title: Impact of amniotic fluid "sludge" on the risk of preterm delivery.
abstract: OBJECTIVE
  To evaluate the impact of amniotic fluid "sludge" (AFS) on the risk of preterm delivery and to describe the effect of antibiotic treatment in that situation.
  
  
  METHODS
  Case-control study including singleton pregnancies with or without AFS, between 15-32 weeks of gestation. Factors associated with preterm delivery before 32 weeks, 34 weeks and 37 weeks were evaluated with univariate and multivariate logistic regression. Since all women with AFS in this study were treated with antibiotics, a historical comparison was performed with similar patients with AFS found before 2007 and not treated with antibiotics.
  
  
  RESULTS
  AFS was observed in 90/1220 patients (7.4%). AFS was associated with shorter cervical length, greater body mass index, cervical cerclage and preterm birth before 28 weeks. However, after adjustment, AFS did not remain associated with preterm delivery before 32 or 34 weeks. The historical comparison suggested that azithromycin could significantly reduce the risk of preterm delivery before 34 weeks (odds ratio: 0.2; 95% CI: 0.04-0.92).
  
  
  CONCLUSIONS
  AFS, treated with azithromycin, was associated with a higher risk of prematurity, but not independently after adjustment for cervical length and second trimester vaginal bleeding. Further studies need to evaluate the effect of antibiotics in pregnancies with AFS.
authors.affiliation: a Department of Obstetrics and Gynecology , CHU Sainte Justine, Université de Montréal , Montréal , QC , Canada .
authors.forename: Florent
authors.initials: F
authors.lastname: Fuchs
authors.forename: Isabelle
authors.initials: I
authors.lastname: Boucoiran
authors.forename: Audrey
authors.initials: A
authors.lastname: Picard
authors.forename: Johanne
authors.initials: J
authors.lastname: Dube
authors.forename: Sandrine
authors.initials: S
authors.lastname: Wavrant
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.forename: François
authors.initials: F
authors.lastname: Audibert
mesh_terms: D000328:Adult; D000653:Amniotic Fluid; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016015:Logistic Models; D007752:Obstetric Labor, Premature / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D047928:Premature Birth; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents
keywords: Amniotic fluid “sludge”; preterm labour; second trimester vaginal bleeding; short cervix; spontaneous preterm delivery; transvaginal ultrasound