Villitis

Villitis is associated with placental infections. There are several conditions that can cause villitis, but in many cases the cause is unknown.

Bacterial causes of villitis include the following:

• Chorioamnionitis
• Streptococci
• Bacteria associated with maternal sepsis

Viral causes of villitis include:

• Cytomegalovirus (CMV)
• Toxoplasmosis
• Herpes
• Rubella
• Syphilis

• Obesity during pregnancy
• Multiple pregnancy (pregnant with more than one baby)
• Urinary complications during pregnancy

• Elevated levels of alpha-fetoprotein when intrauterine growth restriction (IUGR) is present
• Non-significant elevations of human growth hormone when testing biological screening of trisomy (abnormal number of chromosomes) in the second quarter

• Abscesses in the placental parenchyma (villi)
• Neutrophilic chorioamnionitis

Villitis is usually not apparent (without a microscope) unless there is abscess formation.  Abscesses can typically be seen with an ultrasound.

Villitis is associated with placental infections and therefore should be considered when any of the following conditions are present: CMV, chorioamnionitis, candida, HSV, group B streptococcus, group A streptococcus, syphilis, toxoplasmosis and chlamydia. It is crucial that physicians promptly diagnose and treat these infections because when villitis develops, there may be an increased risk for fetal death.

Research has shown that when villitis is suspected, steroids and aspirin during pregnancy are beneficial. Most of the time, the cause of villitis is unknown. However, since villitis is associated with placental infections, it is imperative that these infections be immediately diagnosed and treated.

If villitis is not properly prevented or promptly treated, it can lead to very serious outcomes in the baby, including:

• Hypoxic-ischemic encephalopathy
• Hydrops fetalis (abnormal amounts of fluid build-up in two or more body areas of a fetus or newborn)
• Intrauterine growth restriction (IUGR)
• Respiratory problems
• Cerebral palsy
• Periventricular leukomalacia
• Neonatal sepsis and meningitis

Some cases of villitis arise as the result of negligent actions by medical professionals. These may include:

• Failure to diagnose premature rupture of membranes (PROM), which is a major risk factor for chorioamnionitis and other infections
• Failure to follow standards of care in prevention of ascending infection
• Failure to diagnose and properly treat placental infections such as chorioamnionitis
• Failure to closely monitor the mother and baby when risk factors for chorioamnionitis and villitis are present
• Failure to obtain adequate informed consent. This includes advising the mother of the risks and alternatives of different delivery methods and procedures
• A lack of adherence to standard of care when delivering the baby

When negligence causes injury to the mother or baby, it is medical malpractice.