Presence Of Meconium-stained Amniotic Fluid Research Articles

Perinatal Outcomes of Pregnancies with Borderline Oligohydramnios at Term

Introduction: Limited evidence exists on borderline oligohydramnios. Our objective was to determine perinatal outcomes in uncomplicated term pregnancies with borderline oligohydramnios. Methods: This retrospective analysis compared adverse perinatal outcomes among pregnancies during 2018–2022, between those with borderline oligohydramnios defined as amniotic fluid index (AFI) of 5.1–8.0 cm, those with oligohydramnios (AFI ≤5 cm), and those with normal AFI (8.1–25 cm). The latter matched one-to-one to the borderline oligohydramnios group and served as the control group. The outcomes compared included birthweight, cesarean delivery due to fetal distress, the presence of meconium-stained amniotic fluid, Apgar scores, neonatal intensive care unit admission, and the occurrence of small-for-gestational-age (SGA) neonates. Results: During the study period, 140 women had borderline oligohydramnios and 345 had oligohydramnios; the control group included 140 women. Borderline oligohydramnios was associated with increased rates of delivering SGA neonates (adjusted odds ratio [aOR] = 3.6, 95% confidence interval [CI] 1.1–11.6, p = 0.034) and cesarean delivery due to fetal distress (aOR = 3.0, 95% CI 1.1–8.3, p = 0.032). Rates of composite neonatal outcome (including at least one of the following: cesarean delivery due to fetal distress, meconium-stained amniotic fluid, 5-min Apgar score <7, umbilical artery pH <7.15, or neonatal intensive care unit admission) were higher in both the borderline oligohydramnios (20.7%) and oligohydramnios (18.6%) groups compared to the control group (9.3%) (p = 0.019). Conclusions: Pregnancies with borderline oligohydramnios were associated with increased risks of delivering SGA neonates and requiring cesarean delivery due to fetal distress. These findings support considering closer antepartum surveillance for these pregnancies, especially for identifying abnormal fetal growth.

Magnitude of meconium stained amniotic fluid and associated factors among women who gave birth in North Shoa Zone hospitals, Amhara Region, Ethiopia 2022.

The presence of meconium-stained amniotic fluid is one of the causes for birth asphyxia. Each year, over five million neonatal deaths occur worldwide because of meconium-stained amniotic fluid and other causes, of which 90% are due to birth asphyxia. The aim of this study was to assess the magnitude of meconium-stained amniotic fluid and associated factors among women who gave birth in North Shoa Zone Hospitals, Amhara Region, Ethiopia, 2022. An institutional-based cross-sectional study was employed. We used 610 women who gave birth at North Shoa Zone Hospitals, Amhara region, Ethiopia. The study was conducted from June 8 to August 8, 2022. Recruitment for the study was made using a multistage sampling procedure. Fifty percent of the study hospitals were randomly selected, and proportional allocation was done. Participants were selected from the sampling frame, labour and delivery register book, using a systematic random sampling approach. The first person was selected at random, while the remaining individuals were selected at every two "K" intervals across all hospitals. An interview-administered structured questionnaire and chart review checklist were used to gather the data that were entered into Epi-Data Version 4.6 and exported to SPSS. Logistics regression was employed, and a p-value <0.05 was considered statistically significant. The magnitude of meconium-stained amniotic fluid was 30.3%. Women with a normal hematocrit level were 83% less likely to develop meconium-stained amniotic fluid. Women whose mid-upper arm circumference value was less than 22.9cm (AOR = 1.9; 95% CI: 1.18-3.20), obstructed labour (AOR = 3.6; 95% CI: 1.48-8.83), prolonged labour ≥ 15 hr (AOR = 7.5; 95% CI: 7.68-13.3), premature rapture of membrane (AOR = 1.7; 95% CI: 3.22-7.40), foetal tachycardia (AOR = 6.2; 95% CI: 2.41-16.3), and Bradycardia (AOR = 3.1; 95% CI: 1.93-5.28) showed a significant association with meconium-stained amniotic fluid. The present study revealed that the magnitude of meconium-stained amniotic fluid in North Shoa Zone is nearly one-third. A normal hematocrit level is a preventive factor for meconium-stained amniotic fluid, and a MUAC value <22.9 cm, obstructed and prolonged labour, PROM, bradycardia, and tachycardia are factors associated with meconium-stained amniotic fluid.

