Effects of antibiotic therapy in women with the amniotic fluid “sludge” at 15–24 weeks of gestation on pregnancy outcomes

Пустотина, О. А.

doi:10.1080/14767058.2019.1567706

Cited by 11 publications

(11 citation statements)

References 52 publications

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“…A recent study demonstrated that women at 15-24 weeks of pregnancy with AFS after intravenous antibiotic treatment with anti-inflammatory drugs showed the elimination of AFS within 2 weeks and reduced risk of PTB. 20 Dinglas et al 21 reported ultrasonographic results showing that the AFS in pregnant women was successfully resolved with metronidazole, azithromycin, and amoxicillin. In the present study, treatment with antibiotics eradicated the AFS in some patients not in others.…”

Section: Ta B L Ementioning

confidence: 99%

Antibiotic treatment of amniotic fluid “sludge” in patients during the second or third trimester with uterine contraction

Jin

Kim

et al. 2020

Intl J Gynecology & Obste

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Objective To assess the effectiveness of antibiotic treatment in patients with amniotic fluid (AF) “sludge” during the second or third trimester with uterine contractions and intact membranes. Methods A retrospective cohort study was conducted of women at 15–32 weeks of pregnancy with uterine contractions and intact membranes. Women with AF “sludge” were treated with an antibiotic regimen of ceftriaxone, clarithromycin, and metronidazole. Based on changes in AF “sludge,” patients were divided into group A (disappearance of “sludge”) and group B (persistent “sludge”). Results Women in group A (n=30) delivered later than those in group B (n=28). Group A showed a smaller initial size of “sludge” than group B (all P<0.05). Women in group A had a lower rate of preterm birth within 7 days, and before 28, 32, and 34 weeks of pregnancy, and composite neonatal morbidity and perinatal death than group B (all P<0.05). Conclusion The administration of antibiotics may eradicate AF “sludge” in women in the second or third trimester with uterine contractions and intact membranes, which are associated with the initial size of “sludge.” Patients with disappearing “sludge” had more favorable pregnancy and neonatal outcomes than those with persistent “sludge.”

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Section: Ta B L Ementioning

confidence: 99%

Antibiotic treatment of amniotic fluid “sludge” in patients during the second or third trimester with uterine contraction

Jin

Kim

et al. 2020

Intl J Gynecology & Obste

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“…Nonetheless, AFS has received recognition as an effective index in treating preterm birth with antibiotics. 22,23 Several studies confirmed that cerclage has a positive effect on the prevention of preterm birth before 34 weeks of gestation. 24,25 In our study, the combination of AFS and CL ≤25 mm has a median gestational age at delivery of 33 weeks.…”

Section: Discussionmentioning

confidence: 97%

“…However, the causal relationship by which AFS causes the cervix to shorten or predisposes women with an extremely short cervix to ascending infection remains uncertain. Nonetheless, AFS has received recognition as an effective index in treating preterm birth with antibiotics 22,23 …”

Section: Discussionmentioning

confidence: 99%

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Relationship of Amniotic Fluid Sludge and Short Cervix With a High Rate of Preterm Birth in Women After Cervical Cerclage

Huang

Liang

Liao

et al. 2022

J of Ultrasound Medicine

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Objective-We aims to determine the relationship of amniotic fluid sludge (AFS) and/or short cervical length (CL, ≤25 mm) with a high rate of preterm birth in women after cervical cerclage.Methods-A retrospective cohort study was conducted among singleton pregnancies after cervical cerclage between January 2018 and December 2021. A total of 296 patients who underwent transvaginal ultrasound to evaluate CL and the presence of AFS within 2 weeks after cerclage were included. Pregnancy outcome after cerclage was analyzed in accordance with the presence of AFS and CL ≤25 mm.Results-In patients with cerclage, AFS was an independent risk factor for preterm birth at <28 and <36 weeks but not for preterm birth at <32 weeks, and CL ≤25 mm was an independent risk factor for preterm birth at <28, <32, and <36 weeks. The Kaplan-Meier analysis showed that the association between the presence of AFS and short gestational age at delivery was statistically significant in women with CL ≤25 mm (log rank test, P = .000). The Cox regression analysis showed that these results remained significant after adjusting for confounding factors (P = .000). The negative linear relationships between AFS and CL (R = À0.454, P < .001) also explained the outcome.Conclusions-AFS and short cervix have a direct effect on pregnancies after cerclage. Mid-trimester AFS can become a supplementary ultrasound index for detecting preterm birth after cerclage in pregnant women with a short cervix.

