Presence Of Meconium Research Articles

Case Report: Newborn with Anorectal Malformation

Anorectal malformations are defined by the relationship of the rectum to the sphincter complex and can be classified as high and low anomaly based on whether meconium is present or absent, presence of dimple, anocutaneous reflex, sacral abnormality or presence of meconium in urine. The diagnosis should be made in the delivery room by inspecting the perineum. Meconuria with absence of anal opening invariably indicates a high malformation which requires a colostomy in the newborn period. Low malformations do not become evident until 24 hours when the meconium may show up in the perineal fistula. These defects can be managed by a perineal anoplasty without a colostomy in the newborn period. A prone cross table lateral shoot abdominal film is required if clinical information at 24 hours is insufficient to decide whether a colostomy is needed. We present a case of newborn, day 4 of life, who did not pass meconium since birth, had abdominal distension, vomiting, poor feeding and lethargy since last 2 days. Anal area showed pigmentation with presence of median raphe, anal dimple and slightly formed anal opening. Baby was initially thought as a case of low type imperforate anus. On further evaluation, was found to have meconuria too. Invertogram done showed high type defect. Rest of the examination was normal. Supportive therapy was initiated and baby underwent transverse loop colostomy for high type imperforate anus on day 5 of life. So it is always advisable to confirm the type of anorectal malformation both clinically and by doing required investigation before deciding for any operative intervention like colostomy or anoplasty, as clinical examination and investigation may not correlate in all occasions. Evaluation should also include screening out for associations and other sacral anomalies. BJHS 2018;3(2)6: 500-503.

Study of outcome of meconium stained amniotic fluid in newborn

Background: The presence of meconium stained amniotic fluid (MSAF) is a serious sign of fetal compromise, which is associated with an increase in perinatal morbidity, clear amniotic fluid on the other hand is considered reassuring. A study by Mathews and Warshaw found that in 98.4% of cases with meconium stained liquor, the neonates were admitted to the neonatal intensive care units, these were delivered at 37 weeks of gestational age or later as it shows maturation of autonomic nervous system. MSAF occurs in 10% of pregnancies with most occurring at term or particularly post term. The purpose of this study was to evaluate the effect of clear liquor and meconium stained liquor on time and mode of delivery and to find out neonatal morbidity and mortality associated with meconium stained amniotic fluid.

Clarity for Improving Standardized Obstetrician-Neonatologist Neonatal Handoffs [33Q

INTRODUCTION: There are currently no standardized methods of handoff between Labor & Delivery (L&D) and Neonatology teams for neonatology-attended deliveries. Communication breakdown occurs in approximately 70% of sentinel events resulting in perinatal mortality or permanent disability. Barriers to effective patient handoffs include confusion over role clarity, transferring unnecessary information, time constraints, and room volume. Standard communication in the delivery room could reduce communication variability and promote safer care. Our goal was to evaluate if standardized handoffs between the L&D and Neonatology teams in unplanned neonatology-attended cesarean deliveries would result in more complete and efficient transfer of critical patient information. METHODS: Members of the L&D and Neonatology teams were surveyed to determine critical areas of patient handoff in neonatology attended cesarean deliveries. Survey results were utilized to determine areas that required change for subsequent Plan-Do-Study-Act worksheets. Reliability of the process was assessed by Neonatology response respiratory therapists who submitted a separate observational survey. RESULTS: Over a 3 month period, 38 deliveries were assessed. The following transfer of critical information was identified: Obstetrician to Neonatologist - gestational age, single versus multiple gestation, presence of meconium, fetal heart rate abnormalities, fetal anomalies, and reason for the call. Whereas Neonatologist to Obstetrician - APGAR score, gender, birth weight, resuscitative measures, and disposition of infant. Both the L&D and Neonatology teams reported that a streamlined handoff process improved workflow and team satisfaction (15 and 16% positive increase, respectively). CONCLUSION: Standardization of handoffs and role identification improve communication of critical information between L&D and Neonatology teams.

Trial of labor following one previous cesarean delivery: the effect of gestational age.