Determinants of meconium-stained amniotic fluid among laboring mother in Ethiopia, systematic review and meta-analysis.

Meconium-stained amniotic fluid (MSAF) occurs during childbirth when the amniotic fluid carries traces of meconium, the initial stool passed by a newborn. Often signaling fetal distress, MSAF is linked to heightened risks for both the mother and the newborn. In Ethiopia, there is insufficient attention given to this condition. Despite varied study results indicating a considerable range in MSAF occurrences, there is an absence of a comprehensive national overview. Therefore, this systematic review and meta-analysis aim to evaluate the aggregated prevalence of meconium-stained amniotic fluid among laboring mothers and its influencing factors in Ethiopia, providing a consolidated understanding for healthcare strategies and policies. Following PRISMA guidelines, a systematic review and meta-analysis were executed. Extensive literature searches were conducted on PubMed, Google Scholar, and African Online Journal databases. The pooled prevalence was estimated using a weighted inverse variance random effect model. Heterogeneity among studies was evaluated through Cochrane Q-test and I 2 statistics. To assess publication bias, a funnel plot and Egger's test were performed. The identification of factors associated with meconium-stained amniotic fluid among laboring mothers in Ethiopia was conducted using Stata v 18 software. In total, 63 articles were initially identified, and ultimately, four articles were deemed suitable for inclusion in this review. The combined prevalence of meconium-stained amniotic fluid among laboring mothers in Ethiopia was determined to be 20% (95% CI: 14%-25%). Upon conducting subgroup analysis, it was revealed that the prevalence of meconium-stained amniotic fluid was highest in the Oromia region and lowest in Addis Ababa. Notably, pregnancies complicated by pregnancy-induced hypertension disorder showed a significant association with the presence of meconium-stained amniotic fluid, with an odds ratio of 6.21 (95% CI: 4.04-8.38). In conclusion, this review emphasizes the common occurrence of meconium-stained amniotic fluid (MSAF). Notably, it identifies a significant association between pregnancy complicated by hypertension and the presence of MSAF. This underscores the need for targeted interventions to reduce MSAF incidence and mitigate associated adverse outcomes in the Ethiopian. http://www.library.ucsf.edu/, (CRD42023491725).

Maternal and Perinatal Outcomes of Low-risk Pregnancies with Amniotic Fluid Index &lt;5 cm: A Prospective Cohort Study

