Department of Obstetrics, Paulista School of Medicine (UNIFESP - EPM), Universidade Federal de São Paulo, São Paulo, Brazil.
Acta Obstet Gynecol Scand. 2019 Sep;98(9):1157-1163. doi: 10.1111/aogs.13603. Epub 2019 Apr 1.
Amniotic fluid "sludge" has been associated with an increased rate of spontaneous preterm delivery before 35 weeks, a higher frequency of clinical and histologic chorioamnionitis in a high-risk population. Only one study evaluating the use of antibiotics in the presence of amniotic fluid "sludge" showed reduced rates of spontaneous preterm birth at <34 weeks. The objective of this study was to evaluate routine antibiotic treatment in the presence of amniotic fluid "sludge" for prevention of preterm delivery.
A historically controlled observational study was performed between October 2010 and January 2015, including a total of 86 pregnant women with singleton pregnancies and the presence of amniotic fluid "sludge" at ultrasound. Women admitted from October 2010 to September 2012 received no treatment with antibiotics, whereas those admitted from October 2012 to January 2015, received routinely clindamycin and first-generation cephalosporin. The groups were compared considering the incidence of spontaneous preterm delivery. The effect of antimicrobials was also compared in the subgroup of women at high risk for spontaneous preterm birth (ie, cervical length ≤25 mm, history of spontaneous preterm birth, previous spontaneous loss in the second trimester, Mullerian malformations or cervical conization).
Antibiotic therapy reduced the incidence of spontaneous preterm birth at <34 weeks (13.2% vs 38.5%, P = 0.047) in women at high-risk for preterm birth, with an odds ratio of 0.24 (95% confidence interval [CI] 0.06-0.99). Birthweight was significantly different between the study groups (2961 ± 705 vs. 2554 ± 819 g, respectively; P = 0.028), with no statistical significance for others variables.
This study suggests that antibiotic treatment in high-risk pregnant women with amniotic fluid "sludge" can be effective in the reduction of the frequency of spontaneous preterm delivery and can increase the birthweight.
羊水“胎粪”与 35 周前自发性早产率增加、高危人群临床和组织学绒毛膜羊膜炎的发生频率较高有关。只有一项研究评估了在存在羊水“胎粪”的情况下使用抗生素，结果显示在<34 周时自发性早产的发生率降低。本研究旨在评估存在羊水“胎粪”时常规使用抗生素预防早产。
一项历史对照观察性研究于 2010 年 10 月至 2015 年 1 月进行，共纳入 86 例单胎妊娠和超声检查存在羊水“胎粪”的孕妇。2010 年 10 月至 2012 年 9 月入院的孕妇未接受抗生素治疗，而 2012 年 10 月至 2015 年 1 月入院的孕妇常规接受克林霉素和第一代头孢菌素治疗。比较两组自发性早产的发生率。还比较了抗生素在自发性早产高危（即宫颈长度≤25mm、自发性早产史、中孕期自发性流产史、苗勒管畸形或宫颈锥切）的孕妇亚组中的作用。
抗生素治疗降低了高危孕妇自发性早产发生率（<34 周）（13.2% vs. 38.5%，P=0.047），早产的优势比为 0.24（95%可信区间[CI] 0.06-0.99）。两组间出生体重存在显著差异（分别为 2961±705g 和 2554±819g，P=0.028），但其他变量无统计学意义。
本研究表明，高危孕妇羊水“胎粪”存在时抗生素治疗可有效降低自发性早产的频率，并可增加出生体重。