To stratify maternal and neonatal outcomes of trials of labor after previous cesarean delivery (TOLAC) by gestational age. Retrospective cohort study of all singleton pregnancies with one previous cesarean delivery in TOLAC at term between 2007 and 2014. We compared outcomes of delivery at an index gestational week, with outcomes of women who remained undelivered at this index gestational week (ongoing pregnancy). Odds ratios and 95% confidence intervals were adjusted for maternal age, previous vaginal delivery, induction of labor, epidural use, presence of meconium, and birth weight>4000g. Overall, 2849 women were eligible for analysis. Of those, 2584 (90.7%) had a successful TOLAC and 16 women (0.56%) had uterine rupture. Those rates did not differ significantly for any gestational age (GA) group. Following adjustment for possible confounders, GA was not found to be independently associated with adverse maternal or neonatal outcomes. Among women at term with a single previous cesarean delivery, GA at delivery was not found to be an independent risk factor for TOLAC success or uterine rupture. We suggest that GA by itself will not serve as an argument for or against TOLAC.

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.

Highlights on MRI of the fetal body.

Fetal MRI is a level III diagnostic tool performed subsequently a level II prenatal ultrasound (US), in cases of inconclusive ultrasonographic diagnosis or when a further investigation is required to confirm or improve the diagnosis, to plan an appropriate pregnancy management. Fetal MRI plays an increasingly important role in the prenatal diagnosis of fetal neck, chest and abdominal malformations, even if its role has been amply demonstrated, especially, in the field of fetal CNS anomalies. Due to its multiparametricity and multiplanarity, MRI provides a detailed evaluation of the whole fetal respiratory, gastrointestinal and genitourinary systems, especially on T2-weighted (W) images, with a good tissue contrast resolution. In the evaluation of the digestive tract, T1-W sequences are very important in relation to the typical hyperintensity of the large intestine, due to the presence of meconium. The objective of this review is to focus on the application of fetal MRI in neck, chest and abdominal diseases.

Risk of operative delivery for intrapartum fetal compromise in small-for-gestational-age fetuses at term: an internally validated prediction model

Small-for-gestational-age fetuses are at an increased risk of intrapartum fetal compromise requiring operative delivery. Factors associated with the risk of intrapartum fetal compromise are yet to be established, and a comprehensive model accounting for both the antenatal and intrapartum variables is lacking. We aimed to develop and validate a predictive model for the risk of operative delivery for presumed intrapartum fetal compromise in fetuses suspected to be small for gestational age at term. This was a single-center cohort study of small-for-gestational-age fetuses, defined as estimated fetal weight below the 10th centile in singleton pregnancies at term. The variables included known risk factors for operative delivery because of fetal compromise: maternal characteristics, estimated fetal weight, abdominal circumference, Doppler parameters, gestational age at delivery, induction of labor, and intrapartum risk factors (presence of meconium, augmentation of labor using oxytocin, the use of epidural analgesia, intrapartum pyrexia, and hemorrhage). The receiver-operating characteristics curve analysis was used to investigate the predictive accuracy. Internal validation of the models was performed with bootstrapped data sets. A total of 927 term pregnancies with 18.7% operative deliveries were included. The antenatal model (area under the curve, 0.69; 95% confidence interval, 0.65-0.73) using only the antenatal risk factors included parity, abdominal circumference centile, gestational age at delivery beyond 39 weeks' gestation, and the cerebroplacental ratio multiples of median. The combined model (area under the curve, 0.76; 95% confidence interval, 0.72-0.80), using both the antenatal and intrapartum risk factors, included the gestational age at delivery beyond 39 weeks' gestation (odds ratio, 1.62; 95% confidence interval, 1.14-2.56), the cerebroplacental ratio multiples of median (odds ratio, 0.38; 95% confidence interval, 0.18-0.79), parity (odds ratio 0.35; 95% confidence interval, 0.22-0.54), induction of labor (odds ratio 1.63; 95% confidence interval, 1.11-2.40), augmentation using oxytocin (odds ratio, 1.84; 95% confidence interval, 1.23-2.73) and the use of epidural analgesia (odds ratio, 2.80; 95% confidence interval, 1.94-4.04). The results indicate that the model has good discrimination and, according to the Hosmer-Lemeshow test, has good fit (P= .591). The prediction model demonstrates 6 important risk factors that are associated with the risk of operative delivery for fetal compromise in small-for-gestational-age fetuses at term. The model shows good discrimination and fit and has the potential to be used for clinical decision making and to counsel women about their individual intrapartum risk.

