OP10.04: Management of women with incidentally discovered short cervix and amniotic fluid sludge at routine mid‐trimester ultrasound

Abstract

Oral poster abstracts OP10.04 Management of women with incidentally discovered short cervix and amniotic fluid sludge at routine mid-trimester ultrasound Objectives: Amniotic fluid 'sludge' (AFS) has been linked to intraamniotic infection, increased rates of spontaneous preterm delivery, PPROM and short interval from ultrasound diagnosis to delivery. This observational pilot study aims to determine if management with broad-spectrum antibiotics and progesterone initiated at diagnosis could delay delivery in patients incidentally found to have extremely premature cervical shortening and the presence of AFS. Methods: From 2008 to 2010, 42 patients were diagnosed with extremely premature cervical shortening (≤ 15 mm) at routine ultrasound between 18-24 weeks' gestation. Ten patients were excluded because of multiple pregnancy or fetal anomaly. The presence of AFS was identified in 17 of the 32 patients and these women were managed uniformly with bed rest, broad-spectrum antibiotics and progesterone initiated at diagnosis and followed prospectively until delivery. Patients without AFS did not receive antibiotics. Results: Mean gestational (GA) at diagnosis was 21.4 ± 1.9 weeks. The mean GA at delivery was 31.9 ± 6.0 (range 23.0-40.6) for patients without AFS and 35.1 ± 6.9 (range 21.9-41.4) weeks for patients with AFS (P = 0.16). The median delay from ultrasound diagnosis to delivery was 9.8 ± 6.2 (range 1.14-19.0) for patients without AFS and 14.3 ± 6.6 weeks (range 1.9-17.7) for patients with AFS. Conclusions: Though limited by small sample size, it appears that the outcome for women with very premature cervical changes and AFS treated with antibiotics and progesterone does not differ from those women with premature cervical changes without 'sludge'. Antibiotic and progesterone therapy may improve outcome in these women who have been shown to have a very poor prognosis when treated expectantly or with cerclage. Future studies involving multiple centers are needed to better answer this question.