Rate Of Meconium-stained Amniotic Fluid Research Articles

Maternal and Perinatal Outcome After Induction of Labor Versus Expectant Management in Low-risk Pregnancies Beyond Term.

Due to still controversial discussion regarding appropriate termination of low-risk singleton pregnancies beyond term, this retrospective study aimed to evaluate maternal and perinatal outcomes depending on gestational age and obstetric management. This is a retrospective cohort analysis including 3.242 low-risk singleton deliveries at the Department of Obstetrics of the University Hospital of Cologne between 2017 and 2022. According to current national guidelines, the cohort was subdivided into three gestational groups, group 1: 40+0-40+6 weeks, group 2: 40+7-40+10 weeks and group 3>40+10 weeks. In our cohort, advanced gestational age was associated with higher rates of secondary caesarean sections, lower rates of spontaneous vaginal deliveries, higher rates of meconium-stained amniotic fluid and depressed neonates with APGAR < 7 after 5 min. Analyzing obstetric management, induction of labor significantly increased the rate of secondary sections and reduced the rate of spontaneous deliveries, while the percentage of assistant vaginal deliveries was independent from obstetric management and gestational age. Induction of labor also significantly enhanced the need for tocolytic subpartu and epidural anesthesia and caused higher rates of abnormalities in cardiotocography (CTG), which also resulted in more frequent fetal scalp blood testing; however, the rate of fetal acidosis was independent of both obstetric management and gestational age. Our study supports expectant management of low-risk pregnancies beyond term, as induction of labor increased the rate of secondary sections and did not improve perinatal outcome.

Cervical Osmotic Dilators versus Dinoprostone for Cervical Ripening during Labor Induction: A Systematic Review and Meta-analysis of 14 Controlled Trials.

This study aimed to conduct a systematic review and meta-analysis of all randomized and nonrandomized controlled trials (RCTs and NCTs, respectively) that explored the maternal-neonatal outcomes of cervical osmotic dilators versus dinoprostone in promoting cervical ripening during labor induction. Six major databases were screened until August 27, 2022. The quality of included studies was evaluated. The data were summarized as mean difference or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model. Overall, 14 studies with 15 arms were analyzed (n = 2,380 patients). Ten and four studies were RCTs and NCTs, respectively. The overall quality for RCTs varied (low risk n = 2, unclear risk n = 7, and high risk n = 1), whereas all NCTs had good quality (n = 4). For the primary endpoints, there was no significant difference between both groups regarding the rate of normal vaginal delivery (RR = 1.04, 95% CI: 0.95-1.14, p = 0.41) and rate of cesarean delivery (RR = 1.04, 95% CI: 0.93-1.17, p = 0.51). Additionally, there was no significant difference between both groups regarding the mean change in Bishop score and mean time from intervention to delivery. The rate of uterine hyperstimulation was significantly lower in the cervical osmotic dilator group. For the neonatal outcomes, during cervical ripening, the rate of fetal distress was significantly lower in the cervical osmotic dilator group. There was no significant difference between both groups regarding the mean Apgar scores, rate of meconium-stained amniotic fluid, rate of umbilical cord metabolic acidosis, rate of neonatal infection, and rate of neonatal intensive care unit admission. During labor induction, cervical ripening with cervical osmotic dilators and dinoprostone had comparable maternal-neonatal outcomes. Cervical osmotic dilators had low risk of uterine hyperstimulation compared with dinoprostone. Overall, cervical osmotic dilators might be more preferred over dinoprostone in view of their analogous cervical ripening effects, comparable maternal-neonatal outcomes, and lack of drug-related adverse events. · This is the first analysis of cervical osmotic dilators versus PGE2 for cervical ripening during labor.. · There was no difference between both arms regarding the rates of normal vaginal/cesarean deliveries.. · There was no difference between both arms regarding the rates of neonatal adverse events.. · Cervical osmotic dilators had significant lower risk of uterine hyperstimulation compared with PGE2.. · Cervical osmotic dilators may be superior to PGE2 in view of their similar efficacy and better safety..

