Adanir Ilknur, Ozyuncu Ozgur, Gokmen Karasu Ayse Filiz, Onderoglu Lutfu S
a Department of Obstetrics and Gynecology , Hacettepe University Faculty of Medicine , Ankara , Turkey.
b Department of Obstetrics and Gynecology , Bezmialem Vakif University , Istanbul , Turkey.
J Matern Fetal Neonatal Med. 2018 Jan;31(2):135-140. doi: 10.1080/14767058.2016.1277700. Epub 2017 Jan 26.
The aim of our study is to determine prevalence and clinical significance of the presence of amniotic fluid "sludge" among asymptomatic patients at high-risk for spontaneous preterm delivery, prospectively.
In our study, 99 patients at high risk for spontaneous preterm delivery were evaluated for the presence of amniotic fluid sludge with transvaginal ultrasonography at 20-22, 26-28, and 32-34 gestational weeks, prospectively; between August 2009 and October 2010 in Hacettepe University Hospital. And, these patients were followed up for their delivery weeks and pregnancy outcomes. We defined the high-risk group as the patients possessing one or more of the followings; a history of spontaneous preterm delivery, recent urinary tract infections, polyhydramnios, uterine leiomyomas, müllerian duct anomalies, and history of cone biyopsy or LEEP. Patients with multiple gestations, placenta previa, fetal anomalies, or symptoms of preterm labor at first examination were excluded. We have obtained ethical board approval from Hacettepe University (16.07.2009-HEK/No:09-141-59).
The prevalence of amniotic fluid sludge in the study population was 19,6% (18/92). The rates of spontaneous preterm delivery at <37 weeks of gestation were 66,7% (12/18), within the patients with sludge and 27,0% (20/74) within the patients without sludge. Patients with sludge had a higher rate of spontaneous preterm delivery (p = 0.002). A higher proportion of neonates born to patients with amniotic fluid sludge had a neonatal morbidity (50% (9/18) vs. 24,3% (18/74), p = 0.044) and died in the perinatal period, (p = 0,013) than those born to patients without sludge. When we combined sludge and cervical lenght (CL) (<25 mm) and used it as a screening test to identify women at risk for preterm delivery; it catched more women with preterm delivery, (p = 0.000). While sensitivity of sludge was 37,5%, and sensitivity of CL was 34%, sensitivity of "sludge positive or CL ≤25 mm" was 56% for preterm birth (PTB) in high-risk group.
The prevalence of amniotic fluid sludge is 19,6% and "sludge" is an independent risk factor for spontaneous preterm delivery among asymptomatic patients at high-risk for spontaneous preterm delivery. PTB is by far the leading cause of infant mortality, and prevention of PTB has been an elusive goal. When sludge added to screening, we can catch more PTB.
我们研究的目的是前瞻性地确定在有自然早产风险的无症状患者中羊水“淤泥”的发生率及其临床意义。
在我们的研究中，2009年8月至2010年10月期间，于哈杰泰佩大学医院对99例有自然早产风险的患者在妊娠20 - 22周、26 - 28周和32 - 34周时进行经阴道超声检查，前瞻性地评估羊水淤泥的存在情况。并且，对这些患者的分娩孕周和妊娠结局进行随访。我们将高危组定义为具有以下一项或多项情况的患者；自然早产史、近期尿路感染、羊水过多、子宫平滑肌瘤、苗勒管畸形以及宫颈锥切活检或利普刀治疗史。首次检查时患有多胎妊娠、前置胎盘、胎儿畸形或早产症状的患者被排除。我们已获得哈杰泰佩大学伦理委员会的批准（2009年7月16日 - HEK/编号：09 - 141 - 59）。
研究人群中羊水淤泥的发生率为19.6%（18/92）。在有淤泥的患者中，妊娠<37周时自然早产的发生率为66.7%（12/18），在无淤泥的患者中为27.0%（20/74）。有淤泥的患者自然早产发生率更高（p = 0.002）。羊水淤泥患者所生新生儿的发病率更高（50%（9/18）对24.3%（18/74），p = 0.044），且围产期死亡的比例也更高（p = 0.013），高于无淤泥患者所生新生儿。当我们将淤泥和宫颈长度（CL）（<25mm）结合起来作为一种筛查试验以识别有早产风险的女性时；它能筛查出更多早产女性（p = 0.000）。对于高危组早产（PTB），淤泥的敏感度为37.5%，CL的敏感度为34%，“淤泥阳性或CL≤25mm”的敏感度为56%。
羊水淤泥的发生率为19.6%，并且“淤泥”是有自然早产风险的无症状患者自然早产的独立危险因素。早产是婴儿死亡的主要原因，预防早产一直是一个难以实现的目标。当将淤泥纳入筛查时，我们可以筛查出更多早产患者。
