Meconium-stained Amniotic Fluid Group Research Articles

Comparison of Umbilical Cord Arterial Blood Gas and Neonatal Outcomes in Women with and without Meconium-Stained Amniotic Fluid During Labor

Introduction: Meconium-stained amniotic fluid (MSAF) may increase maternal and neonatal complications. The favorable mode of delivery is controversial in women with MSAF. This study aimed to compare umbilical cord arterial blood gas (ABG) and neonatal outcomes in deliveries complicated by meconium and clear amniotic fluid during the active phase of labor. Materials and Methods: This observational study was performed on 144 term pregnant women (72 with MSAF and 72 with clear amniotic fluid) during the active phase of labor with ruptured membranes admitted to Al-Zahra and Taleghani hospitals in Tabriz, Iran, from June 2019 to June 2020. A checklist was used to record the ABG and neonatal outcomes. Results: The frequency of cesarean delivery in the MSAF group (25%) was significantly higher than in the women with clear amniotic fluid (20%) (P = 0.006). There was no statistically significant difference between the groups regarding pH, base excess, PCO2, 1- and 5- minute Apgar scores, and neonatal intensive care unit (NICU) admission of the newborn due to MSAF (P> 0.05). There was no incidence of hypoxic-ischemic encephalopathy, sepsis, and seizure. Conclusion: Given the non-significant difference between two groups of women with and without MSAF during labor in terms of neonatal outcomes and umbilical cord ABG, it seems that MSAF alone is not an indication for cesarean delivery. Thus, vaginal delivery is recommended in pregnant women with MSAF.

Mekonyumlu Gebeliklerde Doğum Eyleminin ve Sonuçlarının Değerlendirilmesi: Prospektif Kohort Çalışması

Background: The aim of this study was to determine the risk factors for meconium-stained amniotic fluid in a low-risk pregnancy and to evaluate birth complications and neonatal outcomes in deliveries with meconium-stained amniotic fluid (MSAF).
 Material and Methods: This prospective study was conducted between April 2015 and September 2015 at Ankara Zekai Tahir Burak Women’s Health Education and Research Hospital. 351 women with singleton pregnancies and cephalic position who had reached 37 weeks of gestation were included in the study. Women with known chronic systemic diseases, pregnancy complications, and previous uterine surgery were excluded. 151 cases with MSAF and 200 randomly selected control cases with clear amniotic fluid were included in this study. We compared the two groups in terms of maternal age, gravidity, parity, gestational age, intrapartum maternal fever, body mass index (BMI), duration of labor, cardiotocographic values (CTG), mode of delivery, neonatal outcomes, and admission to the neonatal intensive care unit.
 Results: In our study, meconium aspiration syndrome (MAS) developed in 2.6% (4/151) of neonates with meconium staining at birth. Gestational age, intrapartum maternal fever and BMI were significantly increased in the MSAF group (p=0.003). The duration of the active phase of labor (cervical dilation from 6 cm to 10 cm) was similar in both groups, and the duration of the second phase of labor was longer in the MSAF group (p=0.002). MSAF was associated with an increased number of abnormal results in cardiotocographic examinations, birth complications, and neonatal outcome (p < 0.001).
 Conclusion: Deliveries with meconium-stained amniotic fluid are associated with increased morbidity; therefore, intrapartum examinations should be performed more frequently and carefully, and precautions should be taken during labor in collaboration with pediatricians to reduce potential adverse neonatal outcomes.

Fetal Heart Tracing Patterns and the Outcomes of Newborns With Meconium-Stained Amniotic Fluid.

ObjectiveTo determine if the presence of meconium-stained amniotic fluid (MSAF) by itself or in combination with abnormal fetal heart tracing (FHT) (category II and III) is associated with poor neonatal outcomes in full-term newborns.Design/methodsThis is a retrospective cohort study. Cases included singleton and full-term neonates with MSAF. Cases were compared to matched controls (clear amniotic fluids) for the outcomes. SPSS (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY, USA) and SAS 9.4 (SAS Institute Inc., Cary, NC, USA) were used for data analysis.ResultsFrom 5512 deliveries, 210 cases (MSAF group) and 210 matched controls were identified. Cases and controls were similar in most maternal characteristics. Abnormal FHT was present in 43.2% of cases compared to 17.6% of controls (p<0.001). Low Apgar scores (<7) at one and five minutes were more common in the MSAF group (p=0.03 and 0.007, respectively). The neonatal intensive care unit (NICU) admission rate was also higher in the MSAF group (p=0.002). However, the mean hospital stay was similar in both groups (p=0.44). Twenty-two (10.5%) cases required resuscitation at birth compared to six (2.9%) controls (p=0.003). After applying the logistic regression model to adjust for the FHT pattern and Apgar scores at one minute, the association of MSAF with resuscitation lost significance. The factors associated with resuscitation requirement at birth were Apgar score at one minute (adjusted odds ratios (aOR) 4.1; 95% CI 2.8-5.1, p<0.001) and abnormal FHTs (aOR, 0.03; 95% CI 0.004-0.257, p=0.001).ConclusionsNeonates born with MSAF were more likely to have abnormal FHT and require resuscitation at birth. However, after adjusting for confounding factors, abnormal FHT and one-minute Apgar scores were the only variables predictive of resuscitation needs at birth.

