Sludge amniótico e prematuridade: revisão sistemática e metanálise

Pannain, Gabriel Duque; Pereira, Ana Maria Gomes; Rocha, Maria Luiza Toledo Leite Ferreira da; Lopes, Reginaldo Guedes Coelho

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Brasil

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Sumário

Original Article • Rev Bras Ginecol Obstet 45 (8) • 2023 • https://doi.org/10.1055/s-0043-1772189 copiar

Sludge amniótico e prematuridade: revisão sistemática e metanálise

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Realizar revisão sistemática e metanálise de estudos que avaliaram os desfechos maternos, fetais e neonatais em gestantes de gravidez única, após concepção espontânea, e com o diagnóstico de sludge amniótico antes de 37 semanas de idade gestacional.

Fontes dos dados

Realizou-se uma pesquisa nas bases de dados PubMed, Cochrane, Bireme e Teses até junho de 2022.

Seleção dos estudos

Usando as palavras-chave intra-amniotic sludge ou fluid sludge ou echogenic particles, foram encontrados 263 artigos, 132 dos quais eram duplicatas, e 70 foram descartados por não corresponderem aos critérios de inclusão.

Coleta de dados

Os artigos encontrados foram analisados por 2 revisores; 61 foram selecionados para análise de texto completo, 18 foram incluídos em uma análise qualitativa e 14, em uma análise quantitativa.

Síntese dos dados

Entre os desfechos maternos analisados, houve aumento do risco de trabalho de parto prematuro (intervalo de confiança de 95% [IC95%]: 1.45–2.03), rotura prematura de membranas ovulares (IC95%: 1.99–3.79), e corioamnionite clínica (IC95%: 1.41–6.19) e histológica (IC95%: 1.75–3.12). Em relação aos desfechos fetais, houve aumento significativo do risco de morbidade (IC95%: 1.80–3.17), mortalidade (IC95%: 1.14–18.57), admissão em Unidade de Tratamento Intensivo (UTI) neonatal (IC95%: 1.17–1.95) e sepse neonatal (IC95%: 2.29–7.55).

Conclusão

Os resultados do presente estudo indicam que a presença de sludge amniótico é um marcador de risco para parto prematuro. Apesar da heterogeneidade dos estudos analisados, até mesmo em pacientes com outros fatores de risco para prematuridade, como colo curto e trabalho de parto prematuro anterior, a presença de sludge amniótico aumenta o risco de trabalho de parto prematuro na gestação. Além do mais, a antibioticoterapia parece ser um tratamento para o sludge amniótico, e pode ser capaz de prolongar a gravidez.

