Perinatal outcome of pregnancies with intrauterine passage of meconium at 37-39 compared with 40-42 weeks' gestation

Abstract

MECONIUM AT 37-39 COMPARED WITH 40-42 WEEKS’ GESTATION SHARON MASLOVITZ, ISHAI LEVIN, BENNY ALMOG, KUPFERMINC MICHAEL, DAVID PAUZNER, ARIEL MANY, Tel-Aviv Sorasky medical center., 0bstetrics and Gynecology, Tel Aviv, Israel OBJECTIVE: Meconium staining of amniotic fluid is considered by some as a marker of fetal maturity but others relate to it as fetal gastro-intestinal (GI) tract response to hypoxia. We sought to assess whether detection of antenatal meconium during earlier gestation (37-39w) is associated with adverse perinatal outcome compared with later appearance of intrauterine meconium (4042w). STUDY DESIGN: All patients delivering at Lis maternity hospital between June 2000 and June 2004 were reviewed for the presence of meconium and divided into two groups by gestational age at delivery (group I: 37-39 weeks, group II: 40-42 weeks). Maternal demographics and birth outcomes including mode of delivery, Apgar scores, NICU (neonatal intensive care unit) admission rate and neonatal complications and mortality were collected. Exclusion criteria included multiple gestations, breech presentations and fetal anomalies. RESULTS: 32428 women delivered at our hospital during the study period and 4798 of them were complicated by antenatal meconium (14.8%). After excluding multiple pregnancies, elective cesareans, induced deliveries and malformed fetuses we reviewed the computerized medical files of 2991 women, 1281 of them delivered spontaneously at 37-39 weeks’ (group I) gestation and 1710 at 40-42 weeks(group II). Cesarean rate was 22.2% and 16.8% (for group I and II respectively, P!0.05), while overall non-elective cesarean rate was 12.6% during that period (p!0.05). Neonates of group I were at higher risk for 5’ Apgar score!7 compared with neonates from group II (4.7% vs 2.8%, respectively, p!0.05) and at higher risk for NICU admission as well (9% VS 6.3%, respectively, p!0.05). No differences were detected with regards to meconium aspiration syndrome, respiratory distress syndrome, intraventricular hemorrhage and neonatal mortality. CONCLUSION: antenatal passage of meconium is associated with less favorable perinatal outcome when detected at 37-39 weeks’ gestation as compared with 40-42 weeks’ gestation in terms of non-elective cesarean rate, low 5’ Apgar scores and NICU admission rate.