Impact of Meconium-Stained Amniotic Fluid on Neonatal Outcome in a Tertiary Hospital.

ObjectiveThe aim of this study was to determine the perinatal outcome of pregnant patients complicated with meconium-stained amniotic fluid (MSAF) compared with clear amniotic fluid.MethodologyThis prospective cross-sectional study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Pediatrics at Indira Gandhi Institute of Medical Sciences, Patna, India, from September 2016 to January 2018. A total of 200 patients were included in the study after taking their written consent. Out of these 200 patients, 100 patients had MSAF, and the other 100 patients with clear liquor were taken as controls after fulfilling the inclusion and exclusion criteria. These two groups of patients were compared regarding various maternal and neonatal parameters. These parameters were compared and tested statistically for significance.ResultsAmong the 100 patients with MSAF, 20 patients had grade 1 meconium (X), 22 patients had grade 2 meconium (Y), and 58 patients had grade 3 meconium (Z). The majority of patients in the MSAF group were primigravida and more than 25 years of age. In addition, 47% of patients in the MSAF group had some associated high-risk factors and 50% of patients had non-reassuring fetal heart rate patterns, and among these, 39 patients had grade 3 MSAF (X). In the MSAF group, 49% of patients had undergone lower segment cesarean section (LSCS), whereas in the non-MSAF group, it was 37%. Also, 30% of babies in the MSAF group and 13% in the non-MSAF group had neonatal intensive care unit (NICU) admission; 22% of babies in the MSAF group and 12% of babies in the non-MSAF group had an adverse neonatal outcome. Meconium aspiration syndrome was present in 14% of the patients in the MSAF group, and among these, two babies had neonatal death and both had severe birth asphyxia. In the non-MSAF group, there was one neonatal death due to neonatal sepsis. However, after statistically analyzing the neonatal outcome in both the groups, there was no statistical difference between the two groups (p<0.001).ConclusionMSAF is associated with increased frequency of operative delivery, poor neonatal outcomes, and increased NICU admission. Management of labor with MSAF requires appropriate intrapartum care with continuous fetal heart rate monitoring, and this can reduce unnecessary cesarean sections in patients with MSAF.

Prolonged exposure to meconium in cases of spontaneous premature rupture of membranes at term and pregnancy outcome

Objective To evaluate the impact of prolonged exposure to meconium-stained amniotic fluid (MSAF), in women with term pre-labor spontaneous rupture of membranes (PROM), on pregnancy outcome. Methods A retrospective cohort study of women who gave birth in a single university-affiliated tertiary medical center (2011–2019). Eligibility was limited to singleton pregnancies at term who presented with PROM. Women with MSAF were immediately induced and were compared to low-risk pregnant women with clear amniotic fluid (CAF) at admission who underwent induction of labor 24 h after rupture of membranes. All women were stratified into 4-time frame groups from rupture of membranes to delivery: T0: 0–7 h, T1: 8–13 h, T2: 14–18 h, and T3: > 18 h for the MSAF group. The time frames for the CAF were: T0 – 24–31 h, T1: 32–38 h, T2: 40–44 h, and T3: > 44 h. The maternal adverse composite outcome included any of the following: intrapartum fever (IPF), prolonged second stage (PSS), need for manual removal of suspected retained placenta, postpartum hemorrhage, and readmission within 45 days after delivery. The adverse composite neonatal outcome included one or more of the following: meconium aspiration syndrome, neonatal asphyxia, need for respiratory support, and intracranial hemorrhage. Results Overall, 1631 women met the inclusion criteria (536 in the MSAF and 1095 in the CAF group). Both groups showed a gradual decrease in the rate of vaginal delivery over time, the vaginal delivery rate in the MSAF group was 75.7% at T0 in comparison to 61.6% at T3 (p < .001). In the CAF group, the vaginal delivery rate was 84.5% at T0 in comparison to 68.8% at T3 (p < .001). This decrease was in concomitance with an increase in the rates of prolonged second-stage and intrapartum fever. There were no significant differences in the rates of postpartum hemorrhage, suspected retained placenta, or readmission within 45 days between women with either MSAF or CAF. There was a significant gradual increase in the adverse composite neonatal outcome in the MSAF group (1.9% at T0, 5.2% at T1, 6.0% at T2, and 8.2% at T3. p = .038). No similar increase was found in the CAF group (2.5% at T0, 4.1% at T1, 2.6% at T2, and 4.1% at T3. p = .449). Conclusion Prolonged rupture of membranes in the presence of meconium does not affect maternal outcomes, however, prolonged exposure to meconium lead to an increased adverse neonatal outcome.