Palavras-chave
sludge ; prematuridade; líquido amniótico

Author, year	N sludge	N no sludge	Short cervix	Cerclage or pessary
Adanir et al., 2018¹⁶16 Adanir I, Ozyuncu O, Gokmen Karasu AF, Onderoglu LS. Amniotic fluid “sludge”; prevalence and clinical significance of it in asymptomatic patients at high risk for spontaneous preterm delivery. J Matern Fetal Neonatal Med. 2018;31(02):135–140	18	74	UR	UR
Bujold et al., 2008¹⁷17 Bujold E, Morency AM, Rallu F, Ferland S, Tétu A, Duperron L, et al. Bacteriology of amniotic fluid in women with suspected cervical insufficiency. J Obstet Gynaecol Can. 2008;30(10):882–887	14	75	UR	UR
Espinoza et al., 2005¹⁸18 Espinoza J, Gonçalves LF, Romero R, Nien JK, Stites S, Kim YM, et al. The prevalence and clinical significance of amniotic fluid ‘sludge’ in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol. 2005;25(04):346–352	19	65	UR	4/16 and 4/65
Gorski et al., 2010¹⁹19 Gorski LA, Huang WH, Iriye BK, Hancock J. Clinical implication of intra-amniotic sludge on ultrasound in patients with cervical cerclage. Ultrasound Obstet Gynecol. 2010;36(04):482–485	60	117	Part	YES
Hatanaka et al., 2014²⁰20 Hatanaka AR, Mattar R, Kawanami T, França MS, Rolo LC, Nomura RM, et al. Clinical significance of the presence of amniotic fluid’-sludge'in asymptomatic patients at low and high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol. 2014;44 (S1):16–6	49	146	Part	UR
Himaya et al., 2011²¹21 Himaya E, Rhalmi N, Girard M, Tétu A, Desgagné J, Abdous B, et al. Midtrimester intra-amniotic sludge and the risk of spontaneous preterm birth. Am J Perinatol. 2011;28(10):815–820	16	200	Part	UR
Huang et al., 2022²²22 Huang Y, Liang X, Liao J, Li Y, Chen Z. Relationship of Amniotic Fluid Sludge and Short Cervix With a High Rate of Preterm Birth in Women After Cervical Cerclage. J Ultrasound Med. 2022;41(11): 2687–2693. Doi: 10.1002/jum.15952 https://doi.org/10.1002/jum.15952...	45	251	Part	YES
Kovavisarach and Jongfuangprinya, 2019²³23 Kovavisarach E, Jongfuangprinya K. Prevalence of Amniotic Fluid Sludge in Low-Risk Pregnant Women of Preterm Delivery. J Med Assoc Thai. 2019;102(05):4–0	72	258	Part	NO
Kusanovic et al., 2007²⁴24 Kusanovic JP, Espinoza J, Romero R, Gonçalves LF, Nien JK, Soto E, et al. Clinical significance of the presence of amniotic fluid ‘sludge’ in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol. 2007;30(05):706–714	66	215	Part	28/215 and 21/66
Saade et al., 2018²⁵25 Saade GR, Thom EA, Grobman WA, Iams JD, Mercer BM, Reddy UM, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30. mm. Ultrasound Obstet Gynecol. 2018;52 (06):757–762	78	579	YES	UR
Ting et al., 2012²⁶26 Ting YH, Lao TT, Law LW, Hui SYA, Chor CM, Lau TK, Leung TY. Arabin cerclage pessary in the management of cervical insufficiency. J Matern Fetal Neonatal Med. 2012;25(12): 2693–2695	5	15	YES	YES
Tsunoda et al., 2020²⁷27 Tsunoda Y, Fukami T, Yoneyama K, Kawabata I, Takeshita T. The presence of amniotic fluid sludge in pregnant women with a short cervix: an independent risk of preterm delivery. J Matern Fetal Neonatal Med. 2020;33(06):920–923	29	81	YES	6/29 and 10/81
Vaisbuch et al., 2010²⁸28 Vaisbuch E, Hassan SS, Mazaki-Tovi S, Nhan-Chang CL, Kusanovic JP, Chaiworapongsa T, et al. Patients with an asymptomatic short cervix (<or=15. mm) have a high rate of subclinical intraamniotic inflammation: implications for patient counseling. Am J Obstet Gynecol. 2010;202(05):433.e1–433.e8	64	45	YES	UR
Yasuda et al., 2020²⁹29 Yasuda S, Tanaka M, Kyozuka H, Suzuki S, Yamaguchi A, Nomura Y, Fujimori K. Association of amniotic fluid sludge with preterm labor and histologic chorioamnionitis in pregnant Japanese women with intact membranes: A retrospective study. J Obstet Gynaecol Res. 2020;46(01):87–92	11	43	UR	UR

