• Am. J. Obstet. Gynecol. · Nov 2014

    Clinical significance of amniotic fluid sludge in twin pregnancies with a short cervical length.

    • Ananda Boyer, Lauren Cameron, Yolanda Munoz-Maldonado, Richard Bronsteen, Christine H Comstock, Wesley Lee, and Luis F Goncalves.
    • Division of Fetal Imaging, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI. Electronic address: dranandakn@gmail.com.
    • Am. J. Obstet. Gynecol. 2014 Nov 1; 211 (5): 506.e1-9.

    ObjectiveThe objective of the study was to determine the clinical significance of amniotic fluid (AF) sludge in twin pregnancies with a short cervix.Study DesignWe 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.ResultsThe 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).ConclusionThe 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.Copyright © 2014 Elsevier Inc. All rights reserved.

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