{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T18:30:39Z","timestamp":1792089039684,"version":"4.4.0"},"reference-count":77,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Preterm labour (PTL) affects about 11% of all deliveries world-wide. It is a major cause of perinatal morbidity and mortality. Although the precise cause is unknown in about 50% of cases, infections are thought to be a major contributing factor. These infections are more common in earlier preterm deliveries. While some women with these infections will manifest the classical features of fever, tachycardia (maternal and\/or fetal), leucocytosis, raised biomarkers of infections, and uterine tenderness\/irritation, others will be asymptomatic. Some of the women may develop a short\/dilating cervix without any obvious contractions. Identifying such women is potentially challenging. Evidence has shown that a condensation of echogenic particles just above the cervix\u2014amniotic fluid (AF) sludge, identified by ultrasound\u2014is a marker for microbial invasion of the amniotic cavity (MIAC) and preterm birth (PTB) in both asymptomatic and symptomatic women (including those with a short or normal cervix). Those with a short cervix with AF sludge have a significantly greater risk of progression to PTB. Treatment with antibiotics has been shown in some but not all case series to result in a resolution of the sludge and either a delay or prevention of PTB. The widely varied results from treatment could be related to the antibiotics used and the route of administration. The use of the parenteral combination of clindamycin, a cephalosporin, and metronidazole has been shown to be more effective compared to azithromycin. Here we review the literature on the relationship between the sludge and PTB and conclude (1) that the AF sludge is an ultrasound marker of MIAC and PTL and (2) that following its diagnosis, appropriate counselling should be offered and the triple antibiotic combination offered. We suggest that randomised trials should be undertaken to determine the most efficacious antibiotic combination.<\/jats:p>","DOI":"10.3390\/diagnostics15162080","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T13:08:51Z","timestamp":1755608931000},"page":"2080","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Infections as a Cause of Preterm Birth: Amniotic Fluid Sludge\u2014An Ultrasound Marker for Intra-Amniotic Infections and a Risk Factor for Preterm Birth"],"prefix":"10.3390","volume":"15","author":[{"given":"Mariam","family":"Al Baloushi","sequence":"first","affiliation":[{"name":"Women\u2019s Wellness Research Centre, Hamad Medical Corporation, Doha 3050, Qatar"},{"name":"Department of Obstetrics and Gynaecology, Qatar University, Doha 2713, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Badreldeen","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Qatar University, Doha 2713, Qatar"},{"name":"Feto Maternal Centre Al Markhiya, Doha 34181, Qatar"},{"name":"Department of Obstetrics and Gynecology, Weill Cornell Medicine, Doha 24144, Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9736-6938","authenticated-orcid":false,"given":"Justin C.","family":"Konje","sequence":"additional","affiliation":[{"name":"Feto Maternal Centre Al Markhiya, Doha 34181, Qatar"},{"name":"Department of Obstetrics and Gynecology, Weill Cornell Medicine, Doha 24144, Qatar"},{"name":"Department of Health Sciences, University of Leicester, P.O. Box 7717, Leicester LE2 7LX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/1742-4755-10-S1-S2","article-title":"Born too soon: The global epidemiology of 15 million preterm births","volume":"10","author":"Blencowe","year":"2013","journal-title":"Reprod. Health"},{"key":"ref_2","unstructured":"World Health Organization (2024, December 23). Children: Improving Survival and Well-Being, Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/children-reducing-mortality."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2183756","DOI":"10.1080\/14767058.2023.2183756","article-title":"Prevention of spontaneous preterm delivery\u2014An update on where we are today","volume":"36","author":"Ahmed","year":"2023","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E37","DOI":"10.1016\/S2214-109X(18)30451-0","article-title":"Global, regional, and national estimates of levels of preterm birth in 2014: A systematic review and modelling analysis","volume":"7","author":"Chawanpaiboon","year":"2019","journal-title":"Lancet Glob. Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/S0140-6736(23)00878-4","article-title":"National, regional, and global estimates of preterm birth in 2020, with trends from 2010: A systematic analysis","volume":"402","author":"Ohuma","year":"2023","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1056\/NEJMra0904308","article-title":"The enigma of spontaneous preterm birth","volume":"362","author":"Muglia","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e244559","DOI":"10.1001\/jamanetworkopen.2024.4559","article-title":"Spontaneous Preterm Birth Phenotyping Based on Cervical Length and Immune-Mediated Factors","volume":"7","author":"Cavoretto","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.clp.2024.02.014","article-title":"Etiologically Based Functional Taxonomy of the Preterm Birth Syndrome","volume":"51","author":"Villar","year":"2024","journal-title":"Clin. Perinatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1001\/jamapediatrics.2020.6087","article-title":"Association Between Preterm-Birth Phenotypes and Differential Morbidity, Growth, and Neurodevelopment at Age 2 Years: Results From the INTERBIO-21st Newborn Study","volume":"175","author":"Villar","year":"2021","journal-title":"JAMA Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Frenquelli, R., Ratcliff, M., Villar de Onis, J., Fernandes, M., Barros, F.C., Hirst, J.E., Papageorghiou, A.T., Kennedy, S.H., and Villar, J. (2022). Complex Perinatal Syndromes Affecting Early Human Growth and Development: Issues to Consider to Understand Their Aetiology and Postnatal Effects. Front. Neurosci., 16.","DOI":"10.3389\/fnins.2022.856886"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"615.e1","DOI":"10.1016\/j.ajog.2022.04.015","article-title":"Toward a new taxonomy of obstetrical disease: Improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology","volume":"227","author":"Romero","year":"2022","journal-title":"Am. J. Obstet Gynecol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1111\/1471-0528.17691","article-title":"Association between adverse pregnancy outcome and placental biomarkers in the first trimester: A prospective cohort study","volume":"131","author":"Sovio","year":"2024","journal-title":"BJOG"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"452.e1","DOI":"10.1016\/j.ajog.2024.01.008","article-title":"First trimester risk of preeclampsia and rate of spontaneous birth in patients without preeclampsia","volume":"231","author":"Cavoretto","year":"2024","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1136\/adc.2009.175067","article-title":"Conceptual issues related to the construction of prescriptive standards for the evaluation of postnatal growth of preterm infants","volume":"95","author":"Villar","year":"2010","journal-title":"Arch. Dis. Child."},{"key":"ref_15","unstructured":"National Institute for Health and Care Excellence (NICE) (2025, August 06). Preterm Labour and Birth. NICE Guideline (NG25), Available online: www.nice.org.uk\/guidance\/ng25."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/00006250-199203000-00005","article-title":"The association of occult amniotic Fluid. infection with gestational age and neonatal outcome in women in preterm labor","volume":"79","author":"Watts","year":"1992","journal-title":"Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.siny.2011.09.001","article-title":"Intrauterine infection and preterm labor","volume":"17","author":"Agrawal","year":"2012","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/0002-9378(89)90409-2","article-title":"Infection and labor. V. Prevalence, microbiology, and clinical significance of intraamniotic infection in women with preterm labor and intact membranes","volume":"161","author":"Romero","year":"1989","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"781","DOI":"10.2105\/AJPH.86.6.781","article-title":"Intrauterine infection and why preterm prevention programs have failed","volume":"86","author":"Goldenberg","year":"1996","journal-title":"Am. J. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.ajog.2015.08.040","article-title":"Acute chorioamnionitis and funisitis: Definition, pathologic features, and clinical significance","volume":"213","author":"Kim","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/0002-9378(92)91609-E","article-title":"The relationship between acute inflammatory lesions of the preterm placenta and amniotic fluid microbiology","volume":"166","author":"Romero","year":"1992","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lee, S.M., Park, K.H., Jung, E.Y., Jang, J.A., and Yoo, H.N. (2017). Frequency and clinical significance of short cervix in patients with preterm premature rupture of membranes. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0174657"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"374.e1","DOI":"10.1016\/j.ajog.2009.01.047","article-title":"Is midtrimester short cervix a sign of intraamniotic inflammation?","volume":"200","author":"Kiefer","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_24","first-page":"294","article-title":"Isolation of Mycoplasma hominis and Ureaplasma urealyticum from amniotic fluid at 16\u201320 weeks of gestation: Potential effect on outcome of pregnancy","volume":"10","author":"Cassell","year":"1983","journal-title":"Sex. Transm. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Daskalakis, G., Psarris, A., Koutras, A., Fasoulakis, Z., Prokopakis, I., Varthaliti, A., Karasmani, C., Ntounis, T., Domali, E., and Theodora, M. (2023). Maternal Infection and Preterm Birth: From Molecular Basis to Clinical Implications. Children, 10.","DOI":"10.3390\/children10050907"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/aji.12189","article-title":"A novel molecular microbiologic technique for the rapid diagnosis of microbial invasion of the amniotic cavity and intra-amniotic infection in preterm labor with intact membranes","volume":"71","author":"Romero","year":"2014","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1002\/uog.1871","article-title":"The prevalence and clinical significance of amniotic fluid \u2018sludge\u2019 in patients with preterm labor and intact membranes","volume":"25","author":"Espinoza","year":"2005","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/0002-9378(84)90038-3","article-title":"Ultrasound diagnosis of meconium-stained amniotic fluid","volume":"149","author":"Benacerraf","year":"1984","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1002\/jcu.1870140316","article-title":"Ultrasound appearance of particulate matter in amniotic cavity: Vernix or meconium?","volume":"14","author":"DeVore","year":"1986","journal-title":"J. Clin. Ultrasound"},{"key":"ref_30","first-page":"333","article-title":"Sonographic detection of echogenic amniotic fluid and its clinical significance","volume":"17","author":"Sepulveda","year":"1989","journal-title":"J. Perinat. Med."},{"key":"ref_31","first-page":"819","article-title":"Sonographically homogeneous echogenic amniotic fluid in detecting meconium-stained amniotic fluid","volume":"78","author":"Sherer","year":"1991","journal-title":"Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"737","DOI":"10.7863\/jum.2003.22.7.737","article-title":"Three-dimensional sonographic findings in congenital (harlequin) ichthyosis","volume":"22","author":"Vohra","year":"2003","journal-title":"J. Ultrasound Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/S1701-2163(16)32108-9","article-title":"Intra-amniotic sludge, short cervix, and risk of preterm delivery","volume":"28","author":"Bujold","year":"2006","journal-title":"J. Obstet. Gynaecol. Can."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1080\/14767058.2016.1277700","article-title":"Amniotic fluid \u201csludge\u201d; prevalence and clinical significance of it in asymptomatic patients at high risk for spontaneous preterm delivery","volume":"31","author":"Adanir","year":"2018","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"107","DOI":"10.7863\/jum.1983.2.3.107","article-title":"Ultrasonographic demonstration of floating Ultrasonographic demonstration of floating particles in amniotic fluid","volume":"2","author":"Parulekar","year":"1983","journal-title":"J. Ultrasound Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1002\/uog.4081","article-title":"Clinical significance of the presence of amniotic fluid \u2018sludge\u2019 in asymptomatic patients at high risk for spontaneous preterm delivery","volume":"30","author":"Kusanovic","year":"2007","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_37","first-page":"527","article-title":"Possible association between amniotic fluid microorganism infection and microflora in the mouth","volume":"109","author":"Bearfield","year":"2002","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1177\/1933719116678690","article-title":"Neutrophil Extracellular Traps in the Amniotic Cavity of Women with Intra-Amniotic Infection: A New Mechanism of Host Defense","volume":"24","author":"Romero","year":"2017","journal-title":"Reprod. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e12723","DOI":"10.1111\/aji.12723","article-title":"Amniotic fluid neutrophils can phagocytize bacteria: A mechanism for microbial killing in the amniotic cavity","volume":"78","author":"Romero","year":"2017","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1038\/nri2873","article-title":"Sterile inflammation: Sensing and reacting to damage","volume":"10","author":"Chen","year":"2010","journal-title":"Nat. Rev. Immunol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1111\/aji.12296","article-title":"Prevalence and clinical significance of sterile intra-amniotic inflammation in patients with preterm labor and intact membranes","volume":"72","author":"Romero","year":"2014","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.3109\/14767058.2014.958463","article-title":"Sterile and microbial-associated intra-amniotic inflammation in preterm prelabor rupture of membranes","volume":"28","author":"Romero","year":"2014","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.3109\/14767058.2014.954243","article-title":"Sterile intra-amniotic inflammation in asymptomatic patients with a sonographic short cervix: Prevalence and clinical significance","volume":"28","author":"Romero","year":"2015","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"135.e1","DOI":"10.1016\/j.ajog.2007.11.026","article-title":"Detection of a microbial biofilm in intraamniotic infection","volume":"198","author":"Romero","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1128\/CMR.15.2.167-193.2002","article-title":"Biofilms: Survival mechanisms of clinically relevant microorganisms","volume":"15","author":"Donlan","year":"2002","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1172\/JCI200320365","article-title":"The application of biofilm science to the study and control of chronic bacterial infections","volume":"112","author":"Costerton","year":"2003","journal-title":"J. Clin. Investig."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"S47","DOI":"10.1097\/00002480-200011000-00037","article-title":"Role of biofilms in antimicrobial resistance","volume":"46","author":"Donlan","year":"2000","journal-title":"ASAIO J."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1128\/iai.58.7.2383-2385.1990","article-title":"Human polymorphonuclear leukocyte response to Pseudomonas aeruginosa grown in biofilms","volume":"58","author":"Jensen","year":"1990","journal-title":"Infect. Immun."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1111\/j.1699-0463.1992.tb03991.x","article-title":"Some bacterial parameters influencing the neutrophil oxidative burst response to Pseudomonas aeruginosa biofilms","volume":"100","author":"Jensen","year":"1992","journal-title":"APMIS"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e244592","DOI":"10.1001\/jamanetworkopen.2024.4592","article-title":"Longitudinal cervical length measurements and spontaneous preterm birth in singleton and twin pregnancies","volume":"7","author":"Wu","year":"2024","journal-title":"JAMA Netw Open."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.1016\/j.ajog.2015.08.041","article-title":"Chronic inflammation of the placenta.: Definition classification, pathogenesis and clinical significance","volume":"213","author":"Kim","year":"2015","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"120","DOI":"10.3109\/14767058.2014.989202","article-title":"Amniotic fluid \u201csludge\u201d is an independent risk factor for preterm delivery","volume":"29","author":"Hatanaka","year":"2016","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/uog.5173","article-title":"What is amniotic fluid sludge?","volume":"30","author":"Romero","year":"2007","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e12807","DOI":"10.1111\/aji.12807","article-title":"Sludge reflects intra-amniotic inflammation with or without microorganisms","volume":"79","author":"Yoneda","year":"2018","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"9770","DOI":"10.1080\/14767058.2022.2053102","article-title":"Characterization of amniotic fluid sludge in preterm and term gestations","volume":"35","author":"Kusanovic","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"S312","DOI":"10.1016\/j.ajog.2018.11.488","article-title":"467: Patients with Short Cervix and Amniotic Fluid Sludge Delivering \u226432 Weeks Have Stereotypic Inflammatory Signature","volume":"220","author":"Gill","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_57","first-page":"2681","article-title":"Amniotic fluid sludge as a marker of intra-amniotic infection and histological chorioamnionitis in cervical insufficiency: A report of four cases and literature review","volume":"29","author":"Paules","year":"2016","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1159\/000325461","article-title":"Risk of impending preterm delivery associated with the presence of amniotic fluid sludge in women in preterm labor with intact membranes","volume":"30","author":"Ventura","year":"2011","journal-title":"Fetal Diagn. Ther."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1055\/s-0031-1295638","article-title":"Midtrimester intra-amniotic sludge and the risk of spontaneous preterm birth","volume":"28","author":"Himaya","year":"2011","journal-title":"Am. J. Perinatol."