Meconium stained amniotic fluid exposure and long-term respiratory morbidity in the offspring.

Meconium stained amniotic fluid (MSAF) is a well-established risk factor for neonatal short-term respiratory complications. Little is known regarding the long-term morbidity. We investigated the possible association between MSAF and offspring respiratory morbidity. A population-based, cohort study of singleton deliveries occurring between 1991 and 2014 at a sole regional tertiary medical center was performed. Incidence of offspring respiratory related hospitalizations up to the age of 18 years were evaluated and compared to unexposed offspring. A Kaplan-Meier survival curve was used to compare cumulative respiratory morbidity incidence, and a Cox proportional hazards model was used to control for confounders. During the study period 242,342 deliveries met the inclusion criteria. Of them, 14.7% (n = 35,609) were complicated with MSAF. Incidence of respiratory-related hospitalizations was significantly lower in children exposed to MSAF as compared to the unexposed group (4.5% vs. 4.9%, respectively; p < .01). Specifically, hospitalizations involving pneumonitis were significantly less common among the MSAF group (odds ratio, 0.35; 95% confidence interval [95% CI], 0.13-0.96; p = .03). The Kaplan-Meier survival curve demonstrated significantly lower total cumulative respiratory morbidity rates in the MSAF exposed group (log rank p < .01). In the Cox model, controlled for clinically relevant confounders, MSAF exhibited an independent and significant protective effect on long-term childhood respiratory morbidity (aHR, 0.91; 95% CI, 0.86-0.96; p < .01). Fetal exposure to MSAF during labor appears to be associated with lower rates of long-term respiratory related hospitalizations in the offspring. Changes in offspring microbiome, as well as functional and anatomical modulations possibly resulting from MSAF exposure, might offer a plausible explanation of our findings.

English

BACKGROUND Meconium stained amniotic fluid (MSAF) occurs in 12 - 15 % of all deliveries and is frequently associated with adverse outcome in pregnancy. The present study was carried out to find out the maternal and fetal outcome in pregnancy complicated by meconium stained liquor in labour METHODS This retrospective study was carried out at a tertiary care centre at Pune. A total of 340 cases who had meconium stained liquor during labour or was detected on amniotomy was analysed. RESULTS Out of 340 cases, 252 (74.1 %) had thin and 88 (25.9 %) had thick meconium. MSAF was detected more in early labour (244, 71.8 %), as compared to advanced labour (96, 28.2 %). 212 (84.13 %) patients with thin meconium delivered by vaginal route. 30 (34.09 %) patients with thick meconium delivered by vaginal route. 40 (15.87 %) patients with thin meconium delivered by LSCS and 58 (65.91 %) with thick meconium delivered by LSCS. This difference was statistically significant (&lt; 0.001). Being multiparous was a protective factor both for mother and baby against the presence of MSAF. A majority of neonates, 199 (58.53 %) were asymptomatic at birth both in thin and thick MSAF group. Endotracheal suctioning was done in 101 (29.7 %) neonates in both groups. 40 neonates (11.77 %) were admitted to NICU for severe birth asphyxia. Meconium aspiration syndrome (MAS) was observed in 20 cases (5.88 %), out of which 18 (90 %) had thick meconium and 02 (10 %) had thin meconium. A total of 04 (1.18 %) neonatal deaths occurred due to MAS. They were born to primigravida, had induced onset of labour with detection of thick meconium and delivered vaginally. CONCLUSIONS Meconium stained amniotic fluid (MSAF) is associated with increased incidence of caesarean section, lower Apgar score, NICU admissions, development of meconium aspiration syndrome and neonatal death. Obstetrician should be more vigilant while dealing with cases of thick type of MSAF. A timely caesarean section improves the neonatal outcome. KEYWORDS Meconium Stained Amniotic Fluid (MSAF), Meconium Aspiration Syndrome (MAS)

Relation of meconium-stained amniotic fluid and postpartum hemorrhage: a retrospective cohort study.

Postpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. The purpose of this study was to evaluate if meconium-stained amniotic fluid (MSAF) is a risk factor for PPH after vaginal delivery. We retrospectively analyzed medical records of all patients who had a vaginal delivery at Fujian Provincial Maternity and Children's Hospital, between 1st January 2013 to 31st December 2018. Women with cesarean deliveries, multiple pregnancies, abnormal coagulation profile, and those with concomitant liver or kidney disorders were excluded. Patients were classified into MSAF (n=13686) and clear amniotic fluid (AF) (n=41511) groups. The incidence of PPH was significantly higher at 2.7% (370/13686) in the MSAF group as compared to 2.18% (904/41511) in the clear AF group (p=0.0004). There was no difference in the incidence of severe PPH between the two groups. Statistically significant difference in the incidence of PPH between MSAF and clear AF was seen in the maternal age groups of 30-34 and 35-39 years, gestational age>40weeks and >3 gravidity (p<0.05). Our study demonstrates that MSAF is a significant risk factor for minor and moderate PPH. Presence of meconium could therefore alert clinicians to expect PPH and make arrangements for further patient management. Further basic research is required to evaluate the mechanism by which meconium influences the incidence of PPH.

Does in utero meconium passage in term stillbirth correlate with autopsy and placental findings of hypoxia or inflammation?

Background The cause of meconium passage in utero is controversial, traditionally being considered evidence of fetal stress and hypoxia, and also associated with intra-amniotic inflammation/infection. It is now recognized to also occur in the absence of fetal stress. Autopsy studies have shown that many term stillborns (SB) have hypoxic/ischemic brain injury and other evidence of stress preceding the time period immediately before demise, including acute thymic involution (ATI); however, these findings, along with placental findings, have not been previously correlated with meconium-stained amniotic fluid (MSAF). Methods 35 structurally normal singleton term SB (21 early term, 14 full/late term) with complete autopsies, including brain and placental examination, were identified. MSAF was visually identified at delivery and confirmed on the placental examination. Autopsy evaluation included brain injury and ATI. Placental evaluation included maternal and fetal vascular malperfusion and acute and chronic inflammatory lesions. Demographic and clinical features were compared. Results 18 (51%) SB had MSAF, and 17 (49%) had clear amniotic fluid (CAF). The was no significant difference in brain injury in the MSAF vs CAF group, including older gray matter injury (karyorrhexis) (67% vs 47%), recent gray matter injury (red neurons, but no karyorrhexis) (28% vs 35%), white matter injury (50% vs 29%), and hemorrhage (22% vs 24%). Severe ATI was more frequent in the MSAF vs CAF group (61% vs 24%, p = .04). There was no significant difference in placental lesions between groups, including acute maternal inflammation (39% vs 18%), acute fetal inflammation (6% vs 6%), fetal vascular malperfusion (11% vs 18%), maternal vascular malperfusion (39% vs 35%), and chronic inflammatory lesions (39% vs 29%). The MSAF group was more likely to be full/late term than early term (72% vs 28%), in contrast to the CAF group (6% vs 94%) (p = .0001). There was no difference in other clinical factors evaluated. Conclusions 51% of term SB had MSAF, and, in contrast to the CAF group, these were significantly more likely to be full/late term. Brain injury was frequent in both MSAF and CAF groups, supporting hypoxia as the mechanism of demise in most of these SB. No placental lesions correlated with MSAF, including inflammation. This suggests that hypoxia is the cause of the MSAF in these SB, but that some additional biologic factor present in the full/late term SB, but not present in the early term SB, including possibly gastrointestinal maturation, is necessary for the meconium passage.

