{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T06:38:07Z","timestamp":1793342287059,"version":"4.5.0"},"reference-count":131,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,7,24]],"date-time":"2018-07-24T00:00:00Z","timestamp":1532390400000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["APMIS"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:p>The placenta functions as a shield against infection of the fetus. The innate and adaptive immune defenses of the developing fetus are poorly equipped to fight infections. Infection by bacteria, viruses, and protozoa may cause infertility, spontaneous abortion, stillbirth, growth retardation, anomalies of development, premature delivery, neonatal morbidity, and mortality. However, appreciation of the human microbiome and host cell\u2013microbe interactions must be taken into consideration as we try to determine what interactions are pathologic. Infection is typically recognized histologically by the presence of inflammation. Yet, several factors make comparison of the placenta to other human organs difficult. The placenta comprises tissues from two persons, complicating the role of the immune system. The placenta is a temporary organ. It must be eventually expelled; the processes leading to partuition involve maternal inflammation. What is normal or pathologic may be a function of timing or extent of the process. We now must consider whether bacteria, and even some viruses, are useful commensals or pathogens. Still, recognizing infection of the placenta is one of the most important contributions placental pathologic examination can give to care of the mother and neonate. This review provides a brief overview of placental defense against infection, consideration of the placental microbiome, routes of infection, and the histopathology of amniotic fluid infection and <jats:styled-content style=\"fixed-case\">TORCH<\/jats:styled-content> infections.<\/jats:p>","DOI":"10.1111\/apm.12847","type":"journal-article","created":{"date-parts":[[2018,7,25]],"date-time":"2018-07-25T02:24:11Z","timestamp":1532485451000},"page":"570-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":108,"title":["Defense and infection of the human placenta"],"prefix":"10.1111","volume":"126","author":[{"given":"Amy","family":"Heerema\u2010McKenney","sequence":"first","affiliation":[{"name":"Robert J. Tomsich Pathology and Laboratory Medicine Institute Cleveland Clinic Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,24]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2017.01.009"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.05.057"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/v6114609"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/11.2.352"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI87490"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.11.043"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3008599"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0143-4004(82)80004-0"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep23129"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2016.10.014"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40168-017-0268-4"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016349509008942"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/aji.12438"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deu292"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2009.02.003"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1128\/MMBR.00036-17"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-011-1157-z"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-3781"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.2350\/09-06-0659-OA.1"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-015-1899-0"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2017.12.004"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm-2014-0249"},{"key":"e_1_2_6_24_1","first-page":"53","article-title":"Clinical chorioamnionitis at term V: umbilical cord plasma cytokine profile in the context of a systemic maternal inflammatory response","volume":"44","author":"Romero R","year":"2016","journal-title":"J Perinat Med"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mib.2011.11.006"},{"key":"e_1_2_6_26_1","first-page":"45","volume-title":"Human Embryology","author":"Hamilton WJ","year":"1945"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2007.06.002"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2006.01.006"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.06.039"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1086\/418170"},{"key":"e_1_2_6_31_1","first-page":"451","article-title":"Cervical mucus. III. Physiological roles","volume":"6","author":"Chr\u00e9tien FC","year":"1977","journal-title":"J Gynecol Obstet Biol Reprod (Paris)"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1038\/mi.2013.120"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.116685"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12296"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0069528"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4757-4199-5_9"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.4049\/jimmunol.1700114"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9440(10)62990-2"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2003.11.002"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1095\/biolreprod.115.134627"},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1006\/cimm.1999.1532"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2017.11.020"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2009.01.002"},{"key":"e_1_2_6_44_1","doi-asserted-by":"publisher","DOI":"10.1093\/molehr\/gat049"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1111\/apm.12474"},{"key":"e_1_2_6_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jri.2012.03.488"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2017.04.007"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1095\/biolreprod.102.004325"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2005.07.008"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/joa.12658"},{"key":"e_1_2_6_51_1","first-page":"855","article-title":"Trophoblast interaction with fibrin matrix. Epithelialization of perivillous fibrin deposits as a mechanism for villous repair in the human placenta","volume":"136","author":"Nelson DM","year":"1990","journal-title":"Am J Pathol"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0143-4004(96)90019-3"},{"key":"e_1_2_6_53_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-07-169433"},{"key":"e_1_2_6_54_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9071(199611)50:3<237::AID-JMV5>3.0.CO;2-A"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001246"},{"key":"e_1_2_6_56_1","article-title":"Intrauterine inflammation, infection, or both (Triple I): a new concept for chorioamnionitis","author":"Peng C\u2010C","year":"2017","journal-title":"Pediatr Neonatol"},{"key":"e_1_2_6_57_1","article-title":"Histologic funisitis and likelihood of intrauterine inflammation or infection: a case\u2010control study","author":"Doty M","year":"2018","journal-title":"Am J Perinatol"},{"key":"e_1_2_6_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2016.10.006"},{"key":"e_1_2_6_59_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.08.040"},{"key":"e_1_2_6_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10024-003-7070-y"},{"key":"e_1_2_6_61_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2015-0225-CC"},{"key":"e_1_2_6_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.11.026"},{"key":"e_1_2_6_63_1","first-page":"2681","article-title":"Amniotic fluid sludge as a marker of intra\u2010amniotic infection and histological chorioamnionitis in cervical insufficiency: a report of four cases and literature review","volume":"29","author":"Paules C","year":"2016","journal-title":"J Matern Fetal Neonatal Med"},{"key":"e_1_2_6_64_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2014.958463"},{"key":"e_1_2_6_65_1","doi-asserted-by":"publisher","DOI":"10.1080\/14767050701236365"},{"key":"e_1_2_6_66_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10024-004-8092-9"},{"key":"e_1_2_6_67_1","doi-asserted-by":"publisher","DOI":"10.2350\/10-07-0867-OA.1"},{"key":"e_1_2_6_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2011.10.001"},{"key":"e_1_2_6_69_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181cb9955"},{"key":"e_1_2_6_70_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2010.550977"},{"key":"e_1_2_6_71_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016348809029862"},{"key":"e_1_2_6_72_1","first-page":"1","article-title":"Prevention of perinatal group B streptococcal disease\u2013revised guidelines from CDC, 2010","volume":"10","author":"Verani JR","year":"2010","journal-title":"MMWR Recomm Reports"},{"key":"e_1_2_6_73_1","doi-asserted-by":"publisher","DOI":"10.1177\/000992288502400504"},{"key":"e_1_2_6_74_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.jp.7211129"},{"key":"e_1_2_6_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s100249900014"},{"key":"e_1_2_6_76_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix119"},{"key":"e_1_2_6_77_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1002005"},{"key":"e_1_2_6_78_1","first-page":"64","article-title":"The human placental villitides: a review of chronic intrauterine infection","volume":"60","author":"Altshuler G","year":"1975","journal-title":"Curr Top Pathol"},{"key":"e_1_2_6_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0143-4004(98)90078-9"},{"key":"e_1_2_6_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0095-5108(18)30670-5"},{"key":"e_1_2_6_81_1","doi-asserted-by":"publisher","DOI":"10.4103\/2229-5070.190813"},{"key":"e_1_2_6_82_1","first-page":"661","article-title":"Placental villous maturation in patients with repeated abortions and chronic toxoplasmosis","volume":"20","author":"Eissa MH","year":"1990","journal-title":"J Egypt Soc Parasitol"},{"key":"e_1_2_6_83_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2016-0401-OA"},{"key":"e_1_2_6_84_1","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.05899-11"},{"key":"e_1_2_6_85_1","first-page":"24","article-title":"Granulomatous placentitis in toxoplasmosis (author's transl)","volume":"93","author":"Susani M","year":"1981","journal-title":"Wien Klin Wochenschr"},{"key":"e_1_2_6_86_1","doi-asserted-by":"publisher","DOI":"10.3109\/15513819209023307"},{"key":"e_1_2_6_87_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2005.07.002"},{"key":"e_1_2_6_88_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro.2016.141"},{"key":"e_1_2_6_89_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6444a3"},{"key":"e_1_2_6_90_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(02)02010-0"},{"key":"e_1_2_6_91_1","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.853288"},{"key":"e_1_2_6_92_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(96)90110-0"},{"key":"e_1_2_6_93_1","doi-asserted-by":"publisher","DOI":"10.1016\/0046-8177(93)90016-A"},{"key":"e_1_2_6_94_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10024-004-2124-3"},{"key":"e_1_2_6_95_1","first-page":"890","article-title":"Identification