Meconium Staining Research Articles

A Review of Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a gestational liver disease characterized by pruritus with abnormal bile acids and an increased risk for adverse fetal outcomes. The etiology is unclear, but it believed to have genetic, hormonal, and environmental components. Possible fetal complications include meconium staining of amniotic fluid, preterm labor, and unexplained sudden intrauterine demise. Researchers are currently investigating multiple different medications for the management of ICP. This article will review the epidemiology, clinical features, pregnancy complications, and treatment for ICP. Furthermore, this review will discuss current recommendations on the timing of delivery to mitigate possible fetal repercussions of this disease. Keywords: Bile acids, intrahepatic cholestasis of pregnancy, ursodeoxycholic acid.

Intrahepatic cholestasis of pregnancy: Relationship between bile acid levels and maternal and fetal complications.

Objective:Intrahepatic cholestasis of pregnancy (ICP) complicates pregnancies which is characterized by elevated serum bile acid levels. ICP increases maternal and fetal morbidities. This study was designed to determine the association of maternal and fetal complications and serum bile acid levels.Material and method:Maternal and fetal characteristics were analyzed from the medical records of 61 patients who gave birth following a pregnancy complicated with ICP between 2009 and 2013.Results:Eighty seven percent of 61 cases were singletons, and 13% of them were twins. Mean SBA level was 36 μmol/L. Preterm birth rate among singletons and twin pregnancies were 24.5% and 62.5%, respectively. Mean SBA level in preterm birth group was statistically higher with respect to the term birth group (100.8 μmol/L and 25.61 μmol/L, respectively; p=0.001). No perinatal mortality associated with ICP was detected in the study group.Conclusion:Pregnant women with the ICP compose high-risk group in regard to fetal and maternal risks. Close follow-up of these patients is required due to increased risks such as preterm delivery, meconium staining and fetal death.

Legal Briefs: Airway Obstruction or Botched Resuscitation?

A 38 5/7-weeks’-gestation male was born to a 23-year-old G1P0 woman who had received prenatal care and whose pregnancy was uncomplicated. Spontaneous rupture of membranes occurred at home, and the fluid was clear. Her group B streptococcus status was unknown. Because labor was ineffective, oxytocin was administered. The second stage of labor was slightly longer than 2 hours. The treating nurses noted variable and late decelerations, tachysystole, and intermittent sinusoidal fetal patterns on the fetal heart rate tracings. The anesthesiologist placed an epidural, and vaginal delivery was allowed to proceed. The infant had meconium staining. The arterial cord blood gas had a pH of 7.13, a Pco2 of 64 mm Hg, a Po2 of 12 mm Hg, and a base deficit of –8. The venous cord blood gas had a pH of 7.31, a Pco2 of 41 mm Hg, a Po2 of 22 mm Hg, and a base deficit of –5. The obstetric expert retained by the plaintiff maintained that the delivery by cesarean delivery should have occurred 6 hours before birth because signs of fetal intolerance to labor were obvious. He contended that the delivery should have occurred even before the second stage of labor began. The defense obstetrician disagreed and pointed to the fairly normal cord gas results as proof that the infant tolerated labor well. The routine practice of the hospital was to call the resuscitation team for every delivery. The resuscitation team at this delivery consisted of a newborn nursery nurse (registered nurse [RN]) and a respiratory therapist (RT). The infant had a weak cry at birth but was limp, blue, and had meconium present on the skin. He was placed on the mother’s abdomen for bonding. The plaintiff neonatologist was critical of the resuscitation team for not placing the infant immediately …

Scar thickness measurement by transvaginal sonography in late second trimester and third trimester in pregnant patients with previous cesarean section: does sequential change in scar thickness with gestational age correlate with mode of delivery?

