Incidence Of Meconium Staining Research Articles

Comparison of low dose vaginal misoprostol with Foley catheter balloon as preinduction cervical ripening agents in term pregnancies

Objective: One of the obstetricians’ nightmare is managing high-risk pregnancies. Also, the emerging trend by pregnant women requesting for specific delivery dates for social reasons adds to this burden. In both instances, the obstetrician is faced with the challenge of inducing labor where the cervix is still unfavorable. The objective of the study was to compare the effectiveness of loe dose vaginal misoprostol and transcervical extra-amniotic Foley catheter balloon as pre-induction cervical ripening agents in term pregnancies. Material and Methods: This was a prospective, single-blind, randomized comparative trial at a tertiary hospital. Pregnant women at term in whom induction of labor was indicated, who made the inclusion criteria and who gave their consent were randomly assigned to either the vaginal misoprostol or the Foley catheter balloon group. Oxytocin was used for the augmentation of labor subsequent to the artificial rupture of the membranes according to the departmental protocols. Results: One hundred and fifty women were recruited and randomized (75 in each group). In the misoprostol group, 58 (77.3%) women achieved cervical ripening (cervical dilation of ≥4) within 12 h, compared to 43 (57.3%) in the Foley catheter balloon group. Spontaneous vaginal delivery within 12 h was 88.0% and 66.3% in the misoprostol and Foley catheter group, respectively. However, 34.7% in misoprostol group had precipitate labor (induction-to-delivery interval ≤3 h), while 9.3% in the Foley catheter group had prolonged labor. There were no significant differences in the incidence of meconium staining and 1st min Apgar scores of the babies in the two groups. Conclusion: Low dose (25 μg) vaginal misoprostol is a more effective pre-induction cervical ripening agent compared to the conventional transcervical extra-amniotic Foley catheter balloon method. While uterine hyperstimulation is the major risk in the misoprostol group, long induction-to-delivery interval is associated with labors induced following use of Foley catheter balloon as the pre-induction cervical ripening agent.

Analysis of clinical characteristics and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy

To analyze the clinical characteristics and perinatal outcome of early-onset intrahepatic cholestasis of pregnancy (ICP). A total of 305 ICP cases were collected in the First Affiliated Hospital of Chongqing Medical University between June 2006 and May 2012. According to the onset time of ICP, patients were divided into early-onset ICP group (onset time < 28 gestational weeks) and late-onset ICP group (onset time ≥ 28 gestational weeks). The late-onset ICP group was further divided into 28 - 31(+6) gestational weeks and ≥ 32 gestational weeks according to the onset time. The biochemical indices and perinatal outcome of each group were assessed. (1) When the diagnosis was made for the first time, the maternal serum concentrations of total bile acid (TBA) and total bilirubin (TBIL) in early-onset ICP group were (41 ± 9) and (32 ± 9) µmol/L, respectively; while TBA and TBIL in late-onset ICP group were (32 ± 6) and (22 ± 9) µmol/L, and the difference between the two groups was statistically significant (P < 0.05). (2) There was no significant difference in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) between early-onset ICP group and late-onset ICP group (P > 0.05). The ALT of early-onset ICP group and late-onset ICP group were (159 ± 50) and (145 ± 52) U/L, respectively; and AST were (151 ± 49) and (138 ± 44) U/L, respectively. (3) The early-onset ICP group had significant higher (P < 0.05) incidence of meconium staining (18.8% vs. 7.4%), fetal distress (22.9% vs. 8.9%), newborn asphyxia (14.6% vs. 5.4%), premature delivery (33.3% vs. 15.6%), developing into severe ICP (41.7% vs. 25.3%) and cesarean section (91.7% vs. 78.6%) when compared to the late-onset ICP group. No significant difference in the incidence of premature delivery, developing into severe ICP and cesarean section was found between the two types of late-onset ICP. (4) There was significant differences in average birth weight and gestational weeks at delivery between the two groups [early-onset ICP group: (3113 ± 443) g and (36.3 ± 2.6) weeks]; late-onset ICP group: [(3513 ± 450) g and (37.7 ± 1.6) weeks]. The early-onset ICP patients presented worse clinical manifestations than late-onset ICP patients, and early-onset ICP is more likely to lead to premature delivery and fetal distress.

