Chorio Paradox: When Clinical & Path DX Don’t Agree

Welcome to "Labor & Delivery Debrief," the podcast where we tackle your toughest questions about childbirth and maternal health. Today, we're diving deep into a fascinating and critical topic sent in by one of our listeners, Sarah. Sarah asks: "Is it possible for a clinical diagnosis of chorioamnionitis to not be confirmed by placental histology? And if so, how is that possible?" This is a fantastic question that touches on the complexities of intrapartum clinical diagnosis of intraamniotic infection (IAI), also commonly known as chorioamnionitis. We'll explore the nuances of clinical versus histological findings, the diagnostic criteria, and why these two assessments don't always perfectly align. Get ready for a detailed discussion that will shed light on this important aspect of obstetric care.1. ACOG CO 712; 2017 (2025)2. Romero R, Pacora P, Kusanovic JP, et al. Clinical Chorioamnionitis at Term X: Microbiology, Clinical Signs, Placental Pathology, and Neonatal Bacteremia - Implications for Clinical Care. Journal of Perinatal Medicine. 2021;49(3):275-298. doi:10.1515/jpm-2020-0297.3. Jung E, Romero R, Suksai M, et al. Clinical Chorioamnionitis at Term: Definition, Pathogenesis, Microbiology, Diagnosis, and Treatment. AJOG. 2024;230(3S):S807-S840. doi:10.1016/j.ajog.2023.02.002.4. Oh KJ, Kim SM, Hong JS, et al. Twenty-Four Percent of Patients With Clinical Chorioamnionitis in Preterm Gestations Have No Evidence Of either Culture-Proven Intraamniotic Infection Or intraamniotic Inflammation. AJOG. 2017;216(6):604.e1-604.e11.