The objective of this study was to evaluate whether scar thickness measured by transvaginal sonography and the sequential change in scar thickness from second to third trimester has any association with mode of delivery in patients with previous cesarean. Pregnant women with previous one cesarean section underwent transvaginal sonography between 24 and 28weeks of gestation and then a repeat scan beyond 36weeks of gestation to measure scar thickness. These scar thickness measurements were then correlated with the mode of delivery. The scar was measured at multiple sites (3-4) of the lower uterine segment and its thinnest portion was considered to be the scar. Scar thickness was thinner in those patients having cesarean delivery than those having vaginal delivery and this difference was statistically significant at both the gestational ages. Mean scar thickness at 24-28weeks of gestation in patients who delivered vaginally is 4.8±1.1mm and in those who had repeat cesarean section is 4.4±1.1mm (p value=0.043). Mean scar thickness beyond 36weeks of gestation in patients who delivered vaginally is 3.3±0.7mm and in those who had repeat cesarean section is 2.9±0.9mm (p value=0.003). The mean decrease in scar thickness was not significantly different between those who delivered vaginally (mean decrease=1.73±0.95mm) and those who had a repeat cesarean (mean decrease=1.91±0.96mm). Our study concluded that thicker scars are associated with better chances of successful vaginal birth after cesarean. Measurement at both late second trimester and third trimester can be done but latter has better correlation with mode of delivery. This association may be explained by the fact that thinner scars have more chances of fetal bradycardia, meconium staining of liquor and previous cesarean for feto-pelvic disproportion.

Intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy is the most common pregnancy-specific liver disease that typically presents in the third trimester. The clinical features are maternal pruritus in the absence of a rash and deranged liver function tests, including raised serum bile acids. Intrahepatic cholestasis of pregnancy is associated with an increased risk of adverse perinatal outcomes, including spontaneous preterm delivery, meconium staining of the amniotic fluid, and stillbirth. It is commonly treated with ursodeoxycholic acid. There is accumulating evidence to suggest that intrahepatic cholestasis of pregnancy has a lasting influence on both maternal and fetal health. We review the etiology, diagnosis, and management of this intriguing condition.

The effects of ursodeoxycholic acid treatment for intrahepatic cholestasis of pregnancy on maternal and fetal outcomes: a meta-analysis including non-randomized studies.

The benefits of ursodeoxycholic acid (UDCA) use for treating intra-hepatic cholestasis of pregnancy (ICP) remain uncertain. A 2010 Cochrane Review of randomized control trials was unable to recommend either for or against the use of UDCA in treating ICP. We conducted a meta-analysis of the literature, including both non-randomized studies (NRSs) and RCTs. The objective of the study was to determine if patients included in NRSs were comparable to those in RCTs, and to determine whether the inclusion of NRSs could strengthen the available evidence and guide clinical practice on UDCA use in women with ICP. We searched Medline (Ovid), Embase (Ovid), EMB Reviews, Cinahl (Ebsco), and Web of Knowledge (Thomson Reuters) for articles published from 1966 to June 2012. We included all eligible RCTs of UDCA versus placebo or other treatments, and all NRSs comparing UDCA with any other treatment in women with ICP. We included 11 RCTs (n = 625 pregnancies) and six NRSs (n = 211 pregnancies). The women included in RCTs and NRSs were comparable, but study quality was poorer for NRSs. Overall, women treated with UDCA had decreased pruritus in 73% of RCTs and in 100% of NRSs with available data. Liver function tests were improved in 82% of RCTs and in 100% of NRSs with available data. UDCA use did not affect the Caesarean section rate, but was associated with less prematurity, less use of neonatal intensive care units (data available in only 3/17 studies), and trends towards increased birth weight and decreased meconium staining. There were 0/356 stillbirths with UDCA and 3/399 stillbirths with comparator. UDCA treatment should be recommended for women with ICP to reduce adverse maternal and fetal outcomes.

Can Carcinoembryonic Antigen Serve as an Indicator for Meconium-Stained Amniotic Fluid?