Comparative Study of Nonstress Test and Fetal Acoustic Stimulation Test in Assessment of Fetal Well-being

ABSTRACT Objectives To compare and evaluate the role of nonstress test and acoustic stimulation test on the perinatal outcome. Materials and methods Around 100 patients above 34 weeks of gestation were selected and subjected to nonstress test (NST) and acoustic stimulation test (AST) on weekly basis to find whether fetus is reactive or nonreactive, and followed till delivery to find out the perinatal outcome. Results When comparison of reactive NST and reactive AST was done, the incidence of meconium staining was 8 (9%) and 9 (9.6%), clinical fetal distress 16 (18.8%) and 18 (19.3%), operative interference for fetal distress 17 (19.3%) and 20 (21.5%), low Apgar score at 5 minutes 1 (1.1%) and 1 (1%), neonatal deaths 3 (3.3%) and 3 (3.2%), low birth weight 27 (30.6%) and 29 (31.1%), and NICU admission 13 (14.7%) and 13 (13.9%) respectively. While the incidence of meconium staining was 4 (33.3%) and 3 (42.8%), clincal fetal distress 8 (66.6%) and 6 (85.7%), operative interference 6 (50%) and 3 (42.8%), low Apgar score at 5 minutes 3 (25%) and 3 (42.8%), neonatal death 4 (33.3%) and 4 (57.1%), low birth weight 7 (58.3%) and 5 (71.4%) respectively in nonreactive NST and nonreactive AST groups.

Admission test as precursor of perinatal outcome: a prospective study

To test the reliability of the admission test to identify the compromised fetus and thus reduce the neonatal morbidity and mortality by early intervention. A prospective analysis over a period of 1 year from December 2007 to December 2008 included 100 antepartum patients and were evaluated for perinatal outcome in two groups. In both low and high risk groups the incidence of meconium staining was 25 and 37.5% in patients with nonreactive traces as compared to 8.6 and 9.5%, respectively, in reactive traces with specificity of 90.9%. Clinically detected fetal distress was more common in patients with nonreactive test. Operative interference for fetal distress was more in patients with nonreactive test. Occurence of low Apgar score was more in patients with nonreactive test. Admission to neonatal unit was more in nonreactive than reactive traces. Incidence of neonatal death was more in nonreactive test. Incidence of low birth weight was more in nonreactive trace group and more so in high risk group than in low risk group. Admission test may be best recommended in all patients irrespective whether they are in low or high risk as incidence of neonatal morbidity is high 33.3% babies required NICU admission and 33% babies expired in nonreactive tracing, in centers where advance facilities are not available. Whenever there is a nonreactive tracing further test should be carried out.

Prolonged pregnancy and the biophysical profile: A birthing center perspective

A triage system for antepartum surveillance of postdates pregnancy is studied in a busy, indigent care service with limited resources for in-hospital delivery. One hundred seventy-eight pregnancies (13.2% of the total population) were thought to be at least 42 weeks' gestation by clinical criteria, and 128 of these underwent at least one complete biophysical profile within seven days of delivery. We find no statistically significant difference in the incidence of meconium staining, fetal distress in labor, or low Apgar scores when either the high or low scoring groups are compared, or when compared with the 50 patients who delivered without a biophysical evaluation. Specific components of the testing schema, however, namely oligohydramnios and spontaneous decelerations on the nonstress test, are highly associated with adverse perinatal events. Of the total population thought to be postmature clinically, only 60 infants (33.9%) were actually beyond 42 weeks' gestation by Dubowitz scoring. We conclude that a modified biophysical assessment as described is easily performed in a nontertiary care setting where a cnm-md team approach is applied and may help to differentiate patients who require expeditious termination of pregnancy in-hospital from those who can be managed expectantly in the birthing center.

Influence of the Legal Imperative and Medical Guidelines on the Incidence and Management of the Meconium-Stained Newborn

• Following a legal action that resulted from the death of a newborn with the meconium aspiration syndrome, I investigated the incidence and management at a community hospital of the meconium-stained newborn during March in each of the years 1973 through 1985. During March in 1973 through 1981, 4.3% of all live births (1368) were meconium stained. After the newborn's death, which initiated a period of legal negotiations, the incidence of meconium staining increased to 14.4% among 582 live births during March of 1982 through 1985. Laryngoscopy increased to include 64.3% of meconium-stained new-borns, and endotracheal suctioning was associated with laryngoscopy in 72.2% of the patients. Also, oxygen administration to newborns with and without meconium staining increased from 10.5% in March of 1973 through 1981 to 45.7% in March of 1982 through 1985. There was no improvement in outcome from the increased recognition and more aggressive management. While the issuance of medical guidelines alone had little effect on the incidence and care of the meconium-stained newborn, the combination of the legal imperative with medical guidelines had a profound and corruptive effect. ( AJDC 1987;141:1124-1127)

