Microbiology 2020;63:44-48. [DOI:10.4103/IJPM.IJPM_464_19] [PMID]
16. Kay VR, Liang I, Turvey S, Vandersluis A, Norgaard A, Twiss J et al. Characteristics and Management of Chorioamnionitis at an Academic Centre in Ontario Before and After Implementation of an Order Set. Journal of Obstetrics and Gynaecology Canada 2024;46:102430. [DOI:10.1016/j.jogc.2024.102430] [PMID]
17. van der Krogt L, Malligiannis Ntalianis K, Resta C, Suff N, Shennan A, Story L. The role of cervical cerclage in preventing preterm birth. European Journal of Obstetrics & Gynecology and Reproductive Biology 2025;311:114060. [DOI:10.1016/j.ejogrb.2025.114060] [PMID]
18. Strong TH, Jr. Amnioinfusion with preterm, premature rupture of membranes. Clinics in perinatology 1992;19:399-409. [DOI:10.1016/S0095-5108(18)30463-9]
19. Redline RW, Ravishankar S, Bagby CM, Saab ST, Zarei S. Four major patterns of placental injury: a stepwise guide for understanding and implementing the 2016 Amsterdam consensus. Modern Pathology 2021;34:1074-92. [DOI:10.1038/s41379-021-00747-4] [PMID]
20. Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol 2015;213:S29-52. [DOI:10.1016/j.ajog.2015.08.040] [PMID] []
21. Miselli F, Cuoghi Costantini R, Creti R, Sforza F, Fanaro S, Ciccia M et al. Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis. Microorganisms 2022;10. [DOI:10.3390/microorganisms10101878] [PMID] []
22. Jung E, Romero R, Suksai M, Gotsch F, Chaemsaithong P, Erez O et al. Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment. American Journal of Obstetrics & Gynecology 2024;230:S807-S40. [DOI:10.1016/j.ajog.2023.02.002] [PMID] []
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