INTRODUCTION: Meconium-stained amniotic fluid occurs in approximately 12% of all pregnancies. Although most pregnancies with meconium-stained amniotic fluid end with no fetal or neonatal complications, there is still a significant number that result in immediate life-threatening complications to the neonate such as meconium aspiration syndrome. Meconium aspiration syndrome still poses a challenge to clinicians and leads to serious morbidity in affected newborns. To date, meconium-stained amniotic fluid is simply detected by the naked eye of the examining health care provider. There is no objective laboratory test or imaging study for the detection of meconium-stained amniotic fluid. The goal of our study was to determine whether carcinoembryonic antigen (CEA) levels can serve as a reliable marker for the detection of meconium-stained amniotic fluid. METHODS: Carcinoembryonic antigen levels were measured quantitatively in amniotic fluid, urine, and serum samples of pregnant women at term in labor with ruptured membranes. RESULTS: Eighty-one amniotic fluid samples were obtained, 45 clear, eight indeterminate, and 28 with visible meconium stain. Those managing the course of labor were blinded to the result of the assay. Carcinoembryonic antigen levels were significantly higher in meconium-stained amniotic fluid compared with clear amniotic fluid (mean [micrograms/mL] of 2,658 compared with 238, respectively; P<.001). The critical concentration of CEA in meconium-stained amniotic fluid was assessed and a cutoff level was determined. Carcinoembryonic antigen levels in urine and serum samples of women with meconium-stained amniotic fluid remained low and similar to those with meconium-free amniotic fluid. CONCLUSIONS: Carcinoembryonic antigen level in amniotic fluid offers a diagnostic modality independent of the clinician's visual estimate. This may be useful in cases when the presence of meconium is in question.

Evaluation of the Effect of Areca Nut Use During Pregnancy in the Commonwealth of the Northern Mariana Islands

INTRODUCTION: Betel quid chewing is very common among the native Pacific Islanders living in the Commonwealth of the Northern Mariana Islands and is the fourth most common habit in the world after tobacco, alcohol, and caffeine. Despite its widespread use, there are no studies regarding the effects of betel quid use during pregnancy in the Pacific Islanders living in the Commonwealth of the Northern Mariana Islands. The intent of this study was to assess whether there was a relationship between chewing areca nut and the incidence of preterm birth or meconium staining of amniotic fluid. METHODS: A retrospective chart review was conducted for all deliveries occurring in the territory during 2009. Residents with singleton pregnancies who self-identified during admission as areca nut chewers were selected as cases and compared with nonchewers after matching by age and ethnicity. RESULTS: Areca nut users had twice the odds of preterm birth compared with those who did not use areca nut and the odds of meconium staining of amniotic fluid were increased for areca nut users, although neither value was statistically significant. CONCLUSIONS: The effects of areca nut use during pregnancy remain largely unknown. Additional research with more accurate documentation and better quantification of intake is needed.

Variation in fetal outcome, viral load and ORF5 sequence mutations in a large scale study of phenotypic responses to late gestation exposure to type 2 porcine reproductive and respiratory syndrome virus.

In spite of extensive research, the mechanisms of reproductive disease associated with Porcine Reproductive and Respiratory Syndrome virus (PRRSv) are still poorly understood. The objectives of this large scale study were to evaluate associations between viral load and fetal preservation, determine the impact of type 2 PRRSv on fetal weights, and investigate changes in ORF5 PRRSv genome in dams and fetuses during a 21-day period following challenge. At gestation day 85 (±1), 114 gilts were experimentally infected with type 2 PRRSv, while 19 gilts served as reference controls. At necropsy, fetuses were categorized according to their preservation status and tissue samples were collected. PRRSv RNA concentrations were measured in gilt serum collected on days 0, 2, 6, and 21 post-infection, as well as in gilt and fetal tissues collected at termination. Fetal mortality was 41±22.8% in PRRS infected litters. Dead fetuses appeared to cluster in some litters but appeared solitary or random in others. Nine percent of surviving piglets were meconium-stained. PRRSv RNA concentration in fetal thymus, fetal serum and endometrium differed significantly across preservation category and was greatest in tissues of meconium-stained fetuses. This, together with the virtual absence of meconium staining in non-infected litters indicates it is an early pathological condition of reproductive PRRS. Viral load in fetal thymus and in fetal serum was positively associated with viral load in endometrium, suggesting the virus exploits dynamic linkages between individual maternal-fetal compartments. Point mutations in ORF5 sequences from gilts and fetuses were randomly located in 20 positions in ORF5, but neither nucleotide nor amino acid substitutions were associated with fetal preservation. PRRSv infection decreased the weights of viable fetuses by approximately 17%. The considerable variation in gilt and fetal outcomes provides tremendous opportunity for more detailed investigations of potential mechanisms and single nucleotide polymorphisms associated with fetal death.

