Augmentation of fetal granulopoiesis with chorioamnionitis during the second trimester of gestation

Abstract

Chorioamnionitis is a major hazard to pregnancy in the second trimester. It affects the fetomaternal unit, causing febrile illness in the mother. The fetus eventually is expelled because uterine contractions can no longer be suppressed after a certain stage of the disease. To determine the effects of chorioamnionitis on the fetus we examined fetal hematopoiesis, which is, for the most part, located extramedullarily during the second trimester of gestation. The study was performed morphometrically on sections of fetal tissues; the results are given as an increase of cells per square millimeter. In chorioamnionitis the fetuses (n = 18) showed increased granulopoiesis in the parenchyma of the liver (x12), in the spleen (x 5), in the portal triads of the liver (x3), and in the bone marrow (x1.35). Erythropoiesis and total hematopoiesis were reduced in all compartments. Inflammatory disease in the mother other than chorioamnionitis did not alter fetal hematopoiesis (n = 13). Under normal conditions fetal liver granulopoiesis is at a very low level within the sinusoids, but an early and substantial increase can be seen most easily in this location during infection; chorioamnionitis can thus be diagnosed from the fetal liver alone. Alterations in fetal hematopoiesis might be caused by cytokines generated at the fetomaternal interface during chorioamnionitis.