The association between increased subjective sensation of fetal movements and pregnancy outcome–a prospective cohort and a retrospective comparative analysis

Objective To determine pregnancy outcomes in women with subjective sensation of increased fetal movements (IFM). Methods A prospective cohort study of women after 20 weeks of gestation who were referred with subjective sensation of IFM (April 2018–April 2019) for assessment. Pregnancy outcome was compared to pregnancies with a normal sensation of fetal movements all through pregnancy who underwent obstetrical assessment at term (37–41 weeks of gestation) matched by maternal age and pre-pregnancy BMI in a 1:2 ratio. Results Overall, out of 28,028 women referred to the maternity ward during the study period, 153 (0.54%) presented due to subjective sensation of IFM. The latter mainly occurred during the 3rd trimester (89.5%). Primiparity was significantly more prevalent in the study group (75.5% vs. 51.5%, p = .002). The study group had increased rates of operative vaginal deliveries and cesarean section (CS) due to non-reassuring fetal heart rate (15.1% vs. 8.7%, p = .048). Multivariate regression analysis showed that IFM was not associated with NRFHR affecting the mode of delivery (OR 1.1, CI 0.55 − 2.19), opposed to other variables such as primiparity (OR 11.08, CI 3.21–38.28) and induction of labor (OR 2.46, CI 1.18–5.15). There were no differences in the rates of meconium-stained amniotic fluid, 5 min Apgar score, birth weight, or rates of large/small for gestational-age newborns. Conclusion Subjective sensation of IFM is not associated with adverse pregnancy outcomes.

The impact of assisted reproductive technology in twin pregnancies complicated by intrahepatic cholestasis: a five-year retrospective study

BackgroundIntrahepatic cholestasis of pregnancy is one of the common complications during pregnancy, and ursodeoxycholic acid has been recommended as the first-line drug. However, if the assisted reproductive technology may increase adverse perinatal outcomes of twin pregnancies complicated by intrahepatic cholestasis is disputed, we aimed to investigate perinatal outcomes between twin pregnancies by assisted reproductive technology versus spontaneous conception, based on these women accepted ursodeoxycholic acid treatment.MethodsFrom January 2014 to January 2019, we retrospectively analysed the clinical data of twin pregnant women with intrahepatic cholestasis, excluding those who did not receive ursodeoxycholic acid treatment. In total, 864 women were included, among whom 500 conceived by assisted reproductive technology and 364 conceived by spontaneous conception. The primary assessment for perinatal outcomes included premature birth, meconium-stained amniotic fluid, low Apgar score, neonatal intensive care unit and still birth, and secondary indicators were serum bile acid and liver enzymes level during medication, so we also finished subgroup analysis based on different elevated bile acid level and drug usage. The statistical analysis was performed by SPSS 22.0.ResultsThe study demonstrated that compared to spontaneous conception, assisted reproductive technology conceived twin pregnancies diagnosed as intrahepatic cholestasis earlier (p = 0.003), and lower birth weight (p = 0.001), less incidence of preterm delivery (p = 0.000) and neonatal intensive care unit admission (p = 0.001), but the rate of meconium-stained amniotic fluid, low Apgar score and still birth have no statistic differences. Moreover, the subgroup analysis showed no significant difference in elevated bile acid levels and medication between assisted reproductive technology and spontaneous conception groups.ConclusionsThe assisted reproductive technology may increase the risk of early-onset intrahepatic cholestasis in twin pregnancies, but it does not seem to increase adverse effects on bile acid levels and perinatal outcomes. Regardless of ursodeoxycholic acid used alone or combination, the effect of bile acid reduction and improving perinatal outcomes in twin pregnancies is limited. Our conclusions still need more prospective randomized controlled studies to confirm.

