title: Clinical significance of amniotic fluid sludge in twin pregnancies with a short cervical length.
abstract: OBJECTIVE
  The objective of the study was to determine the clinical significance of amniotic fluid (AF) sludge in twin pregnancies with a short cervix.
  
  
  METHODS
  We evaluated twin pregnancies with a short cervical length that had an ultrasound between 16 and 26 weeks (n = 78). Pregnancy outcomes in those with sludge (n = 27) and those without (n = 51) were compared. Outcome variables included gestational age at delivery, premature rupture of the membranes, chorioamnionitis, funisitis, composite neonatal morbidity, and perinatal death. For statistical analysis, the first-born (A) and second-born (B) twins were studied separately.
  
  
  RESULTS
  The prevalence of AF sludge was 34.6% (27 of 78). Pregnancies with sludge delivered earlier (27.2 ± 5.6 weeks vs 31.0 ± 4.05 weeks, P < .01) and had a higher rate of extreme prematurity (<26 weeks: 52.2% [12 of 23] vs 15.6% [5 of 32]; P < .01). Both twins had higher rates of histological chorioamnionitis (twin A, 50.0% [13 of 26] vs 12.8% [6 of 47]; P < .01; twin B, 42.3% [11 of 26] vs 13.3% [6 of 45]; P < .01) and neonatal death (twin A, 33.3% [9 of 27] vs 3.9% [2 of 51]; P < .01; twin B, 33.3% [9 of 27] vs 6.0% [3 of 50]; P = .01). Higher rates of funisitis (23.1% [6 of 26] vs 4.3% [2 of 47]; P = .02) and composite neonatal morbidity were observed for twin A only (66.7% [14 of 21] vs 37.5% [18 of 48]; P = .04).
  
  
  CONCLUSIONS
  The presence of AF sludge in twin pregnancies with a short cervix is a risk factor for extreme prematurity, histological chorioamnionitis, and perinatal death. Twin A had higher rates of funisitis and neonatal morbidity in the presence of AF sludge.
authors.affiliation: Division of Fetal Imaging, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI. Electronic address: dranandakn@gmail.com.
authors.forename: Ananda
authors.initials: A
authors.lastname: Boyer
authors.affiliation: Wayne State University Medical School, Detroit, MI.
authors.forename: Lauren
authors.initials: L
authors.lastname: Cameron
authors.affiliation: Research Institute, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Munoz-Maldonado
authors.affiliation: Division of Fetal Imaging, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
authors.forename: Richard
authors.initials: R
authors.lastname: Bronsteen
authors.affiliation: Division of Fetal Imaging, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
authors.forename: Christine H
authors.initials: CH
authors.lastname: Comstock
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Wesley
authors.initials: W
authors.lastname: Lee
authors.affiliation: Division of Fetal Imaging, Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, MI; Department of Pediatric Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
authors.forename: Luis F
authors.initials: LF
authors.lastname: Goncalves
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000000981:diagnostic imaging*; D054791:Cervical Length Measurement / Q000706:statistics & numerical data*; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D002821:Chorioamnionitis / Q000453:epidemiology*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology*; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D047928:Premature Birth / Q000453:epidemiology*; D013223:Statistics as Topic
keywords: amniotic fluid sludge; neonatal morbidity; prematurity; short cervix; twins