Presence of amniotic fluid sludge and pregnancy outcomes: A systematic review

Pergialiotis, Vasilios; Bellos, Ioannis; Antsaklis, Aris; Loutradis, Dimitrios; Daskalakis, Georgios

doi:10.1111/aogs.13893

Cited by 10 publications

(6 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Statistical heterogenicity was high (I 2 = 44%) and the trial sequential analysis revealed that the required sample size (2837 women) to reach concrete conclusions was not reached (Figs. 10,11).…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

Antibiotic therapy in patients with amniotic fluid sludge and risk of preterm birth: a meta-analysis

Sapantzoglou

Pergialiotis

Prokopakis

et al. 2023

Arch Gynecol Obstet

View full text Add to dashboard Cite

Purpose Amniotic Fluid Sludge (AFS) has been theorized to be sonographic evidence of an underlying infection/inflammation and studies have concluded that approximately 10% of the patients who show signs of preterm labor with intact membranes have an underlying intraamniotic infection, mostly subclinical, carrying an increased risk for preterm birth with its subsequent neonatal and maternal complications. The purpose of the present systematic review is to evaluate the impact of antibiotic therapy on preterm birth rates of women diagnosed with AFS. Methods We searched Medline, Scopus, the Cochrane Central Register of Controlled Trials CENTRAL, Google Scholar, and Clinicaltrials.gov databases for relevant articles published until the 30th of September 2022. Observational studies (prospective and retrospective) that evaluated the impact of antibiotics on preterm delivery rates of patients with AFS were considered eligible for inclusion. Statistical meta-analysis was performed with RStudio and we calculated pooled risk ratios (OR) and 95% confidence intervals (CI). To evaluate the information size, we performed trial sequential analysis (TSA) and the methodological quality of the included studies was assessed using RoBINS tools. Results Overall, four retrospective cohort studies were included in the present systematic review and 369 women were enrolled. We demonstrated that preterm delivery prior to 34, 32 and 28 weeks of gestational age was comparable among the groups of women that had antibiotics and those that did not (OR: 0.34, 95% CI 0.05, 2.14, 0.40 [0.09, 1.66], 0.35 [0.08, 1.58], respectively) but the statistical heterogenicity of the studies included was high for every gestational period that was examined. Conclusions According to our study, we cannot conclude that the use of antibiotics in women with amniotic fluid sludge benefit the prognostic risk to deliver prematurely. It is quite clear that data from larger sample sizes and more well adjusted and designed studies are needed.

show abstract

Section: Synthesis Of Resultsmentioning

confidence: 99%

Antibiotic therapy in patients with amniotic fluid sludge and risk of preterm birth: a meta-analysis

Sapantzoglou

Pergialiotis

Prokopakis

et al. 2023

Arch Gynecol Obstet

View full text Add to dashboard Cite

show abstract

“…An ultrasound-detectable sludge was shown to be a risk for SPTB in this study. A systematic review showed that patients with sludge had higher incidences of SPTB [ 15 , 17 ]. Recent studies also showed that amniotic fluid sludge is an independent risk factor for PTB [ 18 – 20 ].…”

Section: Discussionmentioning

confidence: 99%

Prognosis and Prognostic Factors of Patients with Emergent Cerclage: A Japanese Single-Center Study

