Acute Placental Villitis as Evidence of Fetal Sepsis: An Autopsy Case Report
Acute Placental Villitis as Evidence of Fetal Sepsis: An Autopsy Case Report
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DOI：
10.2350/15-06-1656-cr.1
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发表时间：
2016-03-01
影响因子：
1.9
通讯作者：
Kim, Jung-Sun
中科院分区：
文献类型：
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作者：
Bae, Go Eun;Yoon, Nara;Kim, Jung-Sun
急性胎盘绒毛炎是非常罕见的，被认为是子宫内胎儿败血症的表现，通常由大肠杆菌或B组链球菌引起。我们报告一个早期B族链球菌感染引起的急性胎盘绒毛炎及急性坏死性绒毛膜炎合并胎儿宫内死亡的病例。一位36岁的女性在怀孕21周时出现胎动减少和发热。超声显示胎儿宫内死亡。分娩后，胎盘显示绒毛膜绒毛中多灶性嗜中性粒细胞浸润，最显著的是滋养层基底膜下，这也伴随着急性坏死性绒毛膜炎。在绒毛血管以及胎儿的主要器官中检测到革兰氏阳性微生物，这与从母体血液中培养的无乳链球菌（B组）一致。急性胎盘绒毛膜炎应被认为是胎儿败血症的证据，与单独的急性绒毛膜炎相关的羊膜内感染相比，胎儿败血症通常具有致命的临床结局。
Acute placental villitis is very rare and believed to reflect overwhelming fetal sepsis in utero, commonly caused by Escherichia coli or group B streptococci. We present a case of intrauterine fetal death associated with acute placental villitis and acute necrotizing chorioamnionitis by early-onset group B streptococcal infection. A 36-year-old woman presented with decreased fetal movement and fever at 21 weeks of gestation. Ultrasound demonstrated intrauterine fetal death. After delivery, the placenta revealed multifocal neutrophilic infiltration in chorionic villi, most prominently beneath the trophoblast basement membrane, which was also accompanied by acute necrotizing chorioamnionitis. Gram-positive microorganisms were detected in villous vessels as well as in the major organs of the fetus, which was consistent with Streptococcus agalactiae (group B) cultured from maternal blood. Acute placental villitis should be recognized as evidence of fetal sepsis that often has lethal clinical outcome, as compared to intra-amniotic infection associated with acute chorioamnionitis alone.