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Abstract
Objective
To characterize the hematologic profile of preterm fetuses delivered spontaneously with acute histologic chorioamnionitis (HCA).
Methods
This was a retrospective cohort study. The relationship between the presence of acute HCA and the change of hematologic profile was examined in 109 singleton pregnant women who were admitted and delivered between 24-32 weeks of gestation. Cases without results of placental histologic examination, cord blood cell count, and the differential count were excluded. From the cord blood, hemoglobin concentration, hematocrit, mean corpuscular volume, total leucocyte count and the differential count, platelet count, normoblast count, and umbilical arterial pH were obtained. All the observed values were corrected for gestational age by calculating a ratio between the observed and mean expected value for gestational age.
Results
1) The prevalence of acute HCA was 60.6% (66/109); 2) newborns with acute HCA had a higher median corrected leucocyte counts and corrected percentage of neutrophil in the differential count and a lower median corrected percentage of lymphocyte in the differential count than those without acute HCA; 3) neutrophilia was significantly frequent in newborns with acute HCA than in those without acute HCA; and 4) acute HCA was not associated with detectable changes in percentage of monocyte, eosinophil, basophil, and normoblast in the differential count, hemoglobin concentration, hematocrit, erythrocyte counts, mean corpuscular volume, platelet counts, or umbilical arterial pH.
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Fig. 1.
Comparison of the fetal blood absolute and corrected leucocyte counts. (A) Fetuses with acute histologic chorioamnionitis had higher median absolute leucocyte counts than those without acute histologic chorioamnionitis (absolute leucocyte count median 10.5 [range, 1.1-35.4] vs. 6.6 [range, 2.4-15.9] ×109/L, P<0.001). (B) Corrected leucocyte counts by gestational age was also higher in fetuses with acute histologic chorioamnionitis (corrected leucocyte count median 2.31 [range, 0.27-8.68] vs. 1.11 [range, 0.41-3.97], P<0.001). HCA, histologic chorioamnionitis.
Fig. 2.
Comparison of the fetal blood percentage of neutrophil in the differential count and corrected neutrophil counts. (A) Median percentage of neutrophil was higher in fetuses with acute histologic chorioamnionitis than in those without acute histologic chorioamnionitis (median percentage of neutrophil in the differential count 53.5% [range, 5.0-85.1] vs. 32.5% [range, 5.0-71.9], P<0.001). (B) Corrected median percentage of neutrophil counts was also higher in fetuses with acute histologic chorioamnionitis (corrected median percentage of neutrophil counts 5.51 [range, 0.43-11.2] vs. 2.20, [range 0.26-5.75], P<0.001). HCA, histologic chorioamnionitis.
Fig. 3.
Comparison of the fetal blood percentage of lymphocyte in the differential count. (A) Median percentage of lymphocyte was lower in fetuses with acute histologic chorioamnionitis than those without acute histologic chorioamnionitis (median percentage of lymphocyte in the differential count 32.4% [range, 8.3-86.0] vs. 53.0% [range, 18.1-85.0], P<0.001). (B) Corrected percentage of lymphocyte counts was also lower in fetuses with acute histologic chorioamnionitis (corrected median percentage of lymphocyte counts 0.41 [range, 0.12-1.26] vs. 0.69 [range, 0.26-1.24], P<0.001). HCA, histologic chorioamnionitis
Table 1.
Demographic and Clinical Characteristics of the Study Population according to the Presence or Absence of Acute Histologic Chorioamnionitis
| Acute histologic chorioamnionitis | P-value | ||
|---|---|---|---|
| Absent (n=43) | Present (n=66) | ||
| Maternal age (yrs) | 30.2 (22.0-45.0) | 31.5 (25.0-43.0) | 0.314 |
| Nulliparity | 24/43 (55.8) | 28/66 (42.4) | 0.171 |
| Etiology of preterm birth | 0.167 | ||
| Preterm labor | 28/43 (65.1) | 33/66 (50.0) | |
| PROM | 15/43 (34.9) | 33/66 (50.0) | |
| Cesarean delivery | 26/43 (60.5) | 28/66 (42.4) | 0.066 |
| Antenatal corticosteroids use | 32/43 (74.4) | 52/66 (78.8) | 0.596 |
| Antenatal antibiotics use | 22/43 (51.2) | 53/66 (80.3) | 0.001 |
| Tocolytics use | 34/43 (79.1) | 46/66 (69.7) | 0.279 |
| Clinical chorioamnionitis | 1/43 (2.3) | 4/66 (6.1) | 0.646 |
| Gestational age at delivery (wks) | 29.7 (24.0-32.0) | 28.2 (24.1-32.0) | 0.001 |
| Birthweight (g) | 1,410.0 (710.0-2,610.0) | 1,150.0 (530.0-2,020.0) | 0.008 |
| AF WBC count ≥20 cells/mm3∗ | 8/23 (34.8) | 32/51 (62.7) | 0.025 |
| Positive AF culture∗ | 3/23 (13.0) | 12/51 (23.5) | 0.365 |
Values are presented as median (range) or number (%). Abbreviations: PROM, premature rupture of membranes; AF, amniotic fluid; WBC, white blood cell.