Introduction: The optimal management of Isolated Oligohydramnios (IO) is controversial. The general consensus is to deliver after 36 weeks. This has led to higher rates of obstetric interventions and adverse neonatal outcomes. Aim: To compare the pregnancy and perinatal outcomes of low-risk pregnancies with IO (Amniotic Fluid Index [AFI] &lt;5 cm) with that of low-risk pregnancies with normal levels of amniotic fluid. Materials and Methods: A prospective cohort study was conducted at the Department of Obstetrics and Gynaecology at Government Medical College, Ernakulam, from April 2018 to March 2020. A total of 66 low-risk singleton pregnancies with IO (AFI &lt;5 cm) between 34 and 40 weeks of gestation were compared with 132 low-risk pregnancies with normal AFI (AFI 5-24), matched by parity and gestational age. The obstetric outcomes measured were gestational age at delivery, mode of delivery, presence of Meconium-Stained Amniotic Fluid (MSAF), presence of Non-reassuring Foetal Heart Rate (NRFHR), stillbirth, and maternal complications. Neonatal outcomes measured were prematurity, birth weight, admission to the Neonatal Intensive Care Unit (NICU), duration of NICU stay, and the presence of Respiratory Distress Syndrome (RDS), Transient Tachypnea of the Newborn (TTN), Meconium Aspiration Syndrome (MAS), seizures, Necrotising Enterocolitis (NEC), Intraventricular Haemorrhage (IVH), Hypoxic Ischemic Encephalopathy (HIE), need for phototherapy, infectious morbidity like suspected or culture-proven sepsis, hypothermia, hypoglycaemia, and Neonatal Death (NND). A composite adverse neonatal outcome was defined as the presence of any one of the above. Continuous variables were calculated as mean with Standard Deviation (SD) or median with Interquartile Range (IQR) as appropriate. The test of significance done using the Student’s t-test. Categorical variables were calculated as numbers (%) and compared using the Chi-square test and Fisher’s exact test. All tests were two-sided, and a p-value of less than 0.05 was considered statistically significant. Results: The mean age of patients in the low AFI group was 26±4.87 years, while in the normal AFI group, it was 24.8±4.39 years. Pregnancies complicated by IO were characterised by a higher rate of labour induction {38 (57.6%) vs. 26 (19.7%), p-value&lt;0.001} and caesarean delivery {34 (51.5%) vs. 35 (26.5%), p-value&lt;0.001}. IO had a significantly higher rate of low birth weight babies {35 (53%) vs. 28 (21.2%), p-value&lt;0.001}, non-vertex presentations {6 (9.1%) vs. 0, p-value&lt;0.001}, and NRFHR {10 (15.2%) vs. 6 (4.5%), p-value=0.001}. Neonates in the low AFI group had a higher rate of admission to the NICU {20 (30.3%) vs. 20 (15.2%)} and composite adverse outcomes {24 (36.4%) vs. 20 (15.2%)}. Conclusion: The isolated oligohydramnios is associated with a higher rate of labour induction, caesarean delivery, and low birth weight babies. Adverse neonatal outcomes may be due to the combined effects of prematurity and low birth weight, rather than to IO per se.

Adverse Fetal Outcomes in Patients with Low Amniotic Fluid Index: Presenting Care Hospital Setting

Background: Pregnancy is a critical period where various physiological parameters are monitored to ensure the well-being of both mother and fetus. Amniotic fluid index (AFI) is one such measure, with deviations from the norm, particularly low AFI, being associated with adverse fetal outcomes. This study delves into the correlation between low AFI and fetal well-being in a tertiary care setting. Objective: The aim of this study was to investigate the association between low AFI and adverse fetal outcomes and to quantify the impact of low AFI on fetal health during delivery in a tertiary care hospital. Methods: A prospective study was conducted on 100 pregnant women attending the Obstetrics and Gynecology Department of Khyber Teaching Hospital, Peshawar, from June 28 to September 27, 2023. AFI was measured using ultrasonography, with a particular focus on participants with an AFI of less than 5 cm. The study also included a systematic sample of patients across various gestational ages and recorded outcomes such as intrauterine growth restriction (IUGR), oligohydramnios-associated deformations, cord compression, variable decelerations in fetal heart rate, and the presence of meconium-stained amniotic fluid. Statistical analysis was performed using chi-square and t-tests, with a significance level set at p&lt;0.05. Results: The mean AFI was 8.7 cm (SD = 1.5). Low AFI (&lt;5 cm) was observed in 15% of the participants. Adverse outcomes included 6 cases of IUGR (6%), 4 cases of oligohydramnios-associated deformations (4%), 3 cases of cord compression (3%), 5 cases of variable decelerations in fetal heart rate (5%), and 8 cases of meconium-stained amniotic fluid (8%). A significant association was found between low AFI and adverse fetal outcomes (χ² = 8.43, p &lt; 0.01). Conclusion: The study confirmed a significant correlation between low AFI and the presence of adverse fetal outcomes, emphasizing the importance of vigilant fetal monitoring and management in pregnancies with low AFI.