Smoking in pregnancy

The course of pregnancy and delivery and the foetal outcome of women who smoked during pregnancy (n = 1751) were compared with nonsmokers (= 4937). The following variables were studied in retrospect: Duration of pregnancy, maternal weight gain, mode of delivery, foetal birthweight and the maturity of the newborn, Apgar scores, pH of the umbilical artery, perinatal mortality, frequency of foetal malformations, amount of amniotic fluid and the incidence of meconium staining, placental weight and the occurrence of placental infarctions. Birth weight, foetal length and head circumference were significantly smaller in the group of women who smoked. The incidence of babies with low birth weight and clinical signs of prematurity as well as placental infarctions was significantly increased in the same group. Gestational age was not different in smoking and nonsmoking gravidae. No statistical difference was found in the rate of C-sections, in Apgar scores, umbilical arterial pH, the incidence of malformations, perinatal mortality, and placental weight. Social factors were not considered in this study.

Epidemiology of meconium staining of amniotic fluid in Hong Kong.

The characteristics of 94 patients with meconium stained amniotic fluid diagnosed during labour in the Prince of Wales Hospital, Hong Kong, from July to August 1984, were analysed. The incidence was 21.4% of deliveries. These patients were compared to a group of non-meconium patients (349 cases) in demographic and obstetric aspects. Patients in low social class and patients with antenatal and medical complications did not have a higher incidence of meconium staining of amniotic fluid. However, a history of previous spontaneous or induced abortion was significantly more common in the meconium group. The labour performance of these patients and the perinatal outcome are discussed.

Is there a gestational age distribution in the passage of meconium?

SummarySome 13 112 infants were born in the Rotunda Hospital, Dublin, from 1 January 1979 to 31 December 1980. Sixteen per cent had passed meconium before delivery. Of the total, 1652 were excluded from analysis as all data was not available. When the remaining 11 460 were divided according to gestational age at delivery, the incidence of meconium staining rose as maturity increased from 35 to 42 weeks. At the same time, the percentage of all babies with an Apgar score below 7 fell. There is a positive association between the passage of meconium and increasing gestational age which should be borne in mind when the presence or absence of meconium is considered clinically significant.

Fine structure of the human placenta in prolonged pregnancy. Preliminary report.

Placentas from 15 prolonged (is greater than 42 weeks), but otherwise normal pregnancies, and 8 normal-term placentas were studied. Placental villi from term placentas revealed intact syncytial and cytotrophoblast elements. All term placentas presented a minimal to mild degree of villous necrosis and deposition of fibrinoid material. Placental villi from cases of prolonged pregnancy presented a moderate to severe degree of necrosis in 11 of 15 placentas and a minimal to mild degree in 4 of 15 placentas. A moderate to severe degree of fibrinoid deposition was noted in 7 of 15 placentas, whilst 8 of 15 revealed a minimal to mild degree of deposition. The presence or absence of meconium was noted in the prolonged-pregnancy group and correlated with the above morphological features. Statistically, a correlation was found between prolonged pregnancy and necrosis (p is less than 0.001), prolonged pregnancy and fibrinoid deposition (p is less than 0.03) and between necrosis and deposition of fibrinoid (p is less than 0.05). There was no correlation between the incidence of meconium staining and the above parameters.

Hyperbilirubinemia in late pregnancy and its correlation with meconium staining

The incidence of hyperbilirubinemia in 1,018 pregnant women was 10.5 per cent. Of the 1,018 patients, 23.7 per cent were of Mediterranean stock, and in this group of patients the incidence of hyperbilirubinemia was 3 times that of the non-Mediterranean group. The incidence of meconium staining was 15.8 per cent in the total population and was significantly higher in the Mediterranean group. The incidence of fetal distress was 24.0 per cent in all patients with meconium staining and only 2.9 per cent in patients with no meconium staining. The routine screening of pregnant women during the last trimester for hyperbilirubinemia is recommended, as hyperbilirubinemia may be a bad prognostic sign.