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Maternal Pyrexia and Villitis of Unknown Etiology

Graham, Dorothy, F., FRACP, PhD; Sung, Eileen, MBBS, FRACP; Berry, Bligh, FRCPA

doi: 10.1097/AOG.0000000000002581
Contents: Case Reports

BACKGROUND: Villitis of unknown etiology is an inflammatory placental condition associated with adverse pregnancy outcomes, including fetal growth restriction and preterm birth.

CASE: We describe maternal pyrexia with daily rigors in the third trimester of two consecutive pregnancies in the same woman. In her second pregnancy, we found no evidence of infection despite an extensive antenatal investigation (blood and urine cultures, serologies, chest X-ray, abdominal ultrasonogram, echocardiogram). The fetus was closely monitored for growth and well-being until spontaneous labor ensued at 36 weeks of gestation, followed by the birth of a vigorous female neonate who weighed 2.235 kg and was healthy. Placental pathology was consistent with villitis of unknown etiology and displayed more prominent abscess formation than is usually described. The patient's first pregnancy 4 years previously followed a similar but milder pattern, without preterm delivery but with similar placental pathology.

CONCLUSION: Maternal pyrexia in both pregnancies was ultimately attributed to placental inflammation secondary to a maternal immunologic response to the fetal–placental unit. A placental origin for maternal pyrexia should be considered in cases in which a maternal cause cannot be identified and the pregnancy managed in light of the possible association with adverse fetal outcomes.

Maternal pyrexia is attributed to placental inflammation secondary to a maternal immunologic response to the fetal–placental unit.

Obstetric Medicine and Pathology, King Edward Memorial Hospital, Subiaco, and the University of Western Australia, Crawley, Australia.

Corresponding author: Dorothy F. Graham, MBBS, FRACP, PhD, Department of Obstetrics and Gynecology, King Edward Memorial Hospital and University of Western Australia, Bagot Road, Subiaco, WA 6008 Australia; email: dorothy.graham@health.wa.gov.au.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Dr. C. Tymchuk and Dr. S. Hart from the University of California for medical and pathologic information regarding the first pregnancy.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.