Serum bile acids in intrahepatic cholestasis of pregnancy: Not just a diagnostic test

Serum bile acids in intrahepatic cholestasis of pregnancy: Not just a diagnostic test

Amnioinfusion for meconium-stained liquor in labour.

Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration. To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013). Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid. Three review authors independently assessed eligibility and trial quality, and extracted data. Fourteen studies of variable quality (4435 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced. Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome

ABSTRACT Objective This study was done to assess the Doppler cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome especially in growth restricted pregnancies. Materials and methods In this study, 62 antenatal women were subjected to Doppler studies at 34 to 42 weeks of gestations. CPR was calculated and less than 1 was taken as predictor of adverse perinatal outcome. Adverse perinatal outcomes was evaluated by mode of delivery, meconium staining, 1 and 5-minute Apgar scores, birth weight, admission to NICU and other neonatal complications. Results Of 62 antenatal women, with an abnormal CPR had higher incidence of meconium, clinical fetal distress, operative delivery, low Apgar score (5 mins), NICU admission and neonatal death, 42.88, 47.62, 26.57, 76.19, 66.17 and 66.67% respectively as compared to women with normal CPR who had 4.88, 2.88, 2.88. 2.88, 12.19, 17.07 and 0% respectively. With the use of an abnormal CPR, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 62, 80, 62 and 80%, respectively, with an odds ratio (95% confidence interval). Conclusion An abnormal CPR is associated with adverse perinatal outcomes, especially in growth-restricted fetuses. How to cite this article Shaheen S, Bano I, Ahmad I, Singh A. Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(1):25-27.

Histopathological study of placentae in low birth weight babies in India.

Background:The antenatal health-care given to pregnant women has great influence on the rates of perinatal death and morbidity. Amongst the different causes of perinatal mortality, low birth weight (LBW) is the single most significant factor therefore placenta from all the LBW babies (LBWB) should be examined routinely to find out the likely cause.Aims:The aims of this study were to assess the pathological changes in the placenta in association with LBWB.Materials and Methods:This is a Case control study performed at Medical College Allahabad,(MLN) India. In this study, 90 placentae were included. 30 placentae from full-term vaginally delivered babies, weighing more than 2500 g were included as the control group. 60 placentae belonged to babies whose birth weight was less than 2500 g (LBW). Weight of the baby was taken within the 1st h of birth and Apgar score was noted. Gross and microscopic examination of placentae was done. Statistical correlation of was carried out between them by using SPSS 18 version. Chi-square test with or without yate's correction was used as and when required. P < 0.05 was taken as critical level of significance.Results:Placenta was circum-marginal in both groups. Attachment of cord was mainly central in the control group 90% (27/30), whereas eccentric attachment was prominent in patient group 66.67% (40/60). The difference was statistically significant (P < 0.001). Calcification and sub-chorionic fibrin deposition was seen in significantly higher numbers of placentae from patients than controls (P < 0.01) infarction and meconium staining were seen in placentae from patients only. Histologically placental ischemia, infarction and calcification were seen in significantly higher number of patients (P < 0.001, P < 0.001 and < 0.01 respectively). Fibrinoid necrosis, stromal fibrosis, placental dysmaturity and obstructive vasculopathy were seen in placentae from patients only.Conclusion:Placental pathology among LBW infants was high in comparison to control group. The findings suggest that chronic ischemia and associated secondary changes probably lead to improper perfusion and LBWB.

Maternal hydration and L-arginine supplementation improves liquor volume in patients with decreased liquor and prolongs pregnancy

