Pediatric and Developmental Pathology

, Volume 6, Issue 5, pp 435–448 | Cite as

Amniotic Infection Syndrome: Nosology and Reproducibility of Placental Reaction Patterns

  • Raymond W. Redline
  • Ona Faye-Petersen
  • Debra Heller
  • Faisal Qureshi
  • Van Savell
  • Carole Vogler
  • the Society for Pediatric Pathology, Perinatal Section, Amniotic Fluid Infection Nosology Committee
Original Articles


Clinically responsive placental examination seeks to provide useful information regarding the etiology, prognosis, and recurrence risk of pregnancy disorders. The purpose of this study was to assemble and validate a complete set of the placental reaction patterns seen with amniotic fluid infection in the hope that this might provide a standardized diagnostic framework useful for practicing pathologists. Study cases (14 with amniotic fluid infection, 6 controls) were reviewed blindly by six pathologists after agreement on a standard set of diagnostic criteria. After analysis of initial results, criteria were refined and a second, overlapping set of cases were reviewed. Majority vote served as the gold standard. Grading and staging of maternal and fetal inflammatory responses was found to be more reproducible using a two- versus three-tiered grading system than a three- versus five-tiered staging system (overall agreement 81% vs. 71%). Sensitivity, specificity, and efficiency for individual observations ranged from 67–100% (24/30 > 90%). Reproducibility was measured by unweighted kappa values and interpreted as follows: < 0.2, poor; 0.2–0.6, fair/moderate; > 0.6, substantial. Kappa values for the 12 lesions evaluated in 20 cases by the six pathologists were: acute chorioamnionitis/maternal inflammatory response (any, 0.93; severe 0.76; advanced stage, 0.49); chronic (subacute) chorioamnionitis (0.25); acute chorioamnionitis/fetal inflammatory response (any, 0.90; severe, 0.55; advanced stage, 0.52); chorionic vessel thrombi (0.37); peripheral funisitis (0.84); acute villitis (0.90); acute intervillositis/intervillous abscesses (0.65), and decidual plasma cells (0.30). Adoption of this clearly defined, clinically relevant, and pathologically reproducible terminology could enhance clinicopathologic correlation and provide a framework for future clinical research.


amniotic infection syndrome chorioamnionitis nomenclature placenta reproducibility 


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Copyright information

© Society for Pediatric Pathology 2003

Authors and Affiliations

  • Raymond W. Redline
    • 1
  • Ona Faye-Petersen
    • 2
  • Debra Heller
    • 3
  • Faisal Qureshi
    • 4
  • Van Savell
    • 5
  • Carole Vogler
    • 6
  • the Society for Pediatric Pathology, Perinatal Section, Amniotic Fluid Infection Nosology Committee
    • 1
  1. 1.Department of PathologyUniversity Hospitals of Cleveland and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106USA
  2. 2.Department of PathologyUniversity of Alabama at Birmingham, Birmingham, ALUSA
  3. 3.Department of PathologyUniversity of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, NJUSA
  4. 4.Pathology Department, DMC University LaboratoriesHutzel Site and Wayne State University, Detroit, MIUSA
  5. 5.Department of PathologyDriscoll Children’s Hospital, Corpus Christie, TXUSA
  6. 6.Department of PathologySt. Louis University School of Medicine, St. Louis, MOUSA

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