The Association between Short Cervix and Amniotic Fluid Sludge on Preterm Labor at MCU-FDTMF Hospital: a Prospective Study

Elijinese Marie  S. Culangen,

The Association between Short Cervix and Amniotic Fluid Sludge on Preterm Labor at MCU-FDTMF Hospital: a Prospective Study

Abstract:

Objective: To determine the association between short cervix and amniotic fluid sludge and preterm labor at the OB-OPD, High Risk Unit, and USI Department of MCU-FDTMF Hospital. Methods: OB-OPD patients are classified as High Risk or Low Risk based on the assessment of the Resident-in-charge at the OPD. Those who were High Risk were referred to the High-Risk Section and re-evaluated by means of on Orange Referral Sheet by the Perinatology Fellow assigned at the OPD. Congenital Anomaly Scan were requested anytime between 18-28 weeks age of gestation. The cervical length measurement was included and a logbook was kept to maintain a record of all the patients included. The principal investigator identified presence of a short cervix, amniotic fluid sludge, and/or both and determined the profile of patients in the study population. Results: One hundred forty-nine subjects 19 to 44 years with a mean age of 29.33 years (SD=6.27) were included. Of these, 13 (8.7%) had presence of short cervix only, 17 (11.4%) had presence of amniotic fluid “sludge” only, while 86 (57.7%) had both short cervix and amniotic fluid “sludge” for a total of 116 (77.9%). The risk for a patient with short cervix to have preterm labor was 2x higher than those without short cervix (OR=2.62; 95%CI = 1.23 to 5.61; p=0.006). The risk for preterm labor among those with amniotic fluid “sludge” was 2x higher than those without amniotic fluid “sludge” (OR=2.06; 95%CI = 1.00 to 4.45; p=0.04). When both short cervix and amniotic fluid “sludge” were present, the risk for preterm labor was 3x higher than those without any of the two (OR=3.21; 95%CI = 1.28 to 8.17; p=0.005). Conclusion: Short cervix and amniotic fluid sludge were associated with preterm labor. A higher risk was noted when the presence of both was evident.

References:

Stacy Beck S, Daniel Wojdyla D, Lale Say L, Ana Pilar Betran AP, Mario Merialdi M, Jennifer Harris
Requejo JH, Craig Rubens C, Ramkumar Menon R, Van Look PFA: The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ 2010;88:31–38
2. Groen R, Leow J, Sadasivam V, Kushner A.: Review: indications for ultrasound use in low- and middle-income countries. Trop Med Int Health. 2011;16(2):1525–1535
Stanton K, Mwanri L: Global Maternal and Child Health Outcomes: The Role of Obstetric Ultrasound in Low Resource Settings. J Prev med.2013, 1 (3); 22-29
Goldenberg RL, Culhane JF, Iams JD, Romero R: Epidemiology and causes of preterm birth. Lancet. Jan2008; 5371(9606):75-84.
Espinoza J, Goncalves LF, Romero R, et al: The prevalence and clinical significance of amniotic fluid ‘sludge’ in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol.2005;25:346-352
Norton S. Callen’s Ultrasonography in Obstetrics and Gynecology. 5th Ed. Philadelphia PA, Elsevier Inc 2008;704.
Guimarães Filho HA, Araujo Júnior E, Pires CR, Nardozza LM, Moron AF: Short cervix syndrome: current knowledge from etiology to the control. Arch Gynecol Obstet. Apr 2013;287(4):621-8
M.T. Mella, V. Berghella: Prediction of Preterm Birth: Cervical Sonography. Semin Perinatol. Oct2009; 33(5) : 317-24
Bujold E, Pasquier JC, Simoneau J, Arpin MH, Duperron L, Morency AM, Audibert F: Intra-amniotic sludge, short cervix, and risk of preterm delivery. J Obstet Gynaecol Can. Mar28 2006(3):198-202.
Fuchs F, Boucoiran I, Picard A, Dube J, Wavrant S, Bujold E, Audibert F: Impact of amniotic fluid “sludge” on the risk of preterm delivery. J Matern Fetal Neonatal Med. 2014:1-5.
Hatanaka AR, Mattar R, Kawanami TEN, França MS, Rolo LC, RMY, Araujo Júnior E, Nardozza LMM, and Moron AF: Amniotic fluid “sludge” is an independent risk factor for preterm delivery. J Matern Fetal Neonatal Med. 2014:1-6
Ventura W, Nazario C, Ingar J, Huertas E, Limay O, Castillo W: Risk of impending preterm delivery associated with the presence of amniotic fluid sludge in women in preterm labor with intact membranes. Fetal Diagn Ther. 2011;30(2):116-21.
Picard A, Boucoiran I, Wavrant S, Dube J, Bujold E, Audibert F: Intra-amniotic sludge observed at cervical ultrasound and the risk of preterm delivery. Ultrasound in Obstet Gynecol.2013;42:48-112.
Himaya E, Rhalmi N, Girard M, Tetu A, Desgagne J, Abdous B, Gekas J, Giguere Y, Bujold E: Midtrimester Intra-Amniotic Sludge and the Risk of Spontaneous Preterm Birth. Amer J Perinatol.2011; 28(10): 815-820.
Kusanovic JP , Espinoza J, Romero R, Goncalves LF, Nien JK, Soto E, Khalek N, Camacho N, Hendler I, Mittal P, Friel LA, Gotsch F, Erez O, Than NG, Mazaki-Tovi S, Schoen ML, Hassan SS: Clinical significance of the presence of amniotic fluid ‘sludge’ in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol.2007; 30: 706–714.
Mungen E, Tutuncu L, Muhcu M: Pregnancy outcome in women with echogenic amniotic fluid at term gestation. Int J Gynaecol Obstet. 2005;88:314.
Zimmer EZ, Bronshtein M. Ultrasonic features of intra-amniotic “unidentified debris” at 14–16 weeks’ gestation. Ultrasound Obstet Gynecol 1996;7:178–81.