Clinical significance of the presence of amniotic fluid 'sludge' in asymptomatic patients at high risk for spontaneous preterm delivery

J. P. Kusanovic, J. Espinoza, R. Romero*, L. F. Gonçalves, J. K. Nien, E. Soto, N. Khalek, N. Camacho, I. Hendler, P. Mittal, L. A. Friel, F. Gotsch, O. Erez, N. G. Than, S. Mazaki-Tovi, M. L. Schoen, S. S. Hassan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To determine the clinical significance of the presence of amniotic fluid (AF) 'sludge' among asymptomatic patients at high risk for spontaneous preterm delivery. Methods: This retrospective case-control study included 281 patients with (n = 66) or without (n = 215) AF 'sludge', who underwent transvaginal ultrasound examination between 13 and 29 completed weeks of gestation. Patients with threatened preterm labor, multiple gestation, fetal anomalies, placenta previa or uterine contractions were excluded. Results: The prevalence of AF 'sludge' in the study population was 23.5% (66/281). The rates of spontaneous preterm delivery at < 28 weeks, < 32 weeks, < 35 weeks and < 37 weeks of gestation were 14.7% (29/197), 21.3% (46/216), 28.7% (62/216) and 42.1% (91/216), respectively. Patients with 'sludge' had: (1) a higher rate of spontaneous preterm delivery at <28 weeks (46.5% (20/43) vs. 5.8% (9/154); P < 0.001), <32 weeks (55.6% (25/45) vs. 12.3% (21/171); P < 0.001) and <35 weeks (62.2% (28/45) vs. 19.9% (34/171); P < 0.001); (2) a higher frequency of clinical chorioamnionitis (15.2% (10/66) vs. 5.1% (11/215); P = 0.007), histologic chorioamnionitis (61.5% (40/65) vs. 28% (54/193); P < 0.001) and funisitis (32.3% (21/65) vs. 19.2% (37/193); P = 0.03); (3) a higher frequency of preterm prelabor rupture of membranes (PROM) (39.4% (26/66) vs. 13.5% (29/215); P < 0.001), lower gestational age at preterm PROM (median 24.7 (interquartile range (IQR), 22.3-28.1) weeks vs. 32.3 (IQR, 27.7-34.8) weeks; P < 0.001); and (4) shorter median ultrasound-to-delivery interval ('sludge' positive 127 days (95% CI, 120-134 days) vs. 'sludge' negative 161 days (95% CI, 153-169 days); P < 0.001) and ultrasound-to-preterm PROM interval ('sludge' positive 23 days (95% CI, 7-39 days) vs. 'sludge' negative 57 days (95% CI, 38-77 days); P = 0.003) than those without 'sludge'. AF 'sludge' was an independent explanatory variable for the occurrence of spontaneous preterm delivery at <28 weeks, <32 weeks and <35 weeks, preterm PROM, microbial invasion of the amniotic cavity (MIAC) and histologic chorioamnionitis. Moreover, the combination of a cervical length <25 mm and 'sludge' conferred an odds ratio of 14.8 and 9.9 for spontaneous preterm delivery at <28 weeks and <32 weeks, respectively. Conclusions: AF 'sludge' is an independent risk factor for spontaneous preterm delivery, preterm PROM, MIAC and histologic chorioamnionitis in asymptomatic patients at high risk for spontaneous preterm delivery. Furthermore, the combination of 'sludge' and a short cervix confers a higher risk for spontaneous preterm delivery at <28 weeks and <32 weeks than a short cervix alone.

Original languageEnglish
Pages (from-to)706-714
Number of pages9
JournalUltrasound in Obstetrics and Gynecology
Volume30
Issue number5
DOIs
StatePublished - Oct 2007
Externally publishedYes

Keywords

  • Amniotic fluid 'sludge'
  • Chorioamnionitis
  • Funisitis
  • Microbial invasion of the amniotic cavity
  • Preterm labor
  • Preterm premature rupture of membranes
  • Short cervix
  • Spontaneous preterm delivery
  • Transvaginal ultrasound

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