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“…So war in einer Subgruppenanalyse der oben erwähnten Metaanalye die Schwangerschaftsdauer signifikant länger (mittlere Differenz 10,5 Tage [95 %CI 4,95-16,06], N = 293), wenn bei drohender Frühgeburt ein Antibiotikum mit anaerobem Wirkspektrum im Vergleich zu keiner antibiotischen Therapie gegeben wurde [17]. Aktuelle Fallserien und Kohortenstudien zeigten, dass eine erfolgreiche antibiotische Therapie intrauteriner Infektionen mit nachfolgender Prolongation der Schwangerschaftsdauer möglich zu sein scheint [28][29][30][31][32][33]. Diagnostische Kriterien waren ein sonografischer "sludge"-Nachweis oder der direkte Erregernachweis mittels Amniozentese, ein invasiver Eingriff der, obwohl im Rahmen der vorliegenden Studie nicht erfragt, in Deutschland wohl eher kaum Anwendung außerhalb von Studien finden dürfte.…”

Section: Diskussionunclassified

Infektionsmanagement bei drohender Frühgeburt – eine Umfrage an deutschen Perinatalzentren

Pech

Gerber

Stubert

2021

Z Geburtshilfe Neonatol

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Zusammenfassung Einleitung Internationalen und nationalen Leitlinien fehlt es an detaillierten Empfehlungen zur Infektionsdiagnostik und -therapie bei drohender Frühgeburt. Ziel der Studie war es, Daten zur Versorgungssituation an deutschen Perinatalzentren zu erheben. Methoden Onlineumfrage zum Infektionsmanagement bei drohender Frühgeburt an allen 212 deutschen Perinatalzentren der Versorgungsstufen Level I und II. Ergebnisse Die Rücklaufquote betrug 31,6% (n=67). Bei drohender Frühgeburt unter 34 vollendeten SSW ohne Blasensprung verzichten 78,8% auf eine kalkulierte Antibiotikagabe. Von den verbleibenden vierzehn Zentren (21,2%) würde die Hälfte generell bei klinischen Zeichen einer drohenden Frühgeburt antibiotisch behandeln. Fast alle Zentren (94%) führen eine vaginale Erregerdiagnostik durch. Eine mikroskopische Abstrichbeurteilung mittels Nugent- oder Amsel-Score erfolgt in 37,3%. Abweichungen von der physiologischen vaginalen Mikrobiota werden mehrheitlich antibiotisch behandelt (bakterielle Vaginose 79,1%, n=53, Candida spp. 77,6%, n=52, Ureaplasma spp. 49,3%, n=33). Kontrollabstriche erfolgen in 70,1%. Konsens besteht hinsichtlich einer Antibiotikagabe bei frühem vorzeitigem Blasensprung. 72,6% bevorzugen eine Monotherapie mit einem β-Laktam-Antibiotikum. Uneinheitlich waren hier die Angaben zur Dauer der Therapie, wobei 58% der Zentren länger als sieben Tage behandeln. Schlussfolgerung An deutschen Perinatalzentren besteht eine hohe Bereitschaft zur Infektionsdiagnostik und -therapie bei drohender Frühgeburt. Das Infektionsmanagement ist jedoch uneinheitlich und partiell widersprüchlich zu den vorliegenden Leitlinien. Es besteht ein Bedarf an qualitativ hochwertigen Studien zu diesem Thema.

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Effects of antibiotic therapy in women with the amniotic fluid “sludge” at 15–24 weeks of gestation on pregnancy outcomes

Cited by 11 publications

References 52 publications

Antibiotic treatment of amniotic fluid “sludge” in patients during the second or third trimester with uterine contraction

Antibiotic treatment of amniotic fluid “sludge” in patients during the second or third trimester with uterine contraction

Relationship of Amniotic Fluid Sludge and Short Cervix With a High Rate of Preterm Birth in Women After Cervical Cerclage

Infektionsmanagement bei drohender Frühgeburt – eine Umfrage an deutschen Perinatalzentren

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