Validation of diagnostic tests for histologic chorioamnionitis: Systematic review and meta-analysis

Publication date: September 2018
Source:European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 228
Author(s): Claudia Patricia Cataño Sabogal, Javier Fonseca, Herney Andrés García-Perdomo
IntroductionThe aim of this study was to determine the diagnostic performance of different diagnostic tests for histologic chorioamnionitis in patients at more than 20 weeks of gestation.MethodsA systematic search was carried out through MEDLINE, EMBASE, LILACS, CENTRAL and unpublished literature. Observational studies included with pregnant women (>20 weeks) with chorioamnionitis. The reference standard was the histopathological study of the placenta, umbilical cord and fetal membranes. Two independent researchers extracted data and performed a meta-analysis of diagnostic tests.ResultsTwenty-nine articles were included. The studies provided evidence in the form of maternal clinical and serological tests; tests of vaginal fluid, amniotic fluid or the umbilical cord; fetal monitoring and ultrasound tests. To assess the performance of maternal serum CRP, 13 studies were included, showing a combined sensitivity of 68.7% (95%CI 58%–77%) and a combined specificity of 77.1% (95%CI 67%–84%). Maternal leukocytosis was evaluated in four publications, showing a combined sensitivity of 51% (95%CI 40%–62%) and a combined specificity of 65% (95%CI 50%–78%).ConclusionsCRP and maternal leukocytosis, showed a low sensitivity and specificity. The sonographic evaluation of the fetal thymus is also more sensitive for the diagnosis of histologic chorioamnionitis than the fetal biophysical profile.