of Treponema pallidum in amniotic fluid and fetal blood from pregnancies complicated by congenital syphilis","volume":"78","author":"Wendel GD","year":"1991","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_96_1","first-page":"357","article-title":"Attachment of Treponema pallidum to fibronectin, laminin, collagen IV, and collagen I, and blockage of attachment by immune rabbit IgG","volume":"60","author":"Fitzgerald TJ","year":"1984","journal-title":"Br J Vener Dis"},{"key":"e_1_2_6_97_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-199709000-00015"},{"key":"e_1_2_6_98_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI117560"},{"key":"e_1_2_6_99_1","doi-asserted-by":"publisher","DOI":"10.1086\/314542"},{"key":"e_1_2_6_100_1","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.75.10.4780-4791.2001"},{"key":"e_1_2_6_101_1","doi-asserted-by":"publisher","DOI":"10.1016\/0143-4004(88)90007-0"},{"key":"e_1_2_6_102_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chom.2016.07.002"},{"key":"e_1_2_6_103_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.coviro.2017.11.008"},{"key":"e_1_2_6_104_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2016-0341-SA"},{"key":"e_1_2_6_105_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4361-5"},{"key":"e_1_2_6_106_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6645a4"},{"key":"e_1_2_6_107_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(82)92677-0"},{"key":"e_1_2_6_108_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(16)33842-X"},{"key":"e_1_2_6_109_1","doi-asserted-by":"publisher","DOI":"10.1080\/152279502760157768"},{"key":"e_1_2_6_110_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)92943-2"},{"key":"e_1_2_6_111_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2559.1985.tb02802.x"},{"key":"e_1_2_6_112_1","doi-asserted-by":"publisher","DOI":"10.2350\/15-01-1603-CR.1"},{"key":"e_1_2_6_113_1","doi-asserted-by":"publisher","DOI":"10.2350\/15-10-1726-CR.1"},{"key":"e_1_2_6_114_1","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.77.24.13301-13314.2003"},{"key":"e_1_2_6_115_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00281-014-0449-1"},{"key":"e_1_2_6_116_1","doi-asserted-by":"publisher","DOI":"10.1128\/JVI.74.15.6808-6820.2000"},{"key":"e_1_2_6_117_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2005.08.011"},{"key":"e_1_2_6_118_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2015.88"},{"key":"e_1_2_6_119_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2017.01904"},{"key":"e_1_2_6_120_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318290f171"},{"key":"e_1_2_6_121_1","first-page":"728","article-title":"Unexpected disseminated herpes simplex infection in a newborn","volume":"50","author":"Von Herzen JL","year":"1977","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_122_1","first-page":"106","article-title":"Ascending transcervical herpes simplex infection with intact fetal membranes","volume":"56","author":"Hain J","year":"1980","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_123_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1974.02110220125020"},{"key":"e_1_2_6_124_1","first-page":"852","article-title":"Congenital herpes infection: placental and umbilical cord findings","volume":"2","author":"Hyde SR","year":"1993","journal-title":"Obstet Gynecol"},{"key":"e_1_2_6_125_1","first-page":"237","article-title":"Pathology of the placenta and cord in some viral infections","volume":"17","author":"Blanc WA","year":"1978","journal-title":"Major Probl Clin Pediatr"},{"key":"e_1_2_6_126_1","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1542\/peds.36.2.192","article-title":"Possible transplacental transmission of herpes simplex infection","volume":"36","author":"Witzleben CL","year":"1965","journal-title":"Pediatrics"},{"key":"e_1_2_6_127_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(80)90901-1"},{"key":"e_1_2_6_128_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jir153"},{"key":"e_1_2_6_129_1","first-page":"97","article-title":"Congenital Chagas disease","volume":"130","author":"Bittencourt AL","year":"1976","journal-title":"Am J Dis Child"},{"key":"e_1_2_6_130_1","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1980.29.571"},{"key":"e_1_2_6_131_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005551"},{"key":"e_1_2_6_132_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2015.08.041"}],"container-title":["APMIS"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fapm.12847","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apm.12847","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,12]],"date-time":"2023-09-12T21:09:57Z","timestamp":1694552997000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apm.12847"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7]]},"references-count":131,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1111\/apm.12847"],"URL":"https:\/\/doi.org\/10.1111\/apm.12847","archive":["Portico"],"relation":{},"ISSN":["0903-4641","1600-0463"],"issn-type":[{"value":"0903-4641","type":"print"},{"value":"1600-0463","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7]]},"assertion":[{"value":"2018-02-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-04-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}