The effect of meconium exposure on the expression and differentiation of amniotic fluid mesenchymal stem cells.

BACKGROUND:The goal of this study was to determine if exposure to meconium would alter the phenotype of amniotic fluid mesenchymal stem cells (AF-MSCs) and the ability of these cells to be differentiated into distal airway type cells.METHODS:Meconium was collected, lyophilized and resuspended in PBS at 3 different concentrations (high, medium, and low). AF-MSCs were cultured in the presence of this meconium suspension for 8 hours and then analyzed for changes in gene expression. Additionally, AF-MSCs exposed to meconium were differentiated for 14 days using modified small airway growth medium (mSAGM) and gene expression was determined. As a spontaneous differentiation control, meconium exposed AF-MSCs were cultured in amniotic fluid stem cell medium (AF medium).RESULTS:After 8 hours of exposure in culture, AF-MSCs had increased expression of distal airway genes aquaporin 5 (AQP5) and surfactant protein c (SPC) when cultured in AF medium containing meconium. These gene expression levels were similar to that of AF-MSCs that were differentiated in mSAGM for 14 days. Furthermore, there was an up regulation of pluripotency genes NANOG and OCT4 in response to low meconium concentration for 8 hours. Following 14 days of culture in mSAGM, there was an upregulation of TTF1, SPC and AQP5 expression in the control, as well as in the low and medium meconium exposed groups indicating that these cells were still able to be differentiated. High meconium concentration did, however, appear to influence the level of distal airway gene expression after 14 days in mSAGM. After 14 days in AF medium, there was significant downregulation in pluripotency and mesenchymal markers as well as distal airway gene expression in all groups.CONCLUSION:The phenotype of AF-MSCs is modulated by meconium exposure; however, the cells were still able to differentiate into distal airway gene and protein expression. This result supports the hypothesis that progenitor cells exist in the amniotic fluid and the presence of meconium may affect their initial phenotype. However, these cells were still able to be differentiated to a distal lung phenotype.

Effects of pushing techniques during the second stage of labor: A randomized controlled trial

ObjectiveSpontaneous pushing is a method that is used in the management of the second stage of labor and suggested to be more physiological for the mother and infant. The present study aims to evaluate the effects of pushing techniques on the mother and newborn. Materials and methodsThis randomized prospective study was performed between June 2013–March 2014 in a tertiary maternity clinic in Istanbul. 80 low risk, nulliparous cases were randomized to pushing groups. Valsalva pushing group was told to hold their breath while pushing. No visual-verbal instructions were given to spontaneous pushing group and they were encouraged to push without preventing respiration. Demographic data, second stage period, perineal laceration rates, fetal heart rate patterns, presence of meconium stained amniotic liquid, newborn APGAR scores, POP-Q examination and Q-tip test results were evaluated in these cases. ResultsThe second stage of labor was significantly longer with spontaneous pushing. Decrease in Hb levels in valsalva pushing group was determined to be higher than spontaneous pushing group. An increased urethral mobility was observed in valsalva pushing group. ConclusionsAlthough the duration of the second stage of labor was longer compared to valsalva pushing technique, women were able to give birth without requiring any verbal or visual instruction, without exceeding the limit value of two hours and without affecting fetal wellness and neonatal results.

Proportion and factors associated with low fifth minute Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia.

