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

Boyer, Ananda; Cameron, Lauren; Maldonado, Yolanda Muñoz; Bronsteen, Richard; Comstock, Christine H.; Lee, Wesley; Gonçalves, Luís F.

doi:10.1016/j.ajog.2014.05.044

Cited by 28 publications

(18 citation statements)

References 49 publications

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“…In all, 657 women had repeat CL measurements at various screening gestations. Authors of 11 studies, reporting on a combined total of 1846 twin pregnancies (29.5% of all eligible participants) did not respond (five studies), could not be located, or declined to provide IPD following initial consent to contribute (six studies) (Supporting Information Table S1) . The authors of these 11 articles were contacted by phone and email up to four times over an 8‐month period to maximise response rate.…”

Section: Resultsmentioning

confidence: 99%

“…Studies on the prediction of sPTB in twin pregnancies using CL are small in size and are not easily comparable. In these studies, there are large variations in the number of patients examined (56–1135), GA at screening (range 16–28 weeks), cut‐offs for defining short CL (range 15–35 mm) and the GA thresholds for defining sPTB (range 28–37 weeks) . The largest study examined 1135 pregnant women attending for routine antenatal care at 22–24 weeks and reported that the risk of sPTB increases with decreasing CL, but even for women with a long cervix the risk is still substantially higher than in singleton pregnancies .…”

Section: Introductionmentioning

confidence: 99%

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The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta‐analysis

Kindinger

Poon

Cacciatore

et al. 2015

BJOG

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta‐analysis

Kindinger

Poon

Cacciatore

et al. 2015

BJOG

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“…However, recent evidence suggests that amniotic fluid bacteria can form biofilms 175-182 . Biofilms are defined as communities of sessile organisms that attach to a substratum or to each other.…”

Section: Pathways Of Microbial Invasion Of the Amniotic Cavitymentioning

confidence: 99%

“…Biofilms are defined as communities of sessile organisms that attach to a substratum or to each other. The presence of biofilms can be clinically suspected when sludge is detected as particulate matter in the amniotic fluid using ultrasound 175-182 (Figure 10). Bacteria in biofilms are embedded in a hydrated matrix of extracellular polymeric substances, and exhibit an altered phenotype with respect to growth rate and gene transcription in comparison to planktonic (free floating) cells.…”

Section: Pathways Of Microbial Invasion Of the Amniotic Cavitymentioning

confidence: 99%

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Kim

Romero

Chaemsaithong

et al. 2015

American Journal of Obstetrics and Gynecology

752

652

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Acute inflammatory lesions of the placenta consist of diffuse infiltration of neutrophils at different sites in the organ. These lesions include acute chorioamnionitis, funisitis, and chorionic vasculitis, and represent a host response (maternal or fetal) to a chemotactic gradient in the amniotic cavity. While acute chorioamnionitis is evidence of a maternal host response, funisitis and chorionic vasculitis represent fetal inflammatory responses. Intra-amniotic infection has been generally considered to be the cause of acute histologic chorioamnionitis and funisitis; however, recent evidence indicates that “sterile” intra-amniotic inflammation, which occurs in the absence of demonstrable microorganisms but can be induced by “danger signals”, is frequently associated with these lesions. In the context of intra-amniotic infection, chemokines (such as interleukin-8 and granulocyte chemotactic protein) establish a gradient favoring the migration of neutrophils from maternal or fetal circulation into the chorioamniotic membranes or umbilical cord, respectively. Danger signals released during the course of cellular stress or cell death can also induce the release of neutrophil chemokines. The prevalence of chorioamnionitis is a function of gestational age at birth, and is present in 3-5% of placentas delivered at term, but in 94% of placentas delivered between 21-24 weeks of gestation. The frequency is higher in patients with spontaneous labor, preterm labor, clinical chorioamnionitis (preterm or term), or ruptured membranes. Funisitis and chorionic vasculitis are the hallmarks for the fetal inflammatory response syndrome, a condition characterized by an elevation in fetal plasma concentrations of interleukin-6, associated with the impending onset of preterm labor, a higher rate of neonatal morbidity (after adjustment for gestational age), and multi-organ fetal involvement. This syndrome is the counterpart of the systemic inflammatory response syndrome in adults; however, in fetuses, it is a risk factor for short- and long-term complications (i.e. neonatal sepsis, bronchopulmonary dysplasia, periventricular leukomalacia, and cerebral palsy). This article reviews the definition, pathogenesis, grading and staging, and clinical significance of the most common lesions in placental pathology. Illustrations of the lesions and diagrams of the mechanisms of disease are provided.

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“…Additionally, twin pregnancies with a short cervix and AF “sludge” were associated with an increased risk of extreme preterm delivery and had a high rate of perinatal morbidity and mortality. ,46…”

Section: Discussionmentioning

confidence: 99%

Sludge reflects intra‐amniotic inflammation with or without microorganisms

Yoneda

Niimi

et al. 2017

American J Rep Immunol

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

Cited by 28 publications

References 49 publications

The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta‐analysis

The effect of gestational age and cervical length measurements in the prediction of spontaneous preterm birth in twin pregnancies: an individual patient level meta‐analysis

Acute chorioamnionitis and funisitis: definition, pathologic features, and clinical significance

Sludge reflects intra‐amniotic inflammation with or without microorganisms

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