Clinical significance of amniotic fluid sludge in twin pregnancies with a short cervical length - 31/07/14

Doi : 10.1016/j.ajog.2014.05.044

Ananda Boyer, MD ^a,^⁎ , Lauren Cameron, BS ^d, Yolanda Munoz-Maldonado, PhD ^b, Richard Bronsteen, MD ^a, Christine H. Comstock, MD ^a, Wesley Lee, MD ^e, Luis F. Goncalves, MD ^a,^c
^a Division of Fetal Imaging, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI
^b Research Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI
^c Department of Pediatric Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, MI
^d Wayne State University Medical School, Detroit, MI
^e Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX

^∗Corresponding author: Ananda Boyer, MD.

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Abstract

Objective

The objective of the study was to determine the clinical significance of amniotic fluid (AF) sludge in twin pregnancies with a short cervix.

Study Design

We evaluated twin pregnancies with a short cervical length that had an ultrasound between 16 and 26 weeks (n = 78). Pregnancy outcomes in those with sludge (n = 27) and those without (n = 51) were compared. Outcome variables included gestational age at delivery, premature rupture of the membranes, chorioamnionitis, funisitis, composite neonatal morbidity, and perinatal death. For statistical analysis, the first-born (A) and second-born (B) twins were studied separately.

Results

The prevalence of AF sludge was 34.6% (27 of 78). Pregnancies with sludge delivered earlier (27.2 ± 5.6 weeks vs 31.0 ± 4.05 weeks, P < .01) and had a higher rate of extreme prematurity (<26 weeks: 52.2% [12 of 23] vs 15.6% [5 of 32]; P < .01). Both twins had higher rates of histological chorioamnionitis (twin A, 50.0% [13 of 26] vs 12.8% [6 of 47]; P < .01; twin B, 42.3% [11 of 26] vs 13.3% [6 of 45]; P < .01) and neonatal death (twin A, 33.3% [9 of 27] vs 3.9% [2 of 51]; P < .01; twin B, 33.3% [9 of 27] vs 6.0% [3 of 50]; P = .01). Higher rates of funisitis (23.1% [6 of 26] vs 4.3% [2 of 47]; P = .02) and composite neonatal morbidity were observed for twin A only (66.7% [14 of 21] vs 37.5% [18 of 48]; P = .04).

Conclusion

The presence of AF sludge in twin pregnancies with a short cervix is a risk factor for extreme prematurity, histological chorioamnionitis, and perinatal death. Twin A had higher rates of funisitis and neonatal morbidity in the presence of AF sludge.

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Key words : amniotic fluid sludge, neonatal morbidity, prematurity, short cervix, twins

Plan

Materials and Methods

Results

Comment

	L.F.G. has lectured for Philips Health Care on Doppler ultrasonography and for GE Healthcare on 3-/4-dimensional ultrasonography and received honoraria for the lectures. Both courses provided continuing medical education credits for radiology technologists and ultrasonographers. The remaining authors report no conflict of interest.
	Cite this article as: Boyer A, Cameron L, Munoz-Maldonado Y, et al. Clinical significance of amniotic fluid sludge in twin pregnancies with a short cervical length. Am J Obstet Gynecol 2014;211:xx-xx.