New born babies with low Apgar scores are at an increased risk of perinatal morbidity and mortality. To assess proportion and factors associated with low 5th minute Apgar Apgar score among singleton newborn babies in Gondar University referral hospital; North West Ethiopia. A cross-sectional study was conducted on singleton 261 live births from March - May, 2013. Data was collected from mother/newborn index using a structured and pre-tested questionnaire. It was then cleaned, coded and entered using EPI INFO version 3.4.3, then analyzed with IBM SPSS statistics versions 20.0. Logistic regression was used to identify significant variables with low 5th minute Apgar score. The proportion of low 5th minute Apgar score in this study was 13.8%. Factors that were significantly associated with low 5th minute Apgar score were: non-vertex fetal presentation, prolonged labor, presence of meconium stained liquor, induced/augmented labor and low birth weight. Mainly obstetric factors contribute to low Apgar score. Improving labor management through implementing regular use of partograph, 1:1 midwife-client ratio and advanced electronic fetal monitoring technology is recommended.

Risk Factors for Postpartum Hemorrhage Following Nulliparous Induction of Labor [3C

INTRODUCTION: Postpartum hemorrhage is the leading cause of maternal mortality worldwide. There are multiple known risk factors, including induction of labor. METHODS: A retrospective cohort study was completed with review of nulliparous women undergoing labor induction at term, from July 2006 to May 2011. Baseline maternal variables and risk factors for postpartum hemorrhage were assessed. All combinations of methods of induction were sequential rather than concurrent. The need for additional uterotonics (beyond routine oxytocin) was used as a surrogate for postpartum hemorrhage. Variables were evaluated for an association with additional uterotonic use based on fitting logistic regression models. RESULTS: A total of 785 women were included in the study. Additional uterotonics were required for 84/785 (11%) of women. Based on univariate analysis, only birth weight and presence of meconium were significantly (p &lt; 0.05) associated with additional uterotonic use, while method of induction approached statistical significance (p=0.06). The mean (SD) birth weight was 3668 (584) vs. 3463 (500) grams in those with and without additional uterotonic use. Multivariate analysis showed an increased risk of additional uterotonics with higher birth weight (adjusted odds ratio (aOR) 1.44 per 500 gram increase in birth weight; 95% CI 1.15, 1.82) and use of Foley plus oxytocin (aOR 4.40; 95% CI 1.36, 14.23). CONCLUSION: In our model, higher birth weight and induction method of Foley followed by oxytocin were associated with increased need for additional uterotonics. This data adds detail to previous studies that have broadly identified induction of labor as a risk factor for postpartum hemorrhage.

Factors affecting the rates of caesarean sections in cases with premature rupture of membranes (PROM) at term

The aim of this retrospective study was to investigate the factors affecting the rates of caesarean section in cases with premature rupture of membranes (PROM) in term pregnancies. Eighty-two term PROM patients who presented to Turgut Ozal University and Erzurum Nene Hatun Hospitals between 2012 and 2014 were included. The effects of demographics, nulliparity, active-latent phase durations, presence of meconium and chorioamnionitis, requirement of oxytocin and cervical dilation at the initial examination on C/S rates were assessed. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%. C/S rates did not change with other variables. We conclude that the factors increasing the risk for C/S in PROM at term group are not different from the non-term PROM.Impact statementThe aim of this retrospective study was to investigate the factors affecting the rates of caesarean section (C/S) in cases with premature rupture of membranes (PROM) in term pregnancies. The C/S rates were changed with the duration of active period and the duration of latent period. It was found that the presence of cervical dilation at the initial examination significantly reduced the risk for progress to C/S at a rate of 87.5%.We conclude that the factors increasing the risk for C/S in PROM at term group, are not different from the non-term PROM groups.Currently, the PROM is considered the start of a pathological process in both term and preterm pregnancies and also considered to increase the rates of caesarean sections. Studies on the management of PROM at term have concentrated rather on whether to intervene for accelerating the labour or spontaneous monitorisation. As found by the studies like this one in the literature, the factors having an impact on C/S rates in the cases of PROM at term are similar to those of non-PROM patients at term, may prevent clinicians from taking an invasive or aggressive approach towards the cases of PROM at term.

Congenital multiple arthrogryposis in bovine

ABSTRACT This report describes an anal atresia, anatomical urethra alteration (slightly caudal to the udder), thickened joints, and changes in the pelvis in a newborn Holstein cow. Visualization of the final portion of the rectum was not possible by perineal access and laparotomy through the right flank was performed in order for abdominal exploration and colostomy attempt. During the surgical procedure visceral rupture and malformations incompatible with life were observed, so surgeons opted for euthanasia and necropsy. Alterations were confirmed in the genitourinary and gastrointestinal tract. The non-formation of the anus caused dilation of the distal portion of the rectum with fecal content retention, which was drained to the body of the uterus, with the presence of meconium. This amount of anatomical and clinical changes were diagnosed as congenital multiple arthrogryposis.