Background: Oligohydramnios (reduced amniotic fluid) may be responsible for the problems of malpresentations, umbilical cord compression, meconium staining of amniotic fluid in the liquor, and difficult or failed external cephalic version. Simple intervention maternal hydration has been reported as a way of increasing amniotic fluid volume in order to reduce some of these problems. Objective: To assess the influence of maternal hydration and l-arginine supplementation in improving liquor volume in patients with decreased liquor. Study Design: Prospective nonrandomized interventional study. Materials and Methods: 50 patients remote from term, with decreased liquor [amniotic fluid index (AFI) < 8] were enrolled in the study. Before the proposed intervention, the antenatal risk factors were studied. Patients with hypertensive disorders of pregnancy were administered l-arginine (one sachet 3 g, two times daily) and others received both arginine and intravenous hydration (500 ml of fructodex which contains 5% dextrose and 5% fructose, and lactated Ringer's solution daily). The treatment was continued till the liquor improved significantly. However, patients were considered for delivery if the liquor remained less than 5. Mean increase in liquor, intervention delivery interval, and neonatal outcome were studied. Results: The mean gestational age at the time of recruitment was 33.4 ΁ 1.9 weeks. The mean AFI at the time of enrolment was 6.9 (SD 0.8). These patients were delivered at 36.3 ΁ 1.3 weeks, and thus, pregnancy could be prolonged by 2.9 weeks. The mean AFI at the end of therapeutic intervention was 9.3 (SD 1.7), and thus, an AFI increase of 2.4 could be obtained. There was no significant neonatal morbidity in these patients. Significant improvement in liquor volume was obtained in these patients after intervention with either or both l-arginine and fructodex infusion (P < 0.0001). The pregnancy could be prolonged from 33.4 weeks to 36.3 weeks. Conclusion: Treatment with l-arginine and fructodex resulted in significant improvement in liquor and prolongation of duration of pregnancy by around 3 weeks, which enabled us to administer steroids for lung maturation (in indicated cases). Thus, treatment with l-arginine and fructodex seems to be promising in improving fetal outcome in pregnancies complicated by decreased liquor.

Intrahepatic cholestasis in pregnancy

Abnormal liver function tests occur in 3-5% of pregnancies, with many potential causes, including coincidental liver disease (most commonly viral hepatitis or gallstones) and underlying chronic liver disease. Pruritus in pregnancy is common, affecting 23% of pregnancies, of which a small proportion will have obstetric cholestasis. Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic disorder characterized by pruritus with onset in the second or third trimester of pregnancy, elevated serum aminotransferases and bile acid levels, and spontaneous relief of signs and symptoms within two to three weeks after delivery. ICP is observed in 0.4-1% of pregnancies in most areas of Central and Western Europe and North America. Genetic and hormonal factors, but also environmental factors may contribute to the pathogenesis of ICP. Intrahepatic cholestasis of pregnancy increases the risk of preterm delivery (19­60%), meconium staining of amniotic fluid (27%), fetal bradycardia (14%), fetal distress (22-41%), and fetal loss (0.4-4.1%), particularly when associated with fasting serum bile acid levels >40 μmol/L. Important ICP-induced changes in serum profiles of amidated bile acids were observed, involving both a marked increase in cholic acid concentration and a shift towards a higher proportion of taurine-conjugated species. Ursodeoxycholic acid (10-20 mg/kg/d) is today regarded as the first line treatment for intrahepatic cholestasis of pregnancy. Delivery has been recommended in the 37-38th week when lung maturity has been established.

English

OBJECTIVE: The purpose of this study was to compare the feto-maternal outcome after induction of labor in oligohydramnios and borderline liquorat term. STUDY DESIGN: This retrospective study was conducted in a medical college and general hospital with women of 37-42 weeks' gestation. The amniotic fluid index (AFI) was determined in all cases using the four-quadrant technique. The cases were divided into two groups based on their AFI. Oligohydramnios group (n=102) with AFI ≤ 5 cm and borderline liquor group (n=99) with AFI of 5.1 to 8 cm. Induction of labor was done by misoprostol in all cases. Different maternal outcomes like mode of delivery, indication for operative or instrumental delivery, meconium stained liquor and perinatal outcomes were compared in between the two groups.RESULTS: The two groups were similar with regard to maternal age, parity, and gestational age. Meconium staining of the amniotic fluid was significantly higher in the group with AFI < 5 cm (p = 0.05). The number of cesarean deliveries and incidence non-reassuring fetal heart (fetal distress) were similar in both the groups. There was no significant difference between the two groups with regard to Apgar scores or admission to neonatal intensive care unit (NICU). CONCLUSION: Induction of labor at term in women with oligohydramnios is associated with an increased incidence of meconium staining of the amniotic fluid but the risk of cesarean delivery or fetal distress it is not increased as compared with borderline liquor.