Clinical Importance of Serum BDNF (Brain-Derived Neurotrophic Factor) Level for the Management of Pregnancies Complicated With Meconium-Stained Amniotic Fluid.

Objective The aim of this study was to investigate the association between poor neonatal outcomes and BDNF (brain-derived neurotrophic factor) levels. We aimed to predict the need for an emergency cesarean and prevent unnecessary interventions in cases complicated with meconium-stained amniotic fluid (MSAF). Methods This study was designed as a case-control study including three groups. Group A included pregnant women who underwent cesarean due to fetal distress. Group B included the women who delivered vaginally. Groups A and B had cases with the presence of meconium in the amniotic fluid. Group C as a control group had clear amniotic fluid. Demographic features, fetal outcomes, and maternal serum and fetal cord blood BDNF levels (Human BDNF ELISA Kit; Synonyms: ANON2, BULN2; Catalog no: E-EL-H0010 96T) were evaluated. Results No significant difference was found between patients with meconium and without meconium in terms of BDNF levels. However, the BDNF level was found to be significantly lowerif fetal distress had occurred with MSAF. Conclusions In conclusion, the study demonstrated that the level of maternal and fetal cord blood BDNF are both significantly lower when fetal distress occurs with the presence of MSAF.

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.

Meconium - Stained Amniotic Fluid in Labour – its Significance and Correlation to Early Maternal and Neonatal Outcome – A Prospective Case Control Study in A Tertiary Care Center

Background: Meconium-stained amniotic fluid (MSAF) is a well-known factor which associated with significant adverse pregnancy outcomes. Meconium Aspiration Syndrome (MAS) occurs in about 5% of deliveries with MSAF and death occurs in about 12% of infants with MAS. The significance of meconium claimed to be varied from being entirely physiological, which exhibits sign of fetal maturity, to a sign of fetal distress as a response to hypoxic insult to the foetus. This study was carried out in a tertiary care centre; with the aim of detecting the significance of MSAF. Additionally, this study compares the fetal and maternal outcome in deliveries complicated by meconium-stained amniotic fluid and critically evaluates the associated predisposing maternal and fetal factors for MSAF. Method: This prospective case-control study was carried out in Colombo South Teaching Hospital (University Professorial Obstetrics Unit), Sri Lanka. Women who presented to the unit with pre-defined selection protocol were recruited to the study until the sample size (n = 216 in each arm) is achieved. The Sample was categorized in to two groups depend on the presence or absence of Meconium-stained amniotic fluid. Mean, standard deviation, median and 95% confidence interval are computed for quantitative variables. Chi-square test is applied for calculating the statistical significance of variables such as grades of meconium and Apgar score at 95% confidence interval. The p-value &lt;0.05 and 95% confident interval was utilised to assess the statistical significance. Results: Presence of diabetes in current pregnancy was a significant risk factor for meconium-stained amniotic fluid at delivery with odd ratio of 2.397 (95% Confident Interval 1.203 - 3.568) and p value of &lt;0.00.1. There is a statistically significant association between the mode of delivery and the nature of meconium with odd ratio of 3.029 (95% Confident Interval 1.887 – 3.136) and p value &lt; 0.001, when its moderate to thick meconium staining. Presence of moderate to thick meconium increase the risk of neonatal respiratory morbidity with increased NICU admissions, which is both statistically and clinically significant with odd ratio of 2.412 (95% Confident Interval 1.674 - 3.199) and p value 0.005 when compared with thin meconium staining. Overall, there is a 2-fold rise in operative vaginal deliveries and EM-LSCS (Emergency Lower Segment Caesarean Section) in the presence of MSAF which accountable for 67.3% of the deliveries compared to 37.2% in the clear liquor group. The follow up of neonates at one month and three months of life, revealed no statistically significant concerns on the development of these babies in either arm of the study population. Conclusion: Presence of meconium-stained amniotic fluid is one of the common indications for caesarean delivery. Therefore, the results of this study may help to reduce the number caesarean sections carried out when the meconium is detected during labour. Presence of thin MSAF can be physiological following gut maturation of term foetuses, thus utilization of continuous electronic fetal monitoring can reliably cut down the caesarean section rates without adding numbers to the adverse perinatal outcomes. On the other hand, timely interventions upon detection of abnormal Cardiotocography (CTG), such as operative vaginal delivery or EM-LSCS, can significantly minimise these adverse neonatal outcomes. Abnormal CTG in a clinical background of moderate to thick meconium is more alarming, which warrant urgent interventions compared to the presence of thin / lightly stained meconium.