Study of respiratory complications and outcome in meconium stained deliveries

Background: To study the development of respiratory complications in the form of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of newborn (PPHN), pulmonary hemorrhage and pneumothorax in neonates born through meconium stained liquor.Methods: It was a prospective study conducted during the period of February to October 2018. All live babies associated with meconium stained liquor were included.Results: Total 606 neonates with meconium stained amniotic fluid (MSAF) were enrolled. Chance of meconium passage was more after 37wk of gestation, in birth weight &gt;2.5 kg and in AGA babies. The rate of LSCS was higher in MSAF group. MAS developed in 28% cases, out of which 42.9% expired. PPHN developed in 6.9% cases, out of which 80% expired. 100% mortality was there in babies with pulmonary hemorrhage. Apgar scores &lt;7 is significantly associated with the development of respiratory complications. 22.8% of vigorous babies and all non-vigorous babies developed respiratory complications showing statistical significance with P-value of &lt;0.00001. Mortality in MSAF was 12%. All babies who expired had severe meconium aspiration syndrome. 83.9% of the patients stayed for &lt;7 days in the hospital. All of the expiry except one occurred within 7 days of life due to development of respiratory complications.Conclusions: MSAF is associated with the development of respiratory complications and mortality in neonates. Non-vigorous babies and the babies with Apgar scores &lt;7 at birth are more prone to developing respiratory complications. Most of the MSAF babies were discharged and mortality was more in patients with respiratory complications.

Meconium-stained amniotic fluid exposure is associated with a lower incidence of offspring long-term infectious morbidity.

Meconium-stained amniotic fluid (MSAF) is a well-established risk factor for immediate adverse neonatal outcomes and was recently suggested to be associated with microbial invasion of the amniotic cavity. We aimed to determine whether MSAF exposure during labor carries a longer lasting impact on pediatric infectious morbidity. A population-based cohort analysis was performed including all singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Exposure was defined as the presence of MSAF during labor. Hospitalizations of the offspring up to the age of 18years involving infectious diseases were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity and a Cox regression model to control for confounders. During the study period, 243725 deliveries met the inclusion criteria. Of them, 35897 (14.7%) involved MSAF. Rate of infectious-related hospitalizations of the offspring was significantly lower in children exposed to MSAF as compared with the unexposed group (10.8% vs 11.1%, P<0.05). Specifically, hospitalizations involving respiratory infections were significantly less common among the MSAF group (5.1% vs 5.6%, P<0.001). The survival curve demonstrated significantly lower cumulative total infectious morbidity rates in the MSAF-exposed group (log rank P<0.001). In the Cox model, controlled for maternal age, diabetes, hypertension, mode of delivery, and gestational age, exposed children exhibited lower rates of long-term childhood infectious morbidity (adjusted HR 0.96, 95% CI 0.92-0.99, P<0.001). Fetal exposure to MSAF during labor and delivery appears to be associated with lower rates of long-term infectious-related hospitalizations in the offspring.

Meconium-stained amniotic fluid as a risk factor for necrotizing enterocolitis in very low-birth weight preterm infants: a retrospective cohort study

Objective: To evaluate whether meconium-stained amniotic fluid (MSAF) is a risk factor for necrotizing enterocolitis (NEC) in very-low-birth-weight preterm infants.Materials and methods: The retrospective study was conducted at the Neonatal Diagnosis and Treatment Center of the Children’s Hospital of Chongqing Medical University from January 2010 to October 2016. The maternal and neonatal characteristics in cases of very low-birth weight infants born prior to 34 weeks of gestation were collected and compared between the MSAF and non-MSAF groups.Results: In the present study, 461 medical records of very low-birth-weight preterm infants were reviewed. A total of 41 (8.9%) infants were born to mothers with MSAF; in all, 180 infants were included in the study. Demographic characteristics and neonatal complications in the MSAF (n = 30) and non-MSAF groups (n = 150) were compared. A higher incidence of NEC (26.7% versus 10%, χ2 = 4.825, p = .028) was found in the MSAF group than in the non-MSAF group. Logistic regression analysis showed that MSAF (OR = 3.385, 95% CI: 1.349–8.492, p = .009) and sepsis (OR = 3.538, 95% CI: 1.442–8.679, p = .006) were independent risk factors for NEC.Conclusions: MSAF might be a risk factor for NEC in very-low-birth-weight infants. MSAF and sepsis contribute to the development of NEC.

