Manual of Pathology of the Human Placenta by Rebecca N. Baergen

Author:Rebecca N. Baergen
Language: eng
Format: epub
Publisher: Springer US, Boston, MA

Figure 16.6.Acute deciduitis in an immature placenta. H&E ×160.

As the fetus normally swallows and breathes in amniotic fluid, exposure to organisms present in the amniotic fluid can occur and result in a fetal response to the infection. Fetal inflammatory cells migrate from the umbilical vessels and the superficial fetal vessels in the chorionic plate constituting a fetal inflammatory response. Fetal response, however, is rare prior to the 20th week of gestation due to immaturity of the fetal immune system. In general, acute funisitis occurs first, with the vein becoming involved before the arteries. The inflammatory cells migrate toward the amnionic surface, marginate first at the vascular intima, and then begin to dissect among the muscle bundles of the umbilical vein and arteries, finally infiltrating Wharton’s jelly (Figs. 16.7 and 16.8). They also reach the cord’s surface and may accumulate there in substantial numbers. Funisitis does not signify the existence of fetal sepsis or even fetal infection. Fetal sepsis is a relatively late event in the course of an ascending bacterial infection and often results from invasion of organisms into the fetal lung, intestinal tract, and even the middle ear. If fetal infection occurs, PMNs can be found in the lung and stomach of the neonate intermixed with squames. Initially, this pus is likely aspirated from the amniotic fluid and not produced in the fetal lung, as only later in the infectious process can one find an inflammatory accumulation within the alveolar tissue.

Figure 16.7.Acute funisitis involving umbilical vein. Leukocytes have penetrated between muscle fibers toward the cord surface. H&E ×100.

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