Early Path Medical Consultation Services

Early Path Medical Consultation Services
Pathology Services Working for Safer Pregnancies

Chronic Inflammation

Maternal hematogenous (blood-bourne) infections are most often associated with either acute or chronic villitis. Acute villitis and decidual and villous microabscesses are caused by maternal bacterial sepsis. Maternal hematogenous and fetal viral infections are more often associated with chronic villitis or with chronic deciduitis and/or amnionitis. Chronic chorioamnionitis may also be caused by chronic bacterial infections such as syphilis. In chronic villitis, the inflammatory cell types may help determine the etiologic agent but are not specific for different etiologic agents. Chronic villitis is diagnosed by the presence of lymphocytic villous stromal infiltrates which may include lymphocytes, monocyte/macrophages, plasma cells, and, rarely, eosinophils, and may be graded (1-4) by the relative volume and spatial extent of villous involvement.

Chronic villitis may be of undetermined or obscure etiology (sometimes referred to as villitis of undetermined etiology). In some cases it may be only that infectious agents have left no clinically of histologically evident trace. Chronic inflammatory pathology has been a common finding in patients with clinical autoimmune and subclinical (e.g. serologic) evidence of autoimmunity.

Chronic intervillositis, often associated with trophoblastic necrosis, is a chronic lymphohistiocytic inflammation of the intervillous space. Observed in maternal malaria, it more commonly seen in the U.S. in cases of maternal immunologic disease and may also represent a maternal response to placental alloantigens or to autoantigens.

Chronic choriodeciduitis/amnionitis indicates both a denser distribution of decidual lymphocytes than expected and the migration of maternal decidual lymphocytes into the fetal tissues of the chorion and even the amnion.

Chronic uteroplacental vasculitis is significantly more common in early euploid pregnancy loss (correct chromosome count) than in aneuploid pregnancy loss. Focal chronic uteroplacental vasculitis is the most common uteroplacental vascular lesion in the term placenta.

Chronic Inflammation Case Reports (coming soon)

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