},{"key":"ref_60","first-page":"215","article-title":"Amniotic sludge and short cervix as inflammation and intraamniotic infection markers","volume":"7","author":"Pedregosa","year":"2017","journal-title":"Obstet. Gynecol. Int. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1080\/01443615.2020.1834520","article-title":"Echogenic particles in the amniotic fluid of term low-risk pregnant women: Does it have a clinical significance?","volume":"41","author":"Buyuk","year":"2021","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"635","DOI":"10.4103\/jfmpc.jfmpc_83_18","article-title":"Hyperechoic amniotic fluid in a term pregnancy","volume":"7","author":"Kaluarachchi","year":"2018","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1046\/j.1469-0705.1996.07030178.x","article-title":"Ultrasonic features of intraamniotic \u2018unidentified debris\u2019 at 14\u201316 weeks\u2019 gestation","volume":"7","author":"Zimmer","year":"1996","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1080\/14767058.2018.1509309","article-title":"The presence of amniotic fluid sludge in pregnant women with a short cervix: An independent risk of preterm delivery","volume":"33","author":"Tsunoda","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1111\/jog.14141","article-title":"Association of amniotic fluid sludge with preterm labor and histologic chorioamnionitis in pregnant Japanese women with intact membranes: A retrospective study","volume":"46","author":"Yasuda","year":"2020","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"7153","DOI":"10.1080\/14767058.2021.1945575","article-title":"Does Amniotic Fluid Sludge Result in Preterm Labor in Pregnancies after Assisted Reproduction Technology? A Nested Case\u2014Control Study","volume":"35","author":"Pahlavan","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"100073","DOI":"10.1016\/j.ajogmf.2019.100073","article-title":"Effect of Antibiotic Treatment of Amniotic Fluid Sludge","volume":"2","author":"Cuff","year":"2020","journal-title":"Am. J. Obstet. Gynecol. MFM"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1111\/aogs.13603","article-title":"Antibiotic treatment for patients with amniotic fluid \u201csludge\u201d to prevent spontaneous preterm birth: A historically controlled observational study","volume":"98","author":"Hatanaka","year":"2019","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"3016","DOI":"10.1080\/14767058.2019.1567706","article-title":"Effects of antibiotic therapy in women with the amniotic fluid \u201csludge\u201d at 15\u201324 weeks of gestation on pregnancy outcomes","volume":"33","author":"Pustotina","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1002\/ijgo.13425","article-title":"Antibiotic treatment of amniotic fluid \u201csludge\u201d in patients during the second or third trimester with uterine contraction","volume":"153","author":"Jin","year":"2021","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1111\/ajo.13648","article-title":"Azithromycin treatment for short cervix with or without amniotic fluid sludge: A matched cohort study","volume":"63","author":"Giles","year":"2023","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.3109\/14767058.2014.947575","article-title":"Impact of amniotic fluid \u201csludge\u201d on the risk of preterm delivery","volume":"28","author":"Fuchs","year":"2015","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"5416","DOI":"10.1080\/14767058.2021.1881477","article-title":"Resolution of acute cervical insufficiency after antibiotics in a case with amniotic fluid sludge","volume":"35","author":"Yeo","year":"2022","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1007\/s00404-023-07045-1","article-title":"Antibiotic therapy in patients with amniotic fluid sludge and risk of preterm birth: A meta-analysis","volume":"309","author":"Sapantzoglou","year":"2024","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"e489","DOI":"10.1055\/s-0043-1772189","article-title":"Amniotic Sludge and Prematurity: Systematic Review and Meta-analysis","volume":"45","author":"Pannain","year":"2023","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Luca, S.T., S\u0103s\u0103ran, V., Muntean, M., and M\u0103rginean, C. (2024). A Review of the Literature: Amniotic Fluid \u201cSludge\u201d-Clinical Significance and Perinatal Outcomes. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175306"},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Karampitsakos, T., Mavrogianni, D., Machaiotis, N., Potiris, A., Pangagopoulos, P., Stavros, S., Antsaklis, P., and Drakakis, P. (2025). The impact of amniotic fluid interleukin-6, interleukin -8 and metalloproteinase -9 on preterm labor: A narrative reveiw. 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