Meconium-stained amniotic fluid and histologic signs of fetal distress in stillbirths

ObjectiveStillbirth is one of the most devastating adverse pregnancy outcome, but it is often associated with a missing post-mortem histological examination. We aimed at evaluating whether the staining of amniotic fluid reflects the fetal conditions surrounding the death and if it correlates with any histologic sign of fetal distress. Study DesignTerminal gasping (represented by the massive presence of intra-alveolar squamous cells), thymic and adrenal cortex modifications were evaluated as histologic signs of fetal distress in stillbirths, and stratified according to the degree of staining of the amniotic fluid. ResultsThe presence of meconium-stained amniotic fluid did not correlate with the presence of gasping and/or thymic and/or adrenal cortex changes. Clear amniotic fluid was not associated with the absence of histologic signs of distress. ConclusionsThe evaluation of the staining of the amniotic fluid fails to identify distressed fetuses. A histologic evaluation of fetal organs provides detailed information, irrespective of the presence/absence of meconium-stained amniotic fluid.

The value of intrapartum factors in predicting maternal morbidity

The rates of severe maternal morbidity and mortality in the United States exceed those in other high-income nations. To aid providers and hospitals in recognizing the risk factors, there have been multiple attempts to develop stratification systems for morbidity based on maternal comorbidities. However, most women giving birth are healthy and do not have comorbidities to suggest that they are at an increased risk for severe maternal morbidity. There are small but inherent maternal risks to labor, and the events after admission may further influence a woman's risk for morbidity even for those initially at a low risk. To determine if the incorporation of intrapartum factors known at the start of the second stage of labor improves the predictive performance of a comorbidity-based risk tool for severe maternal morbidity. This is a retrospective cohort study of women at 8 hospitals in a single health system between July 1, 2016, and June 30, 2020. The women had term, singleton gestations and were admitted in labor and reached the second stage. The primary outcome was severe maternal morbidity. We compared logistic regression models using a validated risk-scoring tool (the Expanded Obstetric Comorbidity Score, which uses diagnosis codes for maternal comorbidities and pregnancy characteristics to predict maternal morbidity) with a model that included the Expanded Obstetric Comorbidity Score combined with parity and intrapartum factors. The intrapartum factors included labor induction or augmentation, length of labor, prolonged rupture of membranes, the presence of meconium-stained amniotic fluid, and gestational age. The hospitals were divided into a training (n=4) and testing (n=4) set to evaluate the predictive model performance. Discrimination was assessed by calculating the area under the receiver operating curve and calibration via calibration plots. Similar model comparisons were performed in a subgroup of women, who the Expanded Obstetric Comorbidity Score predicted to be at low risk for morbidity. This analysis included 33,770 deliveries from the 8 hospitals; severe maternal morbidity occurred in 498 (1.5%) deliveries. The model performance is reported among the testing set (n=15,350). Using the Expanded Obstetric Comorbidity Score alone, the area under the receiver operating curve was 0.676 (95% confidence interval, 0.636-0.716) and 155 (71%) events occurred among individuals above the median predicted risk. When combining intrapartum factors, the area under the receiver operating curve increased to 0.729, (95% confidence interval, 0.693-0.764) and 171 (78%) events occurred among individuals above the median predicted risk. The significant factors that were associated with severe maternal morbidity in this combined model included the Expanded Obstetric Comorbidity Score, length of labor, and the presence of meconium-stained amniotic fluid. The area under the receiver operating curve for the model with intrapartum factors was significantly higher than the models using the Expanded Obstetric Comorbidity Score alone (P<.001). The incorporation of intrapartum factors along with a validated risk tool (Expanded Obstetric Comorbidity Score) improved the ability to predict severe maternal morbidity at the start of the second stage. These findings emphasize the evolution of a woman's risk during her labor course and suggests that the prediction of maternal risk can be improved by considering intrapartum factors.

