Is meconium-stained amniotic fluid in near-term infants associated with increased rates of adverse maternal and neonatal outcomes?

Abstract

WITH INCREASED RATES OF ADVERSE MATERNAL AND NEONATAL OUTCOMES? SUSAN TRAN, ANJALI KAIMAL, MICHAEL KUZNIEWICZ, AARON CAUGHEY, University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California, University of California, San Francisco, Pediatrics, San Francisco, California OBJECTIVE: To evaluate neonatal and maternal outcomes in near-term pregnancies complicated by meconium-stained amniotic fluid (MSAF). STUDY DESIGN: This is a retrospective cohort study of 3,480 deliveries between 32-0/7 and 36-6/7 weeks gestation. Neonatal outcomes included: Apgar scores, intensive care nursery (ICN) admission, sepsis, meconium aspiration syndrome (MAS), and respiratory distress syndrome (RDS). Maternal outcomes included: endomyometritis, postpartum hemorrhage, blood transfusion, operative vaginal delivery, and cesarean delivery. Bivariate and multivariate analyses were performed. RESULTS: MSAF was associated with an increased risk of adverse neonatal outcomes except RDS when compared to pregnancies with clear amniotic fluid in the bivariate analyses (Table). No differences were found in maternal outcomes, except for an increased risk of maternal transfusion in the MSAF group. Adjusting for ethnicity, maternal age, gestational age, birthweight, antenatal corticosteroid administration, year of delivery, and cesarean section, MSAF remained associated with increased risks of 5 minute Apgar score !7, sepsis, and maternal blood transfusion, and a decreased risk for RDS (Table). CONCLUSION: We found that MSAF occurring at 32 – 36-6/7 weeks’ gestation was only associated with 5 minute Apgar score !7 when controlling for potential confounding variables. MSAF in these near-term infants was inversely associated with RDS. This is consistent with the findings that with increasing gestational ages, rates of MSAF tend to increase, while rates of RDS tend to decrease. These findings differ somewhat in comparison to term infants with MSAF, suggesting that meconium passage at these earlier gestational ages may represent a different pathophysiologic process.