Perinatal risk factors for low and moderate five-minute Apgar scores at term

ObjectiveTo evaluate the specific maternal and perinatal variables associated with a low (≤3) or moderate (4–6) Apgar score, compared to a high (≥7) score. Study designThis was a retrospective, cohort study of 58429 term singleton babies born at the Mater Mother’s Hospital in Brisbane, Australia in 2007–2013. Maternal demographics, socio-economic status using the Australian Socioeconomic Index for Areas (SEIFA) score, obstetric factors, and birth outcomes were compared for neonates grouped into three categories based on their five-minute Apgar: low (≤3), moderate (4–6) and high (≥7). The low- and moderate-score cohorts were individually compared to the high-score cohort using both univariate and multivariate analysis. ResultsLogistic regression analysis confirmed that of the variables analysed, only maternal public insurance status (OR 2.1, 95% CI 1.5–3.1), breech presentation (OR 2.4, 95% CI 1.1–4.6), other non-cephalic presentation (OR 9.5, 95% CI 2.2–25.4), intramuscular narcotic use (OR 2.3, 95% CI 1.5–3.5), and presence of meconium (OR 3.7, 95% CI 2.5–5.4) were significantly associated with low Apgar scores. Variables significantly associated with a moderate score were: SEIFA ≤50th centile (OR 1.6, 95% CI 1.2–2.0) and 61st to 70th centile (OR 1.31, 95% CI 0.9–1.8) categories, maternal public insurance status (OR 2.7, 95% CI 2.2–3.3), nulliparity (OR 2.0, 95% CI 1.7–2.5), emergency caesarean birth (OR 2.6, 95% CI 2.1–3.2), instrumental birth (OR 2.3, 95% CI 1.9–2.9), and presence of meconium (OR 2.6, 95% CI 2.1–3.2). ConclusionsFactors associated with low and moderate Apgar scores vary in type and degree of influence. Distinctions in the perinatal background can help predict newborn compromise and accelerate delivery of care.

Why do multiparous women with a history of vaginal delivery give birth by cesarean section?

A cesarean section (C-section) is performed to deliver a baby through the mother's abdomen. In recent years, the rate of incidences requiring a C-section is steadily increasing all over the world. Advanced maternal age, chronic health problems, multiple pregnancies as a result of the development of assisted reproductive technologies, and an insufficient supplementary health network can be considered as the reasons why mothers and obstetricians prefer a C-section. Our study aimed to identify the risk factors for the need of C-section in women with a history of vaginal delivery. 238 multiparous women with a history of vaginal birth at 37-42 gestational weeks were enrolled in our study. 110 women had underwent C-section. Control group was chosen randomly from women giving birth by vaginal route. Overall, 238 multiparous women with a history of vaginal delivery at 37-42 gestational weeks were enrolled in our study. The history of operative delivery, that of labor induction and presence of meconium and the indication of admission to the delivery room were different between groups. A lower Bishop score and biophysical profile, smaller gestational period, and lower birth weight were associated with the group requiring a C-section, whereas older age and a long time interval from the previous birth were associated with the group not requiring a C-section. A strategy involving either labor induction or not could be individualized for each patient to eliminate the risk factors for adverse outcomes. To identify criteria for the standardization of labor management, further studies are needed.