Role of Intravenous Magnesium Sulphate in Term Neonates with Hypoxic Ischemic Encephalopathy (HIE) in a Low-income Country: A Randomised Clinical Trial.

To determine the effects of magnesium sulphate in term neonates with hypoxic ischemic encephalopathy (HIE) in reducing mortality and morbidity. Randomised clinical trial. Department of Neonatology, Services Hospital, Lahore, Pakistan from April to December 2019. Term babies (inborn or outborn), fulfilling the operational definition of hypoxic ischemic encephalopathy, reaching within 6 hours of delivery in Nursery Department of Pediatric Medicine Unit-II, Services Hospital, Lahore, were included. Sarnat score was used for staging the severity of HIE. Cases were administered magnesium sulphate (MgSO4) as intravenous infusion. Rest of the management was similar for cases and controls. Mortality was defined as death due to birth asphyxia; whereas, morbidity was assessed by comparing the following at discharge: the grade of hypoxic ischemic encephalopathy, presence and frequency of seizures, duration of seizures, ability to suck feed and neurological problems such as abnormalities of muscle tone and neonatal reflexes. Babies with prematurity, dysmorphism comorbidities or arriving after 6 hours of birth, were excluded. Chi-square test was used for comparison; and p value <0.05 was considered significant. Gender, mode of delivery, mode of resuscitation at birth, major risk factors (prolonged labour, premature rupture of membranes, presence of meconium-stained amniotic fluid) were comparable in both groups. The duration of seizures, ability to suck feed and presence of neurological problems at discharge were significantly better in magnesium sulphate group as compared to control group. Magnesium sulphate is better in establishing earlier suck feed and reducing the duration of seizures and neurological problems in babies with birth asphyxia. Key Words: Hypoxic ischemic encephalopathy, Magnesium sulphate, Outcome, Term, Low income country.

Absence of fetal heart rate cycling on the intrapartum cardiotocograph (CTG) is associated with intrapartum pyrexia and lower Apgar scores

Background Cycling consists of alternating periods of reduced and normal fetal heart variability, reflecting changes in fetal behavioral states. Occurrence of active and quiet sleep cycles is considered to be a hallmark of fetal autonomic nervous system integrity, demonstrating healthy interaction between the parasympathetic and sympathetic nervous systems. Cycling is an overlooked feature in most international cardiotocography (CTG) guidelines. The authors tested the hypothesis that fetuses showing no cycling in the intrapartum period have poorer outcomes. Aim To investigate whether the absence of cycling at the commencement of intrapartum fetal monitoring is associated with poorer neonatal outcomes (umbilical arterial cord pH, Apgar scores and neonatal unit admission). Methods Analysis of a database of sequentially acquired intrapartum CTG traces from a single center. Only cases of singleton pregnancies over 36 weeks gestation in cephalic presentation with recorded umbilical artery cord pH were considered. Neonatal outcomes were assessed based on umbilical cord artery pH, Apgar ≤7 at 5 min and unexpected admission to the neonatal unit. Intrapartum pyrexia, presence of meconium-stained amniotic fluid and mode of delivery were also recorded. Results A total of 684 cases were analyzed. Absence of cycling from the beginning of the intrapartum CTG recording was noted in 5% of cases. Cases with no cycling were more likely to have maternal pyrexia (≥37.8 °C) (p = .006) and Apgars ≤7 at 5 min (p = .04). There was an association between increasing baseline fetal heart rate and the proportion of cases with no cycling. There was no significant difference between the two groups with regard to the mode of delivery or umbilical cord arterial pH <7.05 (p = .53). Conclusion Absence of cycling is associated with intrapartum maternal pyrexia and fetuses with the absence of cycling are more likely to have poorer perinatal outcomes measured by Apgar ≤ 7 at 5 min, despite no association with fetal acidosis. Results from this research were presented at the XXVI European Congress of Perinatal Medicine in September 2018.

