Funisitis

Funisitis is an inflammatory condition of the umbilical cord, specifically affecting the connective tissue within the Wharton's jelly. This condition is a significant aspect of intrauterine infection and is closely associated with chorioamnionitis, an inflammation of the fetal membranes due to a bacterial infection. Funisitis is an important marker for intra-amniotic infection (IAI) and can lead to adverse neonatal outcomes, including preterm birth, sepsis, and neonatal mortality.

Etiology

The primary cause of funisitis is an ascending bacterial infection from the vagina and cervix into the amniotic cavity. The most common pathogens involved include Ureaplasma urealyticum, Mycoplasma hominis, and various species of anaerobic bacteria. The infection typically spreads from the chorioamniotic membranes into the umbilical cord, leading to inflammation.

Pathophysiology

In funisitis, the infection induces an inflammatory response within the umbilical cord, particularly affecting the Wharton's jelly and the surrounding vascular structures. This response is characterized by the infiltration of neutrophils, a type of white blood cell, into the affected tissues. The presence of neutrophils within the Wharton's jelly and around the umbilical vessels is a key diagnostic feature of funisitis.

Clinical Significance

Funisitis is a critical indicator of intra-amniotic infection and is associated with several adverse outcomes for both the mother and the fetus. For the fetus, the condition can lead to preterm labor, fetal distress, and increased risk of neonatal sepsis. For the mother, funisitis can increase the risk of postpartum infections and complications related to preterm delivery.

Diagnosis

Diagnosis of funisitis is typically made postnatally, through histopathological examination of the umbilical cord following delivery. The presence of neutrophils within the Wharton's jelly and around the umbilical vessels is indicative of the condition. Additionally, clinical signs of chorioamnionitis in the mother, such as fever, uterine tenderness, and foul-smelling amniotic fluid, may suggest the presence of funisitis.

Treatment

The primary treatment for funisitis involves managing the underlying intra-amniotic infection. This typically includes the administration of broad-spectrum antibiotics to the mother before delivery. In cases where funisitis is diagnosed or highly suspected, early delivery may be recommended to reduce the risk of adverse neonatal outcomes.

Prevention

Preventive measures for funisitis focus on reducing the risk of intra-amniotic infection. This includes the use of prophylactic antibiotics during labor for women at high risk of infection and careful monitoring for signs of chorioamnionitis during pregnancy.