Presence of “Sludge” Does Not Justify the Need for Amniocentesis to Rule Out Infection in Patients With a Short Cervix [27I]

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Abstract

INTRODUCTION:

Previously we found that biomarkers for infection at the time of cervical cerclage were similar between patients (pts) with Intra-amniotic “sludge” (IAS), an ultrasound (US) finding of hyperechoic matter in amniotic fluid (AF) close to the internal os, and without IAS. We aim to find if addition of 23 pts to previously reported 41 pts changes the result.

METHODS:

Record of 64 consecutive pts who underwent a high MacDonald cerclage between 16–24 6/7 weeks (wks) for a sonographically short Cx (<25 mm) from 2007–2015, performed or supervised by a single operator (FB) were evaluated. Transvaginal US images prior to cerclage evaluated for Cx length and presence or absence of IAS. AF collected at the time of cerclage (transabdominal amniocentesis) evaluated for presence of infection by culture, Gram stain (GS), glucose (Glu), red (RBC), and white blood cell (WBC) count.

RESULTS:

36 of 64 pts (56%) had IAS, 28 (43%) did not. All culture and GS were negative. No differences between groups were detected with regards to Glu, (P=.48), RBC (P=.44) or WBC (P=.85). Pregnancy outcomes were similar in terms of gestational age (GA) at delivery. Baseline Cx lengths were similar between groups. Cerclage occurred at slightly earlier GA and patients were slightly older for the IAS Group.

CONCLUSION:

IAS does not indicate the presence of infection. The presence of IAS in asymptomatic pts with sonographically short Cx at mid-trimester does not constitute an indication for an amniocentesis to rule out IA infection or increased risk for premature birth.

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