458 Maternal passive-smoking during pregnancy. the effect on pregnancy outcomes and placental-pathology. A prospective case-control study

The effect of maternal passive smoking (MPS) during pregnancy is difficult to investigate and was poorly studied before. This study was designed to investigate the effects of MPS during pregnancy- on placental pathology and pregnancy outcomes. We performed a prospective case-control study. We recruited low-risk laboring women at 37+0 to 41+0 weeks between 9/2019-7/2020. MPS was defined as exposure to a spouse that reported in-house tobacco smoking of > 20 cigarettes/day in the absence of maternal active smoking. In an attempt to "purify" the effect of MPS - we excluded cases with preeclampsia, diabetes, suspected fetal growth restriction (FGR), preterm labor, and illicit drug use. Maternal characteristics, pregnancy outcomes, and placental pathology were compared between the MPS group and a control group matched for gestational age, maternal age, and delivery date. Placental lesions were classified according to “Amsterdam” criteria. The study was powered to detect a 33% difference in placental malperfusion lesion and was calculated as 115 cases in each group. Multivariable regression analysis was performed to identify independent associations with placental malperfusion lesions. In labor, the MPS group (n=115) had higher rates of meconium-stained amniotic fluid (MSAF, p<0.001) and non-reassuring fetal heart rate (NRFHR) that necessitated immediate delivery (p=0.03), compared to controls (n=115). Neonates in the MPS group had higher rates of undiagnosed FGR (p=0.01) and NICU admissions (p=0.004). In placental pathology, the MPS group had higher rates of placental hypoplasia (p=0.02) and fetal vascular malperfusion (FVM) lesions (p=0.04). In regression analysis MPS was associated with FVM lesions independent of background confounders (aOR=2.3 95% CI 1.26-6.34). In otherwise low-risk pregnancies, MPS was associated with higher rates of MSAF, NRFHR, undiagnosed FGR, and NICU admissions, probably mediated via placental FVM. These worrisome findings mandate patient counseling and further investigation in larger population-based studies.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Echogenic particles in the amniotic fluid of term low-risk pregnant women: does it have a clinical significance?

In this study, we aimed to analyse the clinical features of the third-trimester pregnant women, with echogenic amniotic fluid and to compare their obstetric and neonatal outcomes with pregnant women with normal amniotic fluid echogenicity. This case-control study was conducted in a tertiary antenatal care centre. A total of 560 term (37–42 weeks of gestation) singleton women; 280 with echogenic particles in amniotic fluid and 280 with clear amniotic fluid, who delivered within 24 h after the ultrasound scan were evaluated. The women in the two groups were similar in terms of age, parity, body mass index, foetal birth weight, and gestational age. More patients in the particulate amnion group had lower Apgar scores (<7) in 1st and 5th minutes than controls (p = .006, p = .031 respectively) however the rate of admission to neonatal intensive care was similar. Vernix stained amniotic fluid was more common in the study group (48.8%, p = .031), the rate of meconium-stained amniotic fluid was similar in the study and control groups (9.6–9.2%, p = .881). The primary caesarean section rate was higher in women with particulate amnion (18.4%, p = .037). Echogenic particles in the amniotic fluid in the third trimester could not be attributed to meconium, however, higher rates of primary caesarean section may require further attention. IMPACT STATEMENT What is already known on this subject? Previous studies showed that high-density intra-amniotic particles were possibly related to vernix caseosa, intra-amniotic bleeding, and meconium. The number of study groups in these studies was also limited. What do the results of this study add? Additional to other previous studies, we found an increased rate of intra-amniotic echogenic particles in male foetuses. What are the implications of these findings for clinical practice and/or further research? The presence of echogenic particles on ultrasound was not related to increased risk for the presence of meconium. Significantly more neonates born to mothers with intra-amniotic echogenic particles tended to have lower Apgar scores (<7), however, this significant difference did not affect the need for NICU admission. The presence of echogenic particles in the amniotic fluid of the third-trimester pregnant women could not be attributed to meconium and adverse perinatal outcomes, however, the higher rates of primary caesarean section may require further attention.

