766: Bloody amniotic fluid during labor – the association with placental abruption and adverse neonatal outcome

Abstract

In the last 10 years we have implemented an institutional protocol that requires obstetricians/midwives to report their subjective impression of the color of amniotic fluid (clear, meconium stained, bloody) during labor. We aimed to study the correlation between bloody amniotic fluid (BAF) and adverse outcomes. The medical records, and neonatal charts of all deliveries at ≥ 370/7 weeks between 10/2008 to 7/2018 were reviewed. The cohort was divided into two groups: clear AF (CL group) BAF (BAF group). Cases with meconium stained amniotic fluid were excluded. Adverse neonatal outcomes included: Umbilical Ph ≤ 7.1, seizures, hypoxic-ischemic encephalopathy, intra- ventricular hemorrhage, periventricular leukomalacia, hypoglycemia, hypothermia, mechanical ventilation, meconium aspiration syndrome (MAS), respiratory distress syndrome, necrotizing enterocolitis, phototherapy, sepsis, or transfusion. The primary outcome was a composite of one or more of the above complications. Multivariate regression analysis models were used to identify the independent association of BAF and various adverse outcomes. Overall, 20,983 deliveries were reviewed, 20,666 (98.5%) in the CL group and 317 (1.5%) in the BAF group. The rate of composite adverse neonatal outcome (primary outcome) did not differ between the BL group (2.2%) and the CL group (2.1%), however there were higher rates of MAS (p=0.002) in the BAF group, and this association remained after controlling for background confounders (aOR= 11.8, 95% CI 3.3-42.0) - table 1. The rate of placental abruption did not differ between the groups (1.3% in the BAF and 1.9% in the CL groups), however BAF was associated with higher rates of labor induction (p=0.002), cesarean deliveries (p=0.03), and slightly lower birth weights (p=0.03) – table 2. BAF observed in labor was not associated with composite adverse neonatal outcome, nor with placental abruption. BAF was associated with higher rates of labor induction, cesarean deliveries, and slightly lower birth weights.