Exame microscópico do cório placentário para o diagnóstico rápido de infecção amniótica

• Ano de defesa: 2013
• Autor(a) principal: Fraga, Laura Fregonassi Ribeiro
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Espírito Santo; BR; Mestrado em Doenças Infecciosas; Centro de Ciências da Saúde; UFES; Programa de Pós-Graduação em Doenças Infecciosas
• Palavras-chave em Português: Amniotic Infection; Pregnancy; Neonate; Fetal Membranes; Chorioamnionitis; Pathology; Diagnosis; Gestação; Neonato; Infecção amniótica; Corioamnionite; Teste diagnóstico; Líquido amniótico; Infecção; Membranas fetais; Patologia; Diagnóstico pré-natal; Doenças Infecciosas e Parasitárias; 61
• Link de acesso: http://repositorio.ufes.br/handle/10/5889

Amniotic infection and chorioamnionitis (CAM) are determining factors of maternal and perinatal infections, preterm births and postnatal mortality and morbidity. As none of clinical, microbiological, biochemical, molecular and histopathological proposed methods for CAM diagnosis has achieved broad and routine employment, many cases remain clinical and epidemiologically occult. After Blanc s proposal (1959), this study analysis the placental chorionic sampling and microscopical examination (EECP) at early postpartum period to CAM diagnosis in order to help a timely clinical decision to treat the risk mother and newborn infant. Objectives. To establish the diagnostic value and the reproducibility of EECP compared to conventional histopathology (HP) CAM diagnosis. Material e Methods. Out from all placentas examined between 2008 and 2012, in two Pathology laboratories at Vitória City, southwestern Brazil, one public (HUCAM) and one private (PAT), 1626 were selected including: a cross-sectional sampling (HCT, n: 108) and two consecutive cases series examined after neonatal clinical infection suspicion (HIB, n: 193) and varied others obstetrical indications (PIV, n: 1325). The EECP was done at immediate postpartum period (HIB and HCT) or as the first step of HP examination (PIV). The cases were categorized by study groups, gestational age, perinatal outcome, method of examination, CAM stage and grade, and the statistic indexes of agreement and diagnostic value between the two methods (EECP and HP) were calculated. Results. In overall cases, CAM diagnosis by HP were observed in 12.8% (HCT: 31.5% e PIV: 11.3%) from which 2.4% with a fetal inflammatory response; CAM diagnosis by EECP were observed in 14.2% (HCT: 41.7%, HIB: 31.1% e PIV: 9.1%). The EECP revealed itself to be a fast and easy to perform method, with 50.0% sensitivity, 93.7% specificity, 53.8 predictive positive and 92.7% predictive negative values, and 7.9 likelihood positive and 0.53 likelihood negative ratios. Agreement between EECP and HP were observed in 88.8%, CAM diagnosis only by EECP in 5.7% and only by HP in 5.5% (kappa: 0,45). Conclusion. The EECP method could be an important contribution to fast CAM diagnosis. It is easy to perform, with significant statistic indexes of diagnosis value and can be helpful to guide the clinical decision at early postpartum period.