705: Meconium stained amniotic fluid exposure is associated with lower rates of respiratory morbidity in offspring

Meconium stained amniotic fluid (MSAF) effects approximately 1 in every 7 pregnancies, and is a well- established risk factor for short-term respiratory complications in neonates. Little is known regarding long-term respiratory morbidity among these children, as lung growth continues throughout the first decade of life. We investigated the possible impact of MSAF presence during labor and delivery on long-term respiratory morbidity of the offspring, during childhood and adolescence A population-based prospectively analyzed cohort study was performed, including all singleton deliveries occurring between 1991-2014 at a single tertiary medical center. Fetuses with congenital malformations were excluded. Exposure was defined as presence of MSAF during labor and delivery. Hospitalizations of the offspring up to the age of 18 years involving respiratory morbidities were evaluated. A Kaplan Meier survival curve was used to compare cumulative morbidity incidence. A Cox hazards regression model was used to control for confounders. During the study period 242,342 deliveries met the inclusion criteria. Of them, 14.7% (n=35,609) deliveries involving MSAF were documented. Rate of respiratory related hospitalizations, up to the age of 18 years, was significantly lower in children exposed to MSAF as compared with the unexposed group (4.5% vs. 4.9%, respectively, p=0.001, Table). Specifically, hospitalizations involving pneumonitis were significantly less common among the MSAF group (OR 0.5, 95%CI 0.13-0.96, p=0.034). The Kaplan Meier survival curve demonstrated significantly lower total cumulative respiratory morbidity rates in the MSAF exposed group (Figure, log rank p<0.001). In the Cox regression model, controlled for maternal age, diabetes, hypertension, gestational age at birth and delivery mode, MSAF exhibited an independent and significant protective effect on long-term childhood respiratory morbidity (adjusted HR 0.91, 95%CI 0.86-0.96, p<0.001). Fetal exposure to MSAF during labor and delivery appears to be associated with lower rates of long- term respiratory related hospitalizations in the offspring. Changes in offspring microbiome possibly resulting from exposure to MSAF during labor and delivery, may offer an explanation for these findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

696: Meconium stained amniotic fluid exposure is associated with a lower rate of offspring's infectious morbidity

Meconium stained amniotic fluid (MSAF) is a well-established risk factor for immediate adverse neonatal outcomes, and was recently found to be associated with an increased incidence of microbial invasion to the amniotic cavity. We aimed to determine whether MSAF exposure during labor and delivery with its potential effect on offspring microbiome, carries a longer lasting impact on pediatric infectious morbidity. A population-based prospective cohort analysis was performed including all singleton deliveries occurring between 1991-2014 at a single tertiary medical center. Fetuses with congenital malformations were excluded. Exposure was defined as presence of MSAF during labor and delivery. Hospitalizations of the offspring up to the age of 18 years involving infectious diseases were evaluated. A Kaplan Meier survival curve was used to compare cumulative morbidity incidence. A Cox hazards regression model was used to control for confounders. During the study period 249,840 deliveries met the inclusion criteria. Of them, 36,914 (14.8%) involved MSAF. Rate of infectious related hospitalizations of the offspring up to the age of 18 years, was significantly lower in children exposed to MSAF as compared with the unexposed group (10.6% vs. 11.1%, respectively, p<0.05). Specifically, hospitalizations involving respiratory infections were significantly less common among the MSAF group (OR 0.88, 95% CI 0.84-0.93, p<0.001, Table). The survival curve demonstrated significantly lower cumulative infectious morbidity rates in the MSAF exposed group (Figure, log rank p<0.001). In the Cox regression model, controlled for maternal age, diabetes, hypertension, mode of delivery and gestational age at birth, MSAF exposed children exhibited an independent association with long-term childhood infectious morbidity (adjusted HR 0.94, 95%CI 0.91-0.97, p<0.001). Fetal exposure to MSAF during labor and delivery appears to be associated with lower rates of long term infectious related hospitalizations in the offspring. Different microbial interactions with the host immune system, resulting from MSAF exposure, may explain the observed long term protective effect.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mode of delivery and fetal outcome in meconium stained amniotic fluid in DMCH