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)

Interleukin-6 as a Biomarker of Early-Onset Neonatal Sepsis.

The aim of this study is to determine the utility of C reactive protein (CRP) and interleukin (IL)-6 in the diagnosis of neonatal sepsis (NS) in a neonatal intensive care unit (NICU) in the south of Colombia. A nonmatched case-control study was conducted. Convenience sampling was performed. Data were obtained from clinical records. IL-6 levels were determined using enzyme-linked immunosorbent assay. Receiver operator characteristic (ROC) curve analysis and Youden's index were used to determine the optimal cutoffs for CRP and IL-6 levels in diagnosing NS, early-onset NS (EONS), and late-onset NS (LONS). Data from 31 cases and 62 controls were included. History of chorioamnionitis (infinite odds ratio [OR] [3.07-infinity]), and the presence of meconium-stained amniotic fluid during birth (OR: 9.04 [1.35-112]) were identified as risk factors for NS. Differences in CRP (p < 0.0001) and IL-6 (p < 0.0485) levels were also found, more significantly for LONS and EONS patients, respectively. In the diagnosis of LONS using CRP levels, the area under the ROC curve (AUC) was 0.8371 (p < 0.0001). The optimal cutoff was 0.53 mg/dL. For EONS diagnosis using IL-6, the AUC was 0.6869 (p = 0.0315) and the optimal cutoff was 17.75 pg/mL. Differences between CRP and IL-6 levels were found between control and NS groups. Furthermore, CRP showed greater potential diagnostic utility in the LONS group, whereas IL-6 showed greater potential utility in the EONS group. · NS is a major morbimortality cause worldwide. · CRP and IL-6 levels may be useful NS biomarkers. · No biomarker alone is enough for the diagnosis of NS.

The Role of Brain-Derived Neurotrophic Factor and Glial Cell Line-Derived Neurotrophic Factor in Chronic Fetal Oxygen Deprivation.

The aim of the study was to define the role of brain-derived and glial cell line-derived neurotrophic factors (BDNF and GDNF) in realization of compensative and adaptive mechanisms of a neonatal organism to hypoxia.Materials and MethodsThe experiments in vivo have been carried out on pregnant C57BL/6 mice (n=36). Chronic hypobaric hypoxia has been modeled in different pregnancy trimesters. On gestation days E19–20, concentration of BDNF and GDNF in the blood of the pregnant females was determined by enzyme immunoassay. Further, the number of neonatal mice, their weight and body length parameters have been assessed.Parturient mothers (n=88) and their newborn babies followed up at the Clinic of Obstetrics and Gynecology of Pavlov University took part in the clinical investigations. Concentration of BDNF, GDNF, neuron-specific enolase (NSE), and hypoxia-inducible factor (HIF-1β) in the fetal cord blood has been determined by ELISA. The obtained data were retrospectively compared with cardiotocography, dopplerometry, presence of meconium-stained amniotic fluid and the neonate state at birth, assessment according to the Apgar score, and the course of adaptation period.ResultsChronic hypobaric hypoxia in pregnant mice in trimester I and II resulted in the significant decrease of BDNF and GDNF level, decrease in the number of embryos, and in significant changes in weight/height characteristics of the newborn pups.According to the clinical observations, an increased expression of the neurotrophic factors BDNF, GDNF provides protection to a neonate even if hypoxia factors are present and realized. A low content of BDNF and GDNF was observed in the group of infants with a high risk of developing unfavorable hypoxic damaging effects.ConclusionThe protective role of BDNF and GDNF in the regulation of fetal homeostasis in chronic hypoxia has been established experimentally and clinically.