The Impact of Assisted Reproductive Technology in Twin Pregnancies Complicated by Intrahepatic Cholestasis of Pregnancy: a Retrospective Cohort Study.

Our study aims to evaluate the perinatal outcomes in twin pregnancies diagnosed with intrahepatic cholestasis of pregnancy (ICP) and to compare these with normal healthy twin pregnancies for perinatal outcomes. The second outcome of the study was to determine whether in vitro fertilization-embryo transfer (IVF-ET) affects the perinatal outcome in ICP patients. In this study, 59 ICP and 641 healthy twin pregnancies were compared for perinatal outcomes retrospectively. According to the mode of conception, the twin pregnancies with ICP were divided into 2 groups. The twin pregnancies with ICP who were conceived with IVF were referred to as the IVF-ET group. The twin pregnancies with ICP who were conceived spontaneously or by ovulation induction and intrauterine insemination (IUI) were referred to as the non-IVF-ET group. Twin pregnancies with ICP give birth significantly earlier than normal twin pregnancies (p ˂ 0.001). The diagnosis of ICP occurred significantly earlier in the IVF-ET pregnancy with ICP than in the non-IVF-ET group. In twin pregnancies with IVF-ET, patients delivered significantly earlier than in the non-IVF-ET group (p=0.002). Twin pregnancies with ICP were found to have significantly higher rates of meconium-stained amniotic fluid, postnatal intubation, and admission to the neonatal intensive care unit (NICU) than healthy twin pregnancies. ICP is a risk factor for preterm delivery in twin pregnancies. In addition, ICP develops earlier and more frequently in twin pregnancies from IVF-ET than in those from non-IVF twin pregnancies, and the disease may be more serious.

Predictors of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy.

Our objective was to evaluate in our clinic the perinatal outcomes of patients diagnosed with ICP based on pre-treatment maternal serum bile acid levels, attempt to identify the risk group and review the literature in light of this information. In total, 370 patients diagnosed with ICP were included in the study, divided into two groups based on the fasting total serum bile acid level before UDCA (Group 1: 10 ≥ 40 μmol/L, and Group 2: ≥ 40 μmol/L). The groups were examined for clinical characteristics and pregnancy outcomes. It was found that preterm delivery and neonatal intensive care need increased at a serum bile acid cut-off value of 34 μmol/L. Regardless of serum bile acid, significantly higher rates of meconium-stained amniotic fluid and foetal distress were observed in patients whose diagnoses were made before 34 weeks of gestation. Foetal complications over 40 μmol/L of serum bile acid were significantly increased. However, slightly lower levels cut-off values (34 μmol/L) were obtained in terms of preterm birth and neonatal intensive care need. The incidence of meconium-stained amniotic fluid and foetal distress was higher in patients whose diagnosis were made before 34 weeks of gestation.

Induction of labor at full-term in pregnant women with uncomplicated singleton pregnancy: A systematic review and meta-analysis of randomized trials.