Evaluation of neuro-developmental outcome among babies with meconium aspiration syndrome

Background: Meconium aspiration syndrome (MAS) is respiratory distress in a neonates caused by the presence of meconium in the tracheobronchial airways. Despite adequate management, there is a high risk of morbidity in the form of seizures, cerebral palsy, mental retardation, respiratory problems of childhood and mortality. Hence, this study was performed in view of developmental issues concerning young infants and pre-school children as maximum brain growth happens in the first three years of life. Methods: This was a prospective study conducted in Chandulal Chandrakar memorial hospital, Bhilai from 1 st September 2013 to 31 st February 2015, with history of meconium stained amniotic fluid (MSAF) in both out-born and in-born neonates. Neonates after meeting inclusion criteria were included in the study. The data were recorded in pre-designed proforma. The data were analyzed using appropriate Chi square test. Level of significance was set at p 2.5 kgs (80%) and common in primiparous mothers (60%) with lower segmental caesarian sections. MAS commonly seen in post -term babies (53.33%) than those of term (36.66%) or pre-term (10%) gestation. Fetal distress was the common complication observed in most of the cases (91.1%) and one death related to this was noted. At the end of 1 year there were predominantly more children (40%) who developed respiratory morbidities. Delayed development was seen among 13.3% children, transient tone abnormalities were noted in about 2% of infants. Conclusions: The findings of the present study suggest that neonates diagnosed with MAS displayed neuro-developmental delay in13% cases. This study gave an overview of all meconium aspiration cases and the neuro-developmental outcome in these babies. However further research should be done with large sample size to confirm these findings.

Advanced Maternal Weight

Maternal obesity has emerged as a major public health problem in developed, as well as developing countries and the incidence at the start of pregnancy is increasing worldwide. Pregnancy with obesity is high risk, and it causes substantial feto-maternal morbidity and mortality. Obesity during pregnancy is defined as a Body Mass Index (BMI) of 30 kg/m2 or more calculated using the height and weight measured at the first antenatal consultation. Pre-pregnancy BMI defines their commended individual gestational weight gain and the Institute of Medicine recently modified their guidelines in regards to healthy weight gain during pregnancy. In India, more than 15% of women are either overweight or obese whereas only one tenth of men report this health condition. The risk factors are overweight or obese during childhood, increased intake of refined carbohydrates, decreased intake of fresh fruits and vegetables and physical activity, low socioeconomic status, urbanization and an unhealthy, energy-dense diet, as well as changing lifestyles, are root causes contributing to obesity. Obesity caused by multifactorial interactions between genetic and environmental factors. Obese women successful at conceiving is at an increased risk for several pregnancy-related complications like increased risk of gestational diabetes, hypertensive disorders, preeclampsia, blood clots, infections, and preterm delivery. Even sensitive and mindful psychological approach is necessary and mandatory as a part of management. Obese mothers are at higher risk for perinatal complications including stillbirth, neonatal death, low Apgar scores, fetal distress, macrosomia, presence of meconium, shoulder dystocia, neural tube defects such as spinabifida and congenital anomalies. Postpartum weight retention leads to postpartum maternal obesity and greater increases in body weight before subsequent pregnancies and contributes to intergenerational cycle of obesity. Variety of health risks for the fetus and infant occurs more likely to be large for gestational age. Maternal obesity can be successfully managed by regular physical activity, dietary supplementation, calorie restriction, and at last pharmacological intervention.

The Effect of Ethnic Variation on the Success of Induced Labour in Nulliparous Women with Postdates Pregnancies.

Objective. To identify the potential effect of ethnic variation on the success of induction of labour in nulliparous women with postdates pregnancies. Study Design. This was an observational cohort study of women being induced for postdates pregnancies (≥41 weeks) between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify the effect of ethnicity on the caesarean section (CS) delivery rates in this cohort of women. Results. 1,636 nulliparous women were identified with a mean age of 27.2 years. 95.8% of the women were of White ethnic origin, 2.6% were Asian, and 1.6% were of Black ethnic origin. The CS delivery rate was 24.4% in the total sample. Women of Black ethnic origin had a 3.26 times greater likelihood for CS in comparison to White women, after adjusting for maternal age, BMI, smoking, presence of meconium, use of epidural analgesia, fetal gender, birth weight, and head circumference (adjusted OR = 3.26; 95% CI: 1.31–8.08, p = 0.011). Conclusion. We have found that nulliparous women of Black ethnicity demonstrate an almost threefold increased risk of caesarean section delivery when induced for postdates pregnancy.

Determination of antepartum and intrapartum risk factors associated with neonatal intensive care unit admission.