Birth characteristics and risk of lymphoma in young children

BackgroundLymphoma is the third most common childhood malignancy and comprises two types, Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). The etiology of pediatric lymphomas is largely unknown, but has been suggested to have prenatal origins. MethodsIn this population-based study, California birth certificates were identified for 478 lymphoma cases diagnosed in children 0–5 years of age between 1988 and 2007; 208,015 controls frequency-matched by birth year were randomly selected from California birth records. ResultsCompared to non-Hispanic whites, Hispanic children had an increased risk of HL (odds ratio (OR) and 95% confidence interval (CI) 2.43 [1.14, 5.17]), and in particular, were diagnosed more often with the mixed cellularity subtype. For all types of lymphoma, we observed an about twofold risk increase with indicators for high risk pregnancies including tocolysis, fetopelvic disproportion and previous preterm birth. NHL risk doubled with the complication premature rupture of membranes (OR and 95% CI 2.18 [1.12, 4.25]) and HL with meconium staining of amniotic fluids (OR and 95% CI 2.55 [1.01, 6.43]). ConclusionThese data support previously reported associations between Hispanic ethnicity and HL and suggest that pregnancy related factors, such as intra-uterine infections and factors associated with preterm labor, may be involved in lymphoma pathogenesis.

English

Objectives: The aim of this study is to determine the incidence and risk factors for MSAF and MAS and to find out whether there any respiratory and neuro-developmental morbidity and mortality among babies with MAS. MATERIAL AND METHODS: This is a longitudinal study carried out at Institute of Maternal and Child Health, Government Medical College Kozhikode, Kerala. 301 pregnant women with neonates born through MSAF between 1 st December 2008 to 30 th November 2009 were studied. Their case records were analyzed in two steps: I - Demographic profile of antenatal, intrapartum risk factors and neonatal outcome of pregnancies complicated by MSAF . II- Babies were divided between MAS (n=65) and non MAS (n=236) groups. Maternal and neonatal risk factors compared between them. Data statistically analyzed by chi-square test using statistical software Epi info 3.5. RESULTS: .Antenatal risk factors like IUGR, hypertensive disorders and oligoamnios is significantly associated with development of MAS. Delayed milestones and recurrent respiratory tract infections were the morbidities. CONCLUSION: The incidence of meconium staining of liquor was found to be 3.2% of all live births, with meconium aspiration syndrome (MAS) occurring in 21.5% of these neonates. Complications were more (72.3%) among MAS babies when compared to non MAS babies (6.8%). Mortality was seen only in MAS babies i.e. 13.8%. On follow up 49.2% babies were normal, 4.6% had cerebral palsy and 10.7% had recurrent respiratory tract

Normal and indeterminate pattern of fetal cardiotocography in admission test and pregnancy outcome.

The aim of this study was to evaluate the prognostic value of normal and indeterminate patterns of cardiotocography in admission test (AT) and pregnancy outcome. A prospective study enrolled 818 intrapartum singleton pregnancies with gestational age of >34 weeks, in the latent phase and with intact membrane. Cases were divided into the high- and low-risk groups. Non-Stress Test was interpreted according to the 2008 National Institute of Child Health and Human Development workshop. Adverse pregnancy outcomes were compared between groups based on AT interpretation. Out of 818 patients, 492 (60%) were categorized as low-risk and 326 (40%) as high-risk pregnancies. In low-risk patients, 410 (83.3%) had normal and 82 (16.7%) had indeterminate AT. These figures were 249 (76.4%) and 77 (23.6%) in high-risk patients, respectively, and two cases (0.6%) had abnormal AT. In both groups, thick meconium staining, non-reassuring fetal heart rate pattern, cesarean section and cesarean section due to non-reassuring fetal heart rate pattern were significantly more frequent in indeterminate AT than normal ones (P < 0.001). In high-risk pregnancies with indeterminate AT, the risk of low birthweight and neonatal intensive care unit (NICU) admission increased. The positive predictive value was less than 30% in predicting thick meconium staining, non-reassuring fetal heart rate pattern, PH ≤ 7.2 and NICU admission in both groups. Overall, negative predictive value of AT for neonatal death and NICU admission was 100% and 96%, respectively. Indeterminate patterns of cardiotocography can predict adverse pregnancy outcomes and when facing this condition, obstetricians should act cautiously.

Meconium Staining of Amniotic Fluid: A Clinical Study

Meconium Staining of Amniotic Fluid: A Clinical Study