The lowest incidence of perinatal morbidity and mortality occurs around 39-40weeks. Therefore, some have advocated induction of uncomplicated singleton gestations once they reach full-term. The aim of the study was to evaluate the risk of cesarean delivery, and any maternal and perinatal effects of a policy of induction of labor in women with full-term uncomplicated singleton gestations. We performed an electronic search from inception of each database to August 2018. All results were then limited to randomized trial. No restrictions for language or geographic location were applied. Inclusion criteria were randomized clinical trials of asymptomatic women with uncomplicated, singleton gestations at full-term (ie, between 39+0 and 40+6 weeks) who were randomized to either planned induction of labor or control (ie, expectant management). Only trials on asymptomatic singleton gestations without premature rupture of membranes or any other indications for induction evaluating the effectiveness of planned induction of labor in full-term singleton gestations were included. The primary outcome was the incidence of cesarean delivery. Seven randomized clinical trials, including 7598 participants were analyzed. Three studies enrolled only women with favorable cervix, defined as a Bishop score of ≥5 in nulliparous women or ≥4 in multiparous women. One trial included only women aged 35years or older. Women randomized to the planned induction of labor, received scheduled induction usually at 39+0 to 39+6 weeks of gestation, whereas women in the control group received expectant management usually until 41-42weeks of gestation, or earlier if medically indicated. Methods of induction usually included cervical ripening, with either misoprostol or Foley catheter, in conjunction with or followed by oxytocin for women with unfavorable cervix, and oxytocin and artificial rupture of membranes for those with favorable cervix. Five trials also used artificial rupture of membranes as a method for induction. Uncomplicated full-term singleton gestations that were randomized to receive induction of labor had similar incidence of cesarean delivery compared with controls (18.6% vs 21.4%; relative risk 0.96, 95% CI 0.78-1.19). Regarding neonatal outcomes, induction of labor at full-term was associated with a significantly lower rate of meconium-stained amniotic fluid (4.0% vs 13.5%; relative risk 0.32, 95% CI 0.18-0.57), and lower mean birthweight (mean difference -98.96g, 95% CI -126.29 to -71.63) compared with the control group. There were no between-group differences in other adverse neonatal outcomes. Induction of labor at about 39weeks is not associated with increased risk of cesarean delivery.

Benefits and risks of induction of labor at 39 or more weeks in uncomplicated nulliparous women: a retrospective, observational study.

ObjectiveTo critically compare the benefits and risks of labor induction versus spontaneous labor in uncomplicated nulliparous women at 39 or more weeks of gestation.MethodsWe conducted a retrospective, observational study of 237 nulliparous women who were at 39 or more weeks of a singleton pregnancy with vertex presentation and intact membranes. We compared maternal outcomes including the Cesarean section rate and neonatal outcomes in the induced labor and spontaneous labor groups.ResultsAmong the 237 women, 199 delivered vaginally (84.0%). The spontaneous labor group and induced labor group had a similar incidence of Cesarean delivery (17.7% vs. 12.3%, P=0.300). The length of stay and blood loss during delivery were also similar between the groups (4.3±1.5 vs. 3.9±1.5 days and 1.9±1.3 vs. 1.8±1.0 mg/sL, respectively; all P>0.05). Regarding neonatal outcomes, the rate of meconium-stained amniotic fluid, Apgar score <7 at 5 minutes, and intubation rate were similar between the groups (18.9% vs. 24.7%, 7.9% vs. 4.1%, and 6.1% vs. 4.4%, respectively, all P>0.05). Only the neonatal intensive care unit admission rate was significantly lower in the induction group than in the spontaneous labor group (28.0% vs. 13.2%, P=0.001).ConclusionMaternal adverse outcomes of labor induction at 39 weeks of gestation were similar to those in a spontaneous labor group in uncomplicated nulliparous women. Neonatal adverse events were also similar between the groups. It may be acceptable to schedule labor induction as long as 7 days before the estimated date, even when the indication is only relative.

A clinical retrospective study on 160 cases of multiple umbilical cord around the neck

