SynthesisArchives of gynecology and obstetrics2026
The microbiology of amniotic fluid sludge: a systematic review and meta-analysis.
Synthesis in Archives of gynecology and obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
7 authors.
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Abstract
purposeAmniotic fluid sludge (AFS) is a sonographic finding associated with intra-amniotic infection and spontaneous preterm birth. The microbial composition of AFS remains poorly characterized. This systematic review and meta-analysis aimed to consolidate existing data on microbial prevalence in AFS and identify consistent microbial patterns.
methodsA systematic search of MEDLINE (PubMed), Dimensions, and OpenAlex was conducted from inception to February 11, 2026. Studies reporting the prevalence of microorganisms in AFS (minimum 10 cases) from pregnant women with AFS diagnosed via transvaginal ultrasound were included. Two reviewers independently performed screening, data extraction, and risk-of-bias assessment, with a third reviewer resolving discrepancies. Random-effects meta-analysis of proportions was used to pool overall and pathogen-specific prevalence.
resultsFour studies comprising 85 women met inclusion criteria. The pooled prevalence of any microorganism was 35% (95%CI 22-48%), with moderate heterogeneity (I
conclusionIn transabdominal cohorts, the pooled prevalence of microorganisms (any) in amniotic fluid sludge was 28% (95%CI 17-41%), with Ureaplasma spp. emerging as the predominant pathogen when an infectious agent was identified. Transvaginal amniocentesis resulted in greater microbial diversity and detection of vaginal commensals, consistent with contamination. Our findings suggest that transabdominal sampling should be the preferred methodological approach for future studies of AFS microbiology.
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