Author, year	VB sludge	VB no sludge	S sludge	S no sludge	HPTD sludge	HPTD no sludge
Adanir et al., 2018¹⁶16 Adanir I, Ozyuncu O, Gokmen Karasu AF, Onderoglu LS. Amniotic fluid “sludge”; prevalence and clinical significance of it in asymptomatic patients at high risk for spontaneous preterm delivery. J Matern Fetal Neonatal Med. 2018;31(02):135–140	9\18	16/74	UR	UR	YES	YES
Bujold et al., 2008¹⁷17 Bujold E, Morency AM, Rallu F, Ferland S, Tétu A, Duperron L, et al. Bacteriology of amniotic fluid in women with suspected cervical insufficiency. J Obstet Gynaecol Can. 2008;30(10):882–887	UR	UR	UR	UR	4/14	20/75
Espinoza et al., 2005¹⁸18 Espinoza J, Gonçalves LF, Romero R, Nien JK, Stites S, Kim YM, et al. The prevalence and clinical significance of amniotic fluid ‘sludge’ in patients with preterm labor and intact membranes. Ultrasound Obstet Gynecol. 2005;25(04):346–352	6\19	3\65	UR	UR	3\19	21/65
Gorski et al., 2010¹⁹19 Gorski LA, Huang WH, Iriye BK, Hancock J. Clinical implication of intra-amniotic sludge on ultrasound in patients with cervical cerclage. Ultrasound Obstet Gynecol. 2010;36(04):482–485	10\60	19\117	5\60	8\117	18/60	34/117
Hatanaka et al., 2014²⁰20 Hatanaka AR, Mattar R, Kawanami T, França MS, Rolo LC, Nomura RM, et al. Clinical significance of the presence of amniotic fluid’-sludge'in asymptomatic patients at low and high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol. 2014;44 (S1):16–6	UR	UR	UR	UR	UR	UR
Himaya et al., 2011²¹21 Himaya E, Rhalmi N, Girard M, Tétu A, Desgagné J, Abdous B, et al. Midtrimester intra-amniotic sludge and the risk of spontaneous preterm birth. Am J Perinatol. 2011;28(10):815–820	UR	UR	UR	UR	3\16	13/200
Huang et al., 2022²²22 Huang Y, Liang X, Liao J, Li Y, Chen Z. Relationship of Amniotic Fluid Sludge and Short Cervix With a High Rate of Preterm Birth in Women After Cervical Cerclage. J Ultrasound Med. 2022;41(11): 2687–2693. Doi: 10.1002/jum.15952 https://doi.org/10.1002/jum.15952...	UR	UR	UR	UR	7\45	40/251
Kovavisarach and Jongfuangprinya, 2019²³23 Kovavisarach E, Jongfuangprinya K. Prevalence of Amniotic Fluid Sludge in Low-Risk Pregnant Women of Preterm Delivery. J Med Assoc Thai. 2019;102(05):4–0	UR	UR	UR	UR	UR	UR
Kusanovic et al., 2007²⁴24 Kusanovic JP, Espinoza J, Romero R, Gonçalves LF, Nien JK, Soto E, et al. Clinical significance of the presence of amniotic fluid ‘sludge’ in asymptomatic patients at high risk for spontaneous preterm delivery. Ultrasound Obstet Gynecol. 2007;30(05):706–714	16/66	25/215	10/57	43/192	21/66	74/215
Saade et al., 2018²⁵25 Saade GR, Thom EA, Grobman WA, Iams JD, Mercer BM, Reddy UM, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Cervical funneling or intra-amniotic debris and preterm birth in nulliparous women with midtrimester cervical length less than 30. mm. Ultrasound Obstet Gynecol. 2018;52 (06):757–762	UR	UR	UR	UR	UR	UR
Ting et al., 2012²⁶26 Ting YH, Lao TT, Law LW, Hui SYA, Chor CM, Lau TK, Leung TY. Arabin cerclage pessary in the management of cervical insufficiency. J Matern Fetal Neonatal Med. 2012;25(12): 2693–2695	UR	UR	UR	UR	UR	UR
Tsunoda et al., 2020²⁷27 Tsunoda Y, Fukami T, Yoneyama K, Kawabata I, Takeshita T. The presence of amniotic fluid sludge in pregnant women with a short cervix: an independent risk of preterm delivery. J Matern Fetal Neonatal Med. 2020;33(06):920–923	3\29	2\81	0/29	0/81	7\29	10\81
Vaisbuch et al., 2010²⁸28 Vaisbuch E, Hassan SS, Mazaki-Tovi S, Nhan-Chang CL, Kusanovic JP, Chaiworapongsa T, et al. Patients with an asymptomatic short cervix (<or=15. mm) have a high rate of subclinical intraamniotic inflammation: implications for patient counseling. Am J Obstet Gynecol. 2010;202(05):433.e1–433.e8	UR	UR	UR	UR	UR	UR
Yasuda et al., 2020²⁹29 Yasuda S, Tanaka M, Kyozuka H, Suzuki S, Yamaguchi A, Nomura Y, Fujimori K. Association of amniotic fluid sludge with preterm labor and histologic chorioamnionitis in pregnant Japanese women with intact membranes: A retrospective study. J Obstet Gynaecol Res. 2020;46(01):87–92	UR	UR	1\11	0\43	3/11	5/43

Author, year	N sludge + ATB	N no sludge	Antibiotic scheme	Outcome
Cuff et al., 2020³⁰30 Cuff RD, Carter E, Taam R, Bruner E, Patwardhan S, Newman RB, et al. Effect of Antibiotic Treatment of Amniotic Fluid Sludge. Am J Obstet Gynecol MFM. 2020;2(01):100073–3	46	51	Azithromycin OA + moxifloxacin OA	There was no reduction in the incidence of PTD
Hatanaka et al., 2019³¹31 Hatanaka AR, Franca MS, Hamamoto TENK, Rolo LC, Mattar R, Moron AF. Antibiotic treatment for patients with amniotic fluid “sludge” to prevent spontaneous preterm birth: A historically controlled observational study. Acta Obstet Gynecol Scand. 2019; 98(09):1157–1163	64	0	Clindamycin OA + cephalexin OA, clindamycin IV + cefazolin IV	Reduction in the incidence of PTD
Hu Jin et al., 2021³²32 Jin WH, Ha Kim Y, Kim JW, Kim TY, Kim A, Yang Y. Antibiotic treatment of amniotic fluid “sludge” in patients during the second or third trimester with uterine contraction. Int J Gynaecol Obstet. 2021;153(01):119–124	58	0	Ceftriaxone IV + clarithromycin OA + metronidazole IV	Reduction in the incidence of PTD and neonatal complications
Pustotina, 2020³³33 Pustotina O. Effects of antibiotic therapy in women with the amniotic fluid “sludge” at 15-24 weeks of gestation on pregnancy outcomes. J Matern Fetal Neonatal Med. 2020;33(17):3016–3027	14	47	Clindamycin VA, butoconazole VA, cefoperazone + sulbactam IV, amoxicillin + clavulonate OA	Reduction in the incidence of PTD, intrauterine and amniotic infection

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[1] Address for correspondence Gabriel Duque Pannain, Resident physician, Federal University of Juiz de Fora, Minas Gerais, MG, Brazil (e-mail: gabrielduquep@gmail.com).