Objective: To compare the neonatal and maternal outcomes between the patients with umbilical cord around the neck (≥3 loops) and with (1 or 2 loops). Methods: A retrospective analysis was conducted on the clinical data of 160 cases with multiple umbilical cord around the neck (≥3 loops) in the Department of Obstetrics, Women's Hospital School of Medicine Zhejiang University between January 2014 and April 2017.For each case, two control women who gave birth at the same day with vertex position and singletons were selected.The neonatal and maternal outcomes were compared. Result: (1) The incidence of cord multiple cord around the neck (≥3 loops) in our hospital was 0.45%. (2) Comparison between groups: The rate of abnormal fetal movement or abnormal cardiotocography in case group was higher than those of the control group, (33.13%, 53/160) vs (8.13%, 26/320), with significant difference, P=0.000.The Umbilical Artery Systolic/diastolic (S/D) ratio of the case group was lower than that of the control group, 2.00(0.40) vs 2.14(0.40), with significant difference, P=0.000.The cesarean section rate of the case group was higher than that of the control group, (81.25%, 130/160) vs (7.50%, 24/320), and the difference was statistically significant, P=0.000.Birth Weight of the case group was lower than that of the control group, (3 143±367) g vs (3 323±349) g, with significant difference, P=0.000.(3) Comparison between subgroups: The rate of lateral incision or obstetrical forceps in the subgroup of virginal delivery among the case group (n=30) was higher than that in the control group (n=296), (30.00%, 9/30) vs (12.50%, 37/296), with significant difference, P=0.009.While, the Apgar score at 1 and 5 min of the virginal delivery case in the case group were lower than that in the control group, 10(1.25) vs 10(0) and 10(0) vs 10(0), there were both significant difference, P=0.000, 0.012, respectively.The rate of meconium-stained amniotic fluid, 1 min Apgar score of ≤7 and NICU admission were showed no significance, all P>0.05.(4) After Logistic regression, the four factors most closely associated with meconium-stained amniotic fluid in patients with multiple cord around the neck (≥3 loops), which were gestational age ≥39 weeks, Birth Weight >3 500 g, umbilical cord around the neck ≥4 loops, and trial of labor. Conclusion: (1) Multiple umbilical cord around the neck (≥3 loops) had a more positive treatment. Vaginal delivery led to lower APGAR score, but didn't increase the incidence of neonatal asphyxia.(2) Independent risk factors for meconium-stained amniotic fluid were gestational age ≥39 weeks, Birth Weight>3 500 g, umbilical cord around the neck ≥4 loops and trial of labor.

Incidence of echogenic amniotic fluid at term pregnancy and its association with meconium

The presence of echogenic amniotic fluid at term gestation on sonography is uncommon. The aim of our study was to investigate the incidence of echogenic amniotic fluid at term pregnancy, and to determine how often echogenic amniotic fluid was associated with meconium. All singleton pregnant women at term who were admitted to our labor unit and who delivered within 24h of the ultrasound scan were included in the study. For each woman, gestational age, maternal age, gravidity, parity, the character of the amniotic fluid on ultrasound at admission (clear or echogenic), birth weight, and the character of the amniotic fluid on artificial or spontaneous rupture of membranes or on cesarean section (clear/with vernix/meconium-stained) were recorded. When amniotic fluid was assessed on ultrasound, among 278 patients, 9 (3.2%) patients' amniotic fluid was echogenic. When the amniotic fluid was assessed at delivery, the rates of meconium-stained amniotic fluid in women with and without echogenic amniotic fluid were 44.44% (4/9) and 9.3% (25/269), respectively; the difference was statistically significant (p=0.035). We found a sensitivity and specificity of 13.79 and 97.99%, and a positive and negative predictive value of 44.44 and 90.7%, respectively, for echogenic amniotic fluid seen on ultrasound in identifying meconium-stained amniotic fluid. The incidence of echogenic amniotic fluid at term gestation was found as 3.2 and 44.4% of cases of echogenic amniotic fluid was associated with meconium.