∗ Transabdominal amniocentesis was performed only in 40 women from whom we received a written consent. In women without acute histologic chorioamnionitis, 61% (14/23) were diagnosed as having preterm labor. Fifty three percent (27/51) had preterm labor in women with acute histologic chorioamnionitis.
Table 2.
Hematologic Profile of the Fetuses according to the Presence or Absence of Acute Histologic Chorioamnionitis
| Acute histologic chorioamnionitis | P-value | ||
|---|---|---|---|
| Absent (n=43) | Present (n=66) | P-value | |
| Leucocyte (×109/L) | 6.6 (2.4-15.9) | 10.5 (1.1-35.4) | <0.001 |
| Corrected leucocyte | 1.11 (0.41-3.97) | 2.31 (0.27-8.68) | <0.001 |
| Neutrophilia | 25/36 (69.4)† | 52/57 (91.2)‡ | 0.007 |
| Neutropenia | 1/36 (92.8)† | 0/57 (0.0)‡ | 0.387 |
| Percentage of neutrophil (%)∗ | 32.5 (5.0-71.9) | 53.5 (5.0-85.1) | <0.001 |
| Corrected percentage of neutrophil∗ | 2.20 (0.26-5.75) | 5.51 (0.43-11.2) | <0.001 |
| Percentage of lymphocyte (%)∗ | 53.0 (18.1-85.0) | 32.4 (8.3-86.0) | <0.001 |
| Corrected percentage of lymphocyte∗ | 0.69 (0.26-1.24) | 0.41 (0.12-1.26) | <0.001 |
| Percentage of monocyte (%)∗ | 7.2 (2.0-19.0)† | 7.1 (0.0-24.0)‡ | 0.981 |
| Corrected percentage of monocyte∗ | 2.38 (0.67-6.33)† | 2.37 (0.0-8.0)‡ | 0.981 |
| Percentage of eosinophil (%)∗ | 2.6 (0.0-11.0)† | 1.6 (0.0-9.0)‡ | 0.057 |
| Percentage of basophil (%)∗ | 0.1 (0.0-3.4)† | 0.17 (0.0-6.2)‡ | 0.976 |
| Nucleated RBC (/100WBCs) | 10.5 (0.0-237.0)† | 0.9 (0.0-175.0)‡ | 0.114 |
| Corrected nucleated RBC | 0.58 (0.0-12.2)† | 0.04 (0.0-8.33)‡ | 0.098 |
| Erythrocyte (×1012/L) | 3.60 (2.25-4.56) | 3.42 (1.60-5.37) | 0.059 |
| Corrected erythrocyte | 0.99 (0.65-1.31) | 0.97 (0.48-1.41) | 0.217 |
| Hemoglobin (g/dL) | 13.6 (2.4-18.1) | 12.8 (6.0-20.6) | 0.085 |
| Corrected hemoglobin | 1.04 (0.19-1.33) | 0.98 (0.46-1.51) | 0.176 |
| Hematocrit (%) | 41.5 (23.9-54.0) | 39.8 (16.2-61.5) | 0.229 |
| Corrected hematocrit | 1.00 (0.58-1.30) | 0.95 (0.40-1.41) | 0.401 |
| MCV (×10-15/L) | 111.9 (92.1-127.3) | 114.9 (96.4-146.4) | 0.173 |
| Corrected MCV | 0.96 (0.78-1.11) | 0.97 (0.10-1.21) | 0.507 |
| Platelet (×109/L) | 206.0 (16.0-380.0) | 232.5 (7.0-491.0) | 0.190 |
| Corrected platelet | 0.88 (0.06-1.57) | 0.98 (0.03-2.03) | 0.224 |
| Umbilical arterial pH | 7.29 (6.85-7.43)§ | 7.30 (6.91-7.53)II | 0.593 |
| Corrected umbilical arterial pH | 0.99 (0.93-1.00)§ | 0.99 (0.92-1.00)II | 0.480 |
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