Resolution of acute cervical insufficiency after antibiotics in a case with amniotic fluid sludge.

Abstract

Cervical insufficiency generally refers to a condition in which there is mid-trimester cervical dilatation or protruding chorioamniotic membranes in the absence of uterine contractions. Such condition is a risk factor for spontaneous mid-trimester abortion or early preterm birth, and is associated with adverse neonatal outcomes. Both intra-amniotic infection and inflammation ascertained by amniocentesis have been identified in patients with cervical insufficiency, and are poor prognostic factors. A subset of patients with intra-amniotic inflammation will have no demonstrable microorganisms detected via cultivation or molecular methods, and therefore represent cases of sterile intra-amniotic inflammation. Amniotic fluid sludge (free-floating hyperechogenic material within the amniotic fluid in close proximity to the uterine cervix) identified on sonography is a biomarker for intra-amniotic infection and inflammation. Recent evidence suggests that intra-amniotic infection, as well as sterile intra-amniotic inflammation can be treated successfully using antimicrobial agents. We report a unique case in which administration of antibiotics in the presence of mid-trimester cervical insufficiency, sterile intra-amniotic inflammation, and amniotic fluid sludge was associated with resolution of the cervical findings, as demonstrated on both sonographic and speculum examination. The patient successfully underwent elective cesarean delivery at 36-2/7 weeks of gestation. This case illustrates that antibiotic therapy may be effective despite the presence of several high-risk pregnancy conditions, and that successful outcome is possible.

• Authors: Lami Yeo, Roberto Romero, Tinnakorn Chaiworapongsa, Robert Para, Jeffrey Johnson, David Kmak, Eunjung Jung, Bo Hyun Yoon, Chaur-Dong Hsu
• Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (J Matern Fetal Neonatal Med) Vol. 35 Issue 25 Pg. 5416-5426 (Dec 2022) ISSN: 1476-4954 [Electronic] England
• PMID: 33596766 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• Sewage

Topics

• Pregnancy
• Female
• Infant, Newborn
• Humans
• Amniotic Fluid
• Anti-Bacterial Agents (therapeutic use)
• Sewage
• Chorioamnionitis (drug therapy, diagnosis)
• Premature Birth (drug therapy)
• Uterine Cervical Incompetence (drug therapy)
• Amniocentesis (methods)
• Inflammation