Predictors of early-onset neonatal sepsis or death among newborns born at

To develop a predictive model for early-onset neonatal sepsis or death among infants born at less than 32 weeks of gestation. This was a case-control study of all deliveries <32 weeks between 2011 and 2015 in a single tertiary care center. Cases were defined as neonates diagnosed with early-onset sepsis based on a blood or cerebrospinal fluid culture or neonates who expired during the first week of life. Controls consisted of neonates without these outcomes. Variables previously identified to be associated with neonatal sepsis or death were abstracted from the medical record. Bivariable analyses and multivariable logistic regression were used to determine independent risk factors for early-onset neonatal sepsis or death. An ROC curve was created and AUC calculated to estimate the predictive capacity of these associations. Of 779 eligible neonates, early-onset neonatal sepsis or death occurred in 73 (9.4%). In bivariable analyses, mothers whose neonates were diagnosed with early-onset sepsis or death were more likely to be obese, have an intrapartum fever, and have meconium-stained amniotic fluid, and were less likely to have received betamethasone or antepartum/intrapartum antibiotics. Gestational age at delivery and birth weight was significantly lower among neonates diagnosed with neonatal sepsis or death. In multivariable analyses, factors remaining independently associated with neonatal sepsis or death were earlier gestational age at the time of delivery (specifically <28 weeks), intrapartum fever, presence of meconium-stained amniotic fluid, and lower birth weight. The AUC for this regression was 0.81 (95% confidence interval 0.77-0.83). Earlier gestational age at the time of delivery, intrapartum fever, meconium, and lower birth weight areindependently associated with early-onset neonatal sepsis or death among deliveries occurring at <32 weeks of gestation; these factors can be used to create a model with fair predictive capability.

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.

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)

Appropriate Management of the Nonvigorous Meconium-Stained Neonate: An Unanswered Question.

* Abbreviations: ILCOR — : International Liaison Committee on Resuscitation MAS — : meconium aspiration syndrome MSAF — : meconium-stained amniotic fluid RCT — : randomized controlled trial In this issue of Pediatrics , Chiruvolu et al1 compare outcomes in infants who are nonvigorous and meconium stained from before and after a recent recommendation was made not to routinely intubate and suction such infants. They found that not performing this procedure resulted in significantly more NICU respiratory admissions as well as an increased requirement for oxygen, mechanical ventilation, and surfactant therapy. Of infants diagnosed with meconium aspiration syndrome (MAS), infants who were not intubated had longer durations of oxygen and mechanical ventilation and longer lengths of stay. Was the recommended management change made too hastily? The presence of meconium-stained amniotic fluid (MSAF) is associated with adverse outcomes.2 Approximately 10% to 15% of all newborns are born through MSAF, with 3% to 9% of them developing MAS and other respiratory disorders. Approximately 20% of infants born through MSAF are nonvigorous and are considerably more likely to have respiratory distress and adverse outcomes. Of term infants admitted to NICUs, 4% to 5% have MAS.3 In 1960, routine intubation and suctioning of neonates born through MSAF was first suggested.4 Three reports published in the mid-1970s revealed better outcomes among infants born through MSAF who had this intervention.5–7 Subsequently, the procedure was widely practiced. In a review … Address correspondence to Thomas E. Wiswell, MD, 2623 Lower Kula Rd, Kula, HI 96790. E-mail: Thomas.E.Wiswell{at}kp.org