Induction of labour at term with misoprostol: the experience of a Tunisian maternity ward

Evaluer l'efficacité et l'innocuité de l'utilisation du misoprostol par voie vaginale pour le déclenchement du travail à terme. Etude prospective réalisée au service de gynécologie obstétrique B de l'hôpital Charles Nicolle de Tunis sur une durée de 4 mois. La population sélectionnée concernait les patientes à terme devant bénéficier d'une maturation cervicale. Le misoprostol à la dose de 50 µg par voie vaginale toutes les 12 h était utilisé. Les paramètres étudiés étaient les anomalies contractiles, les anomalies du RCF, le mode d'accouchement, le délai d'accouchement et l’état néonatal. 44 patientes ont bénéficié d'une maturation cervicale par misoprostol. Le terme moyen était de 40 SA. Le taux de nullipare était de 23/44 (52%). Le taux d'accouchement par voie basse était de 31/44 (70.4%). 84% des patientes ont reçu une seule dose de misoprostol. Les anomalies du RCF ont été notées dans 14/44 (32%). Le taux de liquides méconiaux était de 12/44 (27%). Un score d'Apgar à 5 mn inférieur à 7 était noté chez 7/44 (16%). Un cas de rupture utérine était survenue chez une primipare et ce après une seule prise de misoprostol. Nos résultats sont décevants en raison de la survenue d'une rupture utérine et d'une morbidité néonatale importante. D'autres études prospectives multicentriques restent utiles pour mieux s'assurer de l'efficacité mais surtout de l'innocuité du misoprostol à dose faible pour le déclenchement du travail à terme.

Gestational weight gain and body mass indexes have an impact on the outcomes of diabetic mothers and infants.

This study evaluated mothers with diabetes to determine whether prepregnancy body mass index (BMI), BMI on delivery or gestational weight gain (GWG) had the greatest impact on maternal and neonatal outcomes. We retrospectively examined the medical charts of 634 full-term infants born to mothers with gestational diabetes mellitus not requiring insulin (n = 476), gestational diabetes mellitus requiring insulin (n = 140) and insulin-dependent diabetes mellitus (n = 18). Data regarding maternal BMI before pregnancy and on delivery were recorded, as well as maternal and neonatal complications. Infants born to women who gained more than the recommended weight during pregnancy had higher birthweights, higher rates of meconium-stained amniotic fluid and neonatal hypoglycaemia. Using logistic regression, Caesarean section delivery was predicted by gestational diabetes requiring insulin, with an odds ratio (OR) of 1.76, maternal hypertension (OR 2.4), infants born large for gestational age (OR 2.78) and maternal BMI ≥ 30 on delivery (OR 1.06). Neonatal complications were predicted by maternal insulin-dependent diabetes (OR 5.21), lower gestational age (OR 0.8) and GWG above the recommended amount (OR 1.56). Women with diabetes should be made aware that higher GWG can lead to Caesarean section delivery, infant macrosomia and other neonatal complications.

Clinical Value of Maternal Bile Acid Quantification in Intrahepatic Cholestasis of Pregnancy as an Adverse Perinatal Outcome Predictor

Aims: To evaluate the correlation between perinatal outcome and bile acid levels in intrahepatic cholestasis of pregnancy (ICP), and to evaluate variations in the mean bile acid level when stratifying by maternal and perinatal factors. A comparison between mild and severe ICP was made. Methods: A prospective observational study was performed in pregnant patients who underwent blood tests for bile acids due to persistent pruritus. Based on bile acid levels, maternal and neonatal data were obtained and were compared between patients presenting with ICP and gestational pruritus (normal bile acid level). Results: A total of 145 patients were included, 47 of whom were diagnosed as ICP (52 newborns) and 98 as gestational pruritus (102 newborns). The ICP group had a higher rate of NICU admission (14/42 vs. 6/98, p < 0.001) and global neonatal morbidity (13/42 vs. 9/98, p = 0.002), but these differences were no longer seen after adjusting for gestational age, singleton pregnancies and induction of labour. Patients presenting with severe ICP (maximum bile acids levels above 40 µmol/l) showed a higher rate of meconium-stained amniotic fluid (0/28 vs. 4/14, p = 0.009), NICU admission (9/34 vs. 11/17, p = 0.01) and neonatal global morbidity (5/32 vs. 8/17, p = 0.02). Conclusions: ICP patients have higher rates of adverse neonatal outcomes when compared to those with gestational pruritus. Some of this neonatal morbidity may be secondary to late spontaneous preterm deliveries, multiple gestation and a policy of elective induction of labour after 37 weeks of gestation. A comparison of outcomes among patients with mild and severe ICP shows that the severely affected group has higher rates of meconium-stained amniotic fluid and neonatal morbidity.

