Chorioamnionitis

What clinical criteria are used to diagnose chorioamnionitis?

Objective and subjective clinical criteria, as well as laboratory criteria, are used to diagnose chorioamnionitis. The main symptoms include:

• Febrile fever — an increase in body temperature $\ge$ 38.0°C, chills, and worsening general condition.
• Maternal tachycardia — heart rate $\ge$ 100 beats per minute.
• Fetal tachycardia — heart rate $\ge$ 160 beats per minute.
• Pathological discharge — purulent or mucopurulent vaginal discharge, sometimes with a foul odor.
• Uterine tenderness — determined upon objective palpation.

Additionally, laboratory signs are taken into account: increasing leukocytosis, positive C-reactive protein, and procalcitonin test.

Which microorganisms are the most common causative agents of chorioamnionitis?

Causative agents of chorioamnionitis are predominantly bacteria, as well as their associations. The infectious process is most frequently caused by the following microorganisms:

• Anaerobes — obligate non-spore-forming and other species.
• Enterococci — representatives of the microflora.
• Streptococci — Gram-positive bacteria.
• Staphylococci — Gram-positive cocci.

Chlamydia, mycoplasmas, ureaplasmas, viruses, and fungi are significantly less common causes of inflammation of the fetal membranes.

What anatomical anomalies of umbilical cord development are distinguished in obstetrics?

In obstetric practice, several groups of anatomical anomalies of umbilical cord development are distinguished. These include:

• Changes in length — absolutely or relatively short, as well as long umbilical cord.
• Changes in thickness — thin umbilical cord.
• Umbilical cord knots — true and false knots.
• Pathological insertion (insertio velamentosa) — marginal or velamentous insertion.
• Improper vascular development — anomalies in the number of vessels (e.g., single umbilical artery).
• Mass lesions — hematomas, cysts, hemangiomas, and teratomas.

What causes lead to the development of oligohydramnios?

Oligohydramnios is caused by:

• Congenital malformations of the fetal urogenital system, including renal agenesis and other anomalies accompanied by decreased urine production.
• Placental insufficiency, which may be accompanied by fetal growth restriction and oligohydramnios.
• Post-term pregnancy: after 41 weeks, a pronounced decrease in amniotic fluid volume is characteristic.

Specific causes and their combinations require taking into account the condition of the fetus and concomitant pathology.

What diagnostic methods are used to assess amniotic fluid volume?

Ultrasonography using objective semi-quantitative echographic criteria is used to assess amniotic fluid volume. The main methods include:

• Depth of the free amniotic fluid pocket — measurement of the maximum vertical pocket (normally 2–8 cm).
• Amniotic fluid index — a more accurate method representing the sum of the maximum pocket dimensions in four quadrants of the uterine cavity (normally 8–18 cm).

These methods make it possible to diagnose amniotic fluid volume pathology by assessing the spaces free of the fetus and umbilical cord.

Which structural anomalies of the placenta are risk factors for perinatal complications?

Pathological structural changes of the placenta include:

• Placental hyperplasia — mass of 1000 g or more.
• Placental hypoplasia — mass less than 400 g at term pregnancy; is an indirect sign of placental insufficiency.
• Placental infarctions associated with impaired placental hemodynamics, microthrombosis, and prolonged spasm of spiral arteries.
• Placental neoplasms, including chorioangioma and gestational trophoblastic disease.
• Placental cysts and calcification detected on ultrasound.
• In decompensated placental insufficiency: poor villous vascularization, stromal sclerosis, and reduction of the vascular bed.

Which nosological forms are included in the classification of gestational trophoblastic disease?

The classification of gestational trophoblastic disease includes:

• Complete hydatidiform mole;
• Invasive mole;
• Choriocarcinoma;
• Placental site trophoblastic tumor;
• Epithelioid trophoblastic tumor.