Kobayashi

Takahashi

Matsubara

et al. 2021

Obstetrics and Gynecology International

View full text Add to dashboard Cite

Objectives. The aims of this study were to clarify the following: (1) how often does prolonged pregnancy ≥34 weeks occur in patients with emergent cerclage without progesterone and (2) the risk factors preventing such pregnancy continuation. Materials and Methods. This retrospective observational study was performed using medical records of patients for whom emergent cerclage had been performed between April 2006 and December 2018 in our institute. Results. Emergent cerclage was performed in 123 patients (median age: 34, interquartile range: 31–36). Primiparous patients numbered 44 (36%). A history of spontaneous preterm birth (SPTB) was present in 30 (24%). The median presurgical cervical length (CL) was 16 (8–21) mm at surgery. Of the 123, 20 (16%) were delivered at 33 + 6 weeks or less (<34 weeks). We conducted logistic regression analysis of the risk factors of SPTBs <34 weeks after cerclage. Three risk factors were identified that increased the risk of SPTB <34 weeks: presurgical CL 0 mm (odds ratio (OR): 5.30; 95% confidence interval (CI): 1.58–17.7), a history of SPTB (OR: 4.65; 95% CI: 1.38–15.7), and the presence of sludge (OR: 4.14; 95% CI: 1.20–14.3). Conclusion. Three risk factors predicted SPTB <34 weeks after emergency cerclage without progesterone administration: unmeasurable CL (CL 0 mm), a history of SPTB, and the presence of sludge on ultrasound. SPTB <34 weeks occurred after emergency cerclage in 16% of patients, being comparable with the recent data with progesterone.

show abstract

“…Modulating factors may include: (1) the load and composition of maternal microbiota [ 23 ], microbial type (e.g., high virulent Gram-negative bacteria and relatively low virulent Ureaplasma spp.) [ 19 ], pathogenic factors of microorganisms (e.g., toxin, biofilm-forming capacity) [ 36 ], and microbial exposure in a sequential manner [ 2 ]; (2) maternal pro- and anti-inflammatory immune status is dynamically regulated across gestational trimesters to tolerate the semi-allogenic fetus while confronting potential pathogens and preparing to trigger delivery [ 37 ]; (3) the developing fetal immune system is not less able to elicit inflammatory responses upon microbial exposure, as compared to their term counterparts and adults, but may incline to imbalanced hyper-inflammation [ 38 , 39 ].…”

Section: Intra-amniotic Infection: Microbes Maternal-fetal Inflammati...mentioning

confidence: 99%

Insights into the Black Box of Intra-Amniotic Infection and Its Impact on the Premature Lung: From Clinical and Preclinical Perspectives

Dong

Rivetti

Lingampally

et al. 2022

IJMS

View full text Add to dashboard Cite

Intra-amniotic infection (IAI) is one major driver for preterm birth and has been demonstrated by clinical studies to exert both beneficial and injurious effects on the premature lung, possibly due to heterogeneity in the microbial type, timing, and severity of IAI. Due to the inaccessibility of the intra-amniotic cavity during pregnancies, preclinical animal models investigating pulmonary consequences of IAI are indispensable to elucidate the pathogenesis of bronchopulmonary dysplasia (BPD). It is postulated that on one hand imbalanced inflammation, orchestrated by lung immune cells such as macrophages, may impact on airway epithelium, vascular endothelium, and interstitial mesenchyme, resulting in abnormal lung development. On the other hand, excessive suppression of inflammation may as well cause pulmonary injury and a certain degree of inflammation is beneficial. So far, effective strategies to prevent and treat BPD are scarce. Therapeutic options targeting single mediators in signaling cascades and mesenchymal stromal cells (MSCs)-based therapies with global regulatory capacities have demonstrated efficacy in preclinical animal models and warrant further validation in patient populations. Ante-, peri- and postnatal exposome analysis and therapeutic investigations using multiple omics will fundamentally dissect the black box of IAI and its effect on the premature lung, contributing to precisely tailored and individualized therapies.

show abstract

Presence of amniotic fluid sludge and pregnancy outcomes: A systematic review

Abstract: Introduction: Several studies acknowledge that the presence of amniotic fluid sludge (AFS) is an independent predictive factor for preterm birth. In the present systematic review, we summarize research that focuses on the comparison of pregnancy outcomes among women with and without AFS.

Cited by 10 publications

References 38 publications

Antibiotic therapy in patients with amniotic fluid sludge and risk of preterm birth: a meta-analysis

Antibiotic therapy in patients with amniotic fluid sludge and risk of preterm birth: a meta-analysis

Prognosis and Prognostic Factors of Patients with Emergent Cerclage: A Japanese Single-Center Study

Insights into the Black Box of Intra-Amniotic Infection and Its Impact on the Premature Lung: From Clinical and Preclinical Perspectives

Contact Info

Product

Resources

About