Management of term newborns following maternal intrapartum fever

Objective: To evaluate the diagnostic and therapeutic approach to full term neonates born to mothers with intrapartum fever. Methods: In a retrospective study, neonates born to mothers with intrapartum fever, (≥37.8°C), were compared to control group matched by gestational age and birthweight. Results: Overall, 159 singleton full term neonates born to women with intrapartum fever (study group) were compared to 159 control infants. No differences in neonatal outcomes were found between the two groups except for a higher rate of meconium-stained amniotic fluid in the maternal-fever group. There were no cases of neonatal infection, severe neonatal morbidity, or neonatal mortality in either of the groups. Full sepsis workup and intravenous antibiotic treatment were provided to 17.6% of the neonates in the study group. Logistic regression analysis revealed that delivery by Cesarean section was the only factor independently associated with the decision to perform a full sepsis work up and antibiotic treatment in cases of maternal intrapartum fever (OR 32.0, 95% CI 9.4–112.1). Conclusions: In low-risk women with asymptomatic intrapartum fever, neonatal infection is uncommon, so that aggressive evaluation and management of these infants may not be necessary and should be balanced against the low risk of neonatal sepsis.

A Population-Based Study of Meconium Aspiration Syndrome in Neonates Born between 37 and 43 Weeks of Gestation

The epidemiology of meconium aspiration syndrome (MAS) in term neonates is described in a population-based retrospective study of data recorded for all births from 2000 to 2007 in a French region (Burgundy). Of the 132 884 eligible term newborns, the rate of meconium-stained amniotic fluid (MSAF) was 7.93%. The prevalence of severe MAS was 0.067% in the overall population. MAS rate was 0.11% at 37-38 weeks of gestation (WG), 0.20% at 39–41 WG, and 0.49% at 42-43 WG. Factors independently associated with severe MAS were identified by a case-control study, that is, thick meconium amniotic fluid, fetal tachycardia, Apgar score ≤3 at 1 minute, and birth in a level III facility. Our results confirm the high prevalence of MSAF after 37 WG but also show the low frequency of severe MAS in a period corresponding to the new international recommendations on the management of birth with MSAF.

Maternal and Fetal Characteristics Associated With Meconium-Stained Amniotic Fluid

To estimate the rates of meconium-stained amniotic fluid (AF) and adverse outcome in relation to gestational age and racial group, and to investigate the predictors of meconium-stained AF. We studied 499,096 singleton births weighing at least 500 g, at 24 or more weeks of gestation, from 1988 to 2000. The predictors of meconium-stained AF from 37 weeks of gestation onward were determined using multiple logistic regression. The crude meconium-stained AF rates in preterm, term, and postterm births were 5.1% (95% confidence interval [CI] 4.9-5.4), 16.5% (95% CI 16.4-16.6), and 27.1% (95% CI 26.5-27.6), respectively; the rates in blacks, South Asians, and whites were 22.6% (95% CI 22.2-23.1), 16.8% (95% CI 16.5-17.1), and 15.7% (95% CI 15.6-15.8), respectively. Independent predictors of meconium-stained AF included being black (odds ratio [OR] 8.4, 95% CI 2.4-28.8), vaginal breech delivery (OR 4.7, 95% CI 4.2-5.3), being South Asian (OR 3.3, 95% CI 1.3-8.3), and being in an advancing week of gestation (OR 1.39, 95% CI 1.38-1.40). More blacks (17.9%, 95% CI 17.3-18.4) and South Asians (11.8%, 95% CI 11.5-12.1) with good outcome and no risk factors for fetal hypoxia had meconium-stained AF than did whites (11.2%, 95% CI