1055: Treatment of amniotic fluid sludge is not associated with decreased incidence of preterm birth

Abstract

To evaluate the incidence of preterm birth (PTB) amongst patients with amniotic fluid sludge according to whether or not they had been treated with antibiotics following initial diagnosis. Additional maternal and neonatal outcomes were evaluated according to cohort. We performed a retrospective cohort study of all patients diagnosed with amniotic fluid sludge in the outpatient ultrasound suite at a single academic center between 2010-2017. Patients were separated into cohorts based on whether or not they had been treated with antibiotics at the time of diagnosis. Patients with multiple gestation, fetal anomalies, pre-viable preterm rupture of membranes prior to initial diagnosis of amniotic fluid sludge, active preterm labor, placenta previa and/or suspected accreta were excluded. Primary outcome of preterm birth was compared by univariate analysis as well as regression analysis, so as to control for potential co-linear and/or confounding variables. Additional outcomes were compared by univariate analysis. A total of 181 patients were identified and considered for inclusion. 97 met inclusion criteria. Of those, 51 were treated with PO antibiotics (46 with PO azithromycin and 5 with PO moxifloxacin) and 46 were not treated. The incidence of PTB < 37 wks was 49.4 % (48/97) and PTB < 28 wks was 22.7% (22/97). There was no significant difference in incidence of preterm birth between the two cohorts, either < 37 weeks (p=0.47) or < 28 weeks (p=0.83). After adjusting for race, BMI, tobacco use, cervical length and PTB history, the incidence of PTB with antibiotic treatment remained insignificant (OR 1.3, 0.77-1.9). No differences were seen in the incidence of PPROM (p=0.94) or mean latency from diagnosis (p=0.95). Neonatal outcomes including birthweight (p=0.77), sepsis (p=0.53), IVH (p=0.95), LOS (p=0.46), and NICU admission (p=0.08) were not different between cohorts. There was no difference in the incidence of either clinical or pathologic chorioamnionitis between cohorts (p=0.92 and 0.14, respectively). Antibiotic treatment administered after the initial diagnosis of amniotic fluid sludge is not associated with a reduction in the rates of premature birth when compared to expectant management. Likewise, treatment of amniotic fluid sludge was not associated with improvement in evaluated obstetric, pathologic, or neonatal variables compared to expectant management. These findings demonstrate the need for a prospective trial.View Large Image Figure ViewerDownload Hi-res image Download (PPT)