Al Baloushi Mariam, Ahmed Badreldeen, Konje Justin C
Women's Wellness Research Centre, Hamad Medical Corporation, Doha 3050, Qatar.
Department of Obstetrics and Gynaecology, Qatar University, Doha 2713, Qatar.
Diagnostics (Basel). 2025 Aug 19;15(16):2080. doi: 10.3390/diagnostics15162080.
Preterm labour (PTL) affects about 11% of all deliveries world-wide. It is a major cause of perinatal morbidity and mortality. Although the precise cause is unknown in about 50% of cases, infections are thought to be a major contributing factor. These infections are more common in earlier preterm deliveries. While some women with these infections will manifest the classical features of fever, tachycardia (maternal and/or fetal), leucocytosis, raised biomarkers of infections, and uterine tenderness/irritation, others will be asymptomatic. Some of the women may develop a short/dilating cervix without any obvious contractions. Identifying such women is potentially challenging. Evidence has shown that a condensation of echogenic particles just above the cervix-amniotic fluid (AF) sludge, identified by ultrasound-is a marker for microbial invasion of the amniotic cavity (MIAC) and preterm birth (PTB) in both asymptomatic and symptomatic women (including those with a short or normal cervix). Those with a short cervix with AF sludge have a significantly greater risk of progression to PTB. Treatment with antibiotics has been shown in some but not all case series to result in a resolution of the sludge and either a delay or prevention of PTB. The widely varied results from treatment could be related to the antibiotics used and the route of administration. The use of the parenteral combination of clindamycin, a cephalosporin, and metronidazole has been shown to be more effective compared to azithromycin. Here we review the literature on the relationship between the sludge and PTB and conclude (1) that the AF sludge is an ultrasound marker of MIAC and PTL and (2) that following its diagnosis, appropriate counselling should be offered and the triple antibiotic combination offered. We suggest that randomised trials should be undertaken to determine the most efficacious antibiotic combination.
早产影响全球约11%的分娩。它是围产期发病和死亡的主要原因。虽然约50%的病例确切病因不明，但感染被认为是一个主要促成因素。这些感染在早期早产中更为常见。虽然一些感染这些病菌的女性会表现出发热、心动过速（母体和/或胎儿）、白细胞增多、感染生物标志物升高以及子宫压痛/刺激等典型特征，但其他女性可能无症状。一些女性可能会出现宫颈缩短/扩张但无明显宫缩。识别这些女性可能具有挑战性。有证据表明，超声检查发现宫颈上方羊水（AF）淤渣上方的强回声颗粒聚集是无症状和有症状女性（包括宫颈短或正常的女性）羊膜腔微生物入侵（MIAC）和早产（PTB）的标志物。宫颈短且有AF淤渣的女性发生PTB进展的风险显著更高。在一些但并非所有病例系列中，抗生素治疗已显示可使淤渣消退，并延迟或预防PTB。治疗结果差异很大可能与所用抗生素和给药途径有关。与阿奇霉素相比，静脉注射克林霉素、头孢菌素和甲硝唑的联合使用已显示出更有效。在此，我们回顾了关于淤渣与PTB关系的文献，并得出结论：（1）AF淤渣是MIAC和PTL的超声标志物；（2）在诊断后，应提供适当的咨询并提供三联抗生素组合。我们建议应进行随机试验以确定最有效的抗生素组合。
