• Suzanne M. JacquesEmail author
  • Faisal Qureshi


Acute inflammatory lesions of the umbilical cord, along with acute inflammation of the chorionic surface blood vessels (acute chorionic vasculitis), represent the histologic hallmark of the fetal inflammatory response syndrome, a condition characterized by elevated fetal plasma levels of interleukin-6 (IL-6) and associated with preterm labour and perinatal morbidity. Acute inflammation of the umbilical cord is characterized by infiltration of fetal neutrophils into the umbilical vein (acute phlebitis) umbilical arteries (acute arteritis) and/or Wharton’s jelly. Candida species infection is associated with a characteristic pattern of umbilical cord inflammation, which has been described as peripheral funisitis. Acute funisitis is more frequent in preterm compared to term neonates and is more likely to be associated with adverse outcomes in the preterm neonates, including congenital sepsis and cerebral palsy. Furthermore, acute funisitis in preterm neonates is more likely to include acute arteritis (stage 2) and to be associated with higher fetal levels of IL-6.


Acute funisitis Acute arteritis Acute phlebitis Chorionic vasculitis Peripheral funisitis Candida funisitis Necrotising funisitis Interleukin-6 Fetal inflammatory response 


  1. 1.
    Pacora P, Chaiworapongsa T, Maymon E, et al. Funisitis and chorionic vasculitis: the histological counterpart of the fetal inflammatory response syndrome. J Matern Fetal Neonatal Med. 2002;11:18–25.CrossRefGoogle Scholar
  2. 2.
    Gotsch F, Romero R, Kusanovic JP, et al. The fetal inflammatory response syndrome. Clin Obstet Gynecol. 2007;50:652–83.CrossRefGoogle Scholar
  3. 3.
    Kim CJ, Romero R, Chaemsaithong P, Chaiyasit N, Yoon BH, Kim YM. Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance. Am J Obstet Gynecol. 2015;213(4 Suppl):S29–52.CrossRefGoogle Scholar
  4. 4.
    Qureshi F, Jacques SM, Bendon RW, et al. Candida funisitis: a clinicopathologic study of 32 cases. Pediatr Dev Pathol. 1998;1:118–24.CrossRefGoogle Scholar
  5. 5.
    Yoon BH, Romero R, Park JS, et al. The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis. Am J Obstet Gynecol. 2000;183:1124–9.CrossRefGoogle Scholar
  6. 6.
    Jessop FA, Lees CC, Pathak S, Hook CE, Sebire NJ. Funisitis is associated with adverse neonatal outcome in low-risk unselected deliveries at or near term. Virchows Arch. 2016;468:503–7.CrossRefGoogle Scholar
  7. 7.
    Lee SE, Romero R, Kim CJ, Shim SS, Yoon BH. Funisitis in term pregnancy is associated with microbial invasion of the amniotic cavity and intra-amniotic inflammation. J Matern Fetal Neonatal Med. 2006;19:693–7.CrossRefGoogle Scholar
  8. 8.
    Khong TY, Mooney EE, Ariel I, et al. Sampling and definitions of placental lesions. Amsterdam Placental Workshop Group consensus statement. Arch Pathol Lab Med. 2016;140:698–713.CrossRefGoogle Scholar
  9. 9.
    Kim CJ, Yoon BH, Kim M, Park JO, Cho SY, Chi JG. Histo-topographic distribution of acute inflammation of the human umbilical cord. Pathol Int. 2001;51:861–5.CrossRefGoogle Scholar
  10. 10.
    Yoon BH, Romero R, Moon J, et al. Differences in the fetal interleukin-6 response to microbial invasion of the amniotic cavity between term and preterm gestation. J Matern Fetal Neonatal Med. 2003;13:32–8.CrossRefGoogle Scholar
  11. 11.
    Kim CJ, Yoon BH, Park SS, Kim MH, Chi JG. Acute funisitis of preterm but not term placentas is associated with severe fetal inflammatory response. Hum Pathol. 2001;32:623–9.CrossRefGoogle Scholar
  12. 12.
    Kim CJ, Yoon BH, Romero R, et al. Umbilical arteritis and phlebitis mark different stages of the fetal inflammatory response. Am J Obstet Gynecol. 2001;185:496–500.CrossRefGoogle Scholar
  13. 13.
    Rogers BB, Alexander JM, Head J, McIntire D, Leveno KJ. Umbilical vein interleukin-6 levels correlate with the severity of placental inflammation and gestational age. Hum Pathol. 2002;33:335–40.CrossRefGoogle Scholar
  14. 14.
    Yoon BH, Romero R, Park JS, et al. Fetal exposure to intra-amniotic inflammation and the development of cerebral palsy at the age of three years. Am J Obstet Gynecol. 2000;82:675–81.CrossRefGoogle Scholar
  15. 15.
    Redline RW, O’Riordan MA. Placental lesions associated with cerebral palsy and neurologic impairment following term birth. Arch Pathol Lab Med. 2000;24:1785–91.Google Scholar
  16. 16.
    Redline RW, Wilson-Costell D, Borawski E, Fanaroff AA, Hack M. The relationship between placental and other perinatal risk factors for neurologic impairment in very low birth weight children. Pediatr Res. 2000;47:721–6.CrossRefGoogle Scholar
  17. 17.
    Jacques SM, Qureshi F. Necrotizing funisitis: a study of 45 cases. Hum Pathol. 1992;23:1278–83.CrossRefGoogle Scholar
  18. 18.
    Fojaco RM, Hensley GT, Moskowitz L. Congenital syphilis and necrotizing funisitis. JAMA. 1989;261:1788–90.CrossRefGoogle Scholar
  19. 19.
    Craver RD, Baldwin VJ. Necrotizing funisitis. Obstet Gynecol. 1992;79:64–70.PubMedGoogle Scholar
  20. 20.
    Heifetz SA, Bauman M. Necrotizing funisitis and herpes simplex infection of placental and decidual tissues: study of four cases. Hum Pathol. 1994;25:715–22.CrossRefGoogle Scholar
  21. 21.
    Wright JR Jr, Stinson D, Wade A, Haldane D, Heifetz SA. Necrotizing funisitis associated with Actinomyces meyeri infection: a case report. Pediatr Pathol. 1994;14:927–34.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Hutzel Women’s Hospital, Detroit Medical CenterWayne State University School of MedicineDetroitUSA

Personalised recommendations