To determine antepartum and intrapartum factors that are associated with admission to neonatal intensive care unit (NICU) among infants delivered between 36.0 and 42.0 weeks at our institution. The retrospective cohort study included 73 consecutive NICU admissions and 375 consecutive non-NICU admissions. Data on demographic, antepartum, intrapartum and neonatal factors were collected. The primary endpoint defined was admission to NICU. Univariate analyses using the Student's t-test, Mann-Whitney U-test, χ2 Fisher's exact test was performed along with multivariate analysis of significant non-redundant variables. Those with a significantly higher risk of NICU admission underwent induction of labor with prostaglandin analogs (12.5% vs. 24.7%, P=0.007). Length of first stage ≥720 min (33.5% vs. 51.9%, P=0.011), length of second stage of labor ≥240 min (10.6% vs. 31.6%, P<0.001) and prolonged rupture of membranes ≥120 min (54.0% vs. 80.0%, P=0.001) were all associated with an increased chance of NICU admission. Intrapartum factors predictive of NICU admission included administration of meperidine (11.7% vs. 27.4%, P<0.001), presence of preeclampsia (5.5% vs. 0.8%, P=0.015), use of intrapartum IV antihypertensives (1.1% vs. 13.7%, P<0.001), maternal fever (5.3% vs. 31.5%, P<0.001), fetal tachycardia (1.9% vs. 12.3%, P<0.001), and presence of meconium (30% vs. 8%, P<0.001). Identification of modifiable risk factors may reduce neonatal morbidity and mortality. Results from this study can be used to develop and validate a risk model based on combined antepartum and intrapartum risk factors.

Meconium Stained Amniotic Fluid: Factors affecting Maternal and Perinatal Outcomes at Jimma University Specialized Teaching Hospital, South West Ethiopia

Background: Meconium is not only a potential sign of fetal hypoxia but is also a potential toxin if the fetus aspirates particulate matters with a gasping breath in utero or when it takes its first breaths following birth. In addition to this the condition of the mother who gives birth in such circumstances is a concern. Methods: A hospital based cross-sectional descriptive study was carried out on labouring mothers with meconium stained amniotic fluid who delivered in the labor ward of Jimma University Specialized Hospital during October1, 2012 to December 30, 2012. All labouring mothers with meconium stained amniotic fluid (MSAF) during the study period were included. Data on history of the patient, patient specific demographics and obstetric information was collected using pretested structured questionnaire. Relevant data was abstracted from the neonatal chart and the logbook in the neonatology ward. Statistical tests of association using SPSS (version 16.0, IBM Corporation) were employed at the level of significance of 5%. Results: The overall rate of meconium stained amniotic fluid was 15.4% (151/979) and 74.8% of the cases had moderate to thick meconium stained amniotic fluid. Mode of delivery in 70.2% of cases was operative delivery; and those mothers with a grade three meconium stained liquor had about 5 times increased risk of operative delivery when compared with mothers with grade 1 staining (OR=4.66, 95%CI:1.52-14.30). First minute Apgar score was less than 7 in 88% of the new born while it was less than 4 in 15% of the cases. However, there was no statistically significant association between the thickness of meconium and low first minute Apgar score. Those babies who were delivered with operative delivery had 16 times increased risk of low 5th minute Apgar score. Among the 27.1% of new born sent to the Neonatal Intensive Care Unit, 71.4% (19.9% of the total) were diagnosed to have Meconium Aspiration Syndrome with clinical examination alone. Those new-borns with first minute Apgar score<7 had three times increased risk of MAS (95% CI: 1.087-10.668) and the presence of meconium stained secretion in the oropharynx of a new born resulted in 9 times increased risk of Meconium Aspiration Syndrome. Conclusion: The study revealed that Moderate to thick meconium stained amniotic fluid was associated with increased risk of operative delivery, low 5th minute Apgar score and Meconium Aspiration Syndrome. Shortening the threshold for intervention for labor with fetal heart rate abnormalities in the presence of meconium stained amniotic fluid and introducing further fetal evaluation methods like fetal scalp PH analysis are recommended.