Background : Meconium is a dark greenish mass of desquamated cells, mucus, and bile that accumulates in the bowel of a fetus and is typically discharged shortly after birth. Meconium stained amniotic fluid (MSAF) has long been considered to be a bad predictor of fetal outcome.Objective : The aim of this study was to determine if the perinatal outcome is affected by mode of delivery in meconium-stained amniotic fluid.Methodology : This ovservational study was carried out in the department of Obstetrics and Gynaecology in Dhaka Medical College Hospital from July 2016 to June 2017. A total of 204 women who satisfied the inclusion and exclusion criteria were taken for the study. The study group comprised of 102 women admitted in labour and having meconium stained amniotic fluid and 102 women in labour but having clear amniotic fluid were taken as comparision group.Results : The mean age was found 26.6±5.9 years in MSAF group and 26.2±5.0 years in clear liquor group. The mean gestational age was found 38.9±1.8 weeks in MSAF group and 38.5±1.3 weeks in clear liquor group. Risk factors were not statistically significant (p&gt;0.05) between two groups. Forty-one (40.2%) patients had caesarian section in MSAF group and 19(18.6%) in clear liquor group. APGAR score at 1 minute and at 5 minute were statistically significant (p&lt;0.05) between two groups. About 100(98.0%) babies were alive in MSAF group and 101(99.0%) in clear liquor group.Conclusion : Meconium stained amniotic fluid group was associated with higher rate of cesarean delivery, increased need for neonatal resuscitation, increased rate of PIH, pre-eclamsia, Oligohydramnios, IUGR, Post dated pregnancy, Rh incompatibility, GDM and long time hospital stay and hospital mortality.Northern International Medical College Journal Vol.9(2) Jan 2018: 304-307

Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage.

Background/aimClinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population.Patients and methodsA retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively.ResultsA total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95% CI: 1.2–1.5, p<0.001 and OR=2.5, 95% CI: 1.5–4.2, p<0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95% CI: 1.0–2.2, p=0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal–perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates.ConclusionTo the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF.

Maternal and Fetal Outcomes Following Labour at Term in Singleton Pregnancies with Meconium-Stained Amniotic Fluid: A Prospective Cohort Study

Background: Meconium stained amniotic fluid (MSAF) is frequently encountered in obstetric practice. Literature on the subject is still poorly documented in the African setting. Objective: The aim of this study was to determine the maternal and fetal outcomes in case of meconium stained amniotic fluid observed during term labour. Materials and Methods: We conducted a prospective cohort study enrolling all consenting pregnant women with term singleton fetus in cephalic presentation admitted for labour with ruptured fetal membranes in the maternity units of the Yaounde Central Hospital (YCH) and the Yaounde Gynaeco-Obstetric and Pediatric Hospital (YGOPH) of Cameroon between December 2014 and April 2015. The exposed grouped was considered as participants having MSAF, while the non-exposed group comprised those with clear amniotic fluid (CAF). The two groups were monitored during labor using the WHO partograph, and then followed up till 72 hours after delivery. Variables studied included the colour and texture of amniotic fluid as well as maternal and fetal complications. Data was analyzed using Epi-info version 3.5.4. The chi-square and Fischer’s exact tests were appropriately used to compare the two groups. A p-value less than 5% was considered statistically significant. Results: 2376 vaginal deliveries were recorded during the study period among which MSAF was observed in 265 cases, hence a prevalence rate of MSAF of 11.15%. Among these cases of MSAF, 52.1% was thick meconium and 47.9% was light meconium. Maternal morbidity was high in the group with MSAF; these included: Higher proportions of caesarean delivery (RR = 2.35 p < 10-4) and prolonged labor (RR = 3 p < 10-4). In this same group, the incidences of chorioamnionitis and puerperal sepsis were low (0.94% and 0.70% respectively), although there was a three-fold higher risk that was not statistically significant (RR = 3, P = 0.31). Fetal and neonatal outcomes were poorer in the MSAF group compared to the CAF group. The complications included fetal heart rate abnormalities, low Apgar score at the 5th minute, need for neonatal resuscitation, neonatal asphyxia and neonatal infection which were significantly higher in the MSAF group (all p < 0.05). Meconium aspiration syndrome (MAS) was found in 2.34% of MSAF cases. Perinatal mortality was 2.34% and all cases of death occurred in the thick MSAF group. Conclusion: MSAF observed during labour is associated with increased perinatal morbidity and mortality. Its detection during labor should strongly indicate very rigorous intra partum and postpartum monitoring. This will ensure optimal management and reduction in the risks of complications.

Significance of assay of nucleated RBCs in umbilical cord blood in neonates with meconium-stained amniotic fluid

Background: Approximately 8–15% of all infants are born with evidence of meconium-stained amniotic fluid (MSAF). MSAF is a potentially serious sign of fetal compromise and may indicate fetal hypoxia Objectives and aim of the work: The present study was designed to evaluate the relationship between meconium stained amniotic fluid and fetal nucleated red blood cell counts. As well, we aim to evaluate the relationship between the presence of meconium in amniotic fluid and Apgar scores in neonates. Subjects and methods: A prospectively case-controlled study was performed on 40 women with clear amniotic fluid as control and 40 women with meconium-stained amniotic fluid as the study group. At delivery, 2 ml of umbilical cord blood was collected and analyzed for nucleated red blood cell (NRBC). Results: The mean NRBC counts in meconium-stained amniotic fluid was significantly higher than the control group (18.35 ± 7.7 and 9.6 ± 4.96), respectively (p < .001). There were statistically significant differences concerning 1- and 5-min Apgar scores with lower values in the MSAF group (p < .001 and .001, respectively). Conclusion: Our results support previous studies which indicate the presence of meconium can be associated with chronic fetal hypoxia as demonstrated by elevated fetal NRBC levels.

Meconium Stained Amniotic Fluid: 10 Years After [12R

INTRODUCTION: Meconium stained amniotic fluid (MSAF) occurs in 10-20% of deliveries, and, in the past, was considered a reason to alter obstetric and newborn management. Over the past decade, however, otherwise uncomplicated pregnancies characterized by MSAF have been managed regardless of the presence of MSAF. Whether the changes in hospital protocol regarding MSAF have resulted in poorer pregnancy outcomes have not been studied. The purpose of this study was to compare the outcomes of MSAF versus no MSAF pregnancies since hospital protocol removed MSAF as a risk factor for modifying management. METHODS: This was a retrospective study of all 45,961 singleton deliveries from 12/2009 to 12/2013. MSAF occurred in N=4,917. RESULTS: Newborn weight and gestational age at delivery were higher in the MSAF group (3344 ± 539 versus 3185 ± 645 grams, and 39 ± 1.8 versus 38 ± 2.5 weeks, respectively, P less than .05. The incidence of Cesarean delivery, and NICU admission were higher and Apgars lower in the MSAF, but umbilical cord pH was similar. CONCLUSION: This study suggests that MSAF influences subjectively assigned Apgar scores, but umbilical cord pH, an objective measure of fetal wellbeing is not different. Abandoning hospital protocols that included obstetric management changes when MSAF was present did not influence umbilical cord pH.

Significance of meconium-stained amniotic fluid in term cesarean sections indicated by suspected fetal distress

Objectives To investigate the clinical significance of degreeⅢ meconium-stained amniotic fluid in term pregnancy. Methods Data of 857 full-term gravidas underwent cesarean section for suspected fetal distress in Peking University First Hospital from October 1, 2012 to September 30, 2014 were retrospectively analyzed. All patients were divided into three groups according to the diagnosis of suspected fetal distress: meconium-stained amniotic fluid group (Group 1, n=172), fetal heart abnormality group (Group 2, n=623) and meconium-stained amniotic fluid in combination with fetal heart abnormality group (Group 3, n=62). General information and fetal prognosis of the three groups were analyzed. Factors that might affect the prognosis of newborns were analyzed between the infants with or without acidosis, asphyxia or aspiration pneumonia. Analysis of variance, independent-samples t test, Chi-square test and rank-sum test were used as statistical methods. Results There were no significant differences in maternal age, gestational age at delivery, parity, nuchal cord loop(s), pH value of umbilical arterial blood and gender of newborns among the three groups (all P>0.05). The neonatal Apgar score, neonatal asphyxia rate and rate of admitting into pediatric ward within 24 hours after birth in Group 1 were similar to those of Group 2 and 3 [1 min Apgar score: 9.9±0.7 vs 9.8±0.7 and 9.8±0.7, F=0.322; 5 min Apgar score: 10.0±0.3 vs 10.0±0.2 and 10.0±0.0, F=0.517; neonatal asphyxia rate: 1.7% (3/172) vs 2.1% (13/623) and 1.6% (1/62), χ2=0.129; rate of admitting into pediatric ward: 16.3% (28/172) vs 14.3% (89/623) and 11.3% (7/62), χ2=0.978] (all P>0.05). The incidence of neonatal aspiration pneumonia in Group 1 was higher than that of Group 2 and 3 [4.7% (8/172) vs 3.2% (2/62) and 1.0% (6/623)], but the differences had no statistical significance (F=10.680, P=0.050). Conclusions Both degreeⅢ meconium-stained amniotic fluid and abnormal fetal heart rate have the same indicating significance and should be treated actively to lower the risk of poor prognosis of the newborns. Key words: Fetal distress; Cesarean section; Meconium aspiration syndrome; Prognosis