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Fetoscopic visualization of a cervical funneling with sludge

      Cervical funneling with sludge is an ultrasonographic marker of preterm birth. In this communication, we demonstrate this finding with direct fetoscopic visualization. A primigravid patient was referred at 17 weeks’ gestation with a monochorionic diamniotic twin pregnancy complicated by stage III twin-to-twin transfusion syndrome and a cervical length of 13 mm with funneling and sludge (Figure 1, A). At 17+3 weeks, a fetoscopic laser photocoagulation was performed, and examination of the funneled cervix (Figure 1, B) demonstrated accumulations of an amorphous material corresponding to the sludge (Figure 1, C) (Video). Gram stain examination of that fluid was negative for microbial invasion and showed no white cells, and the amniotic fluid culture was negative. Cytologic examination showed some squamous epithelial cells and polymorphonuclear cells, and scarce macrophages. A total of 7 days later, the patient ruptured membranes and delivered. The placenta histology showed acute inflammatory response with chorioamnionitis and acute vasculitis of umbilical vessels.
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      FigureA, A 17 weeks pregnant complicated with twin-to-twin transfusion syndrome stage III, and a cervical length of 13 mm with funneling and sludge. B and C, Fetoscopic visualization of the funneling and sludge (∗)
      Meller. Fetoscopic visualization of a cervical funneling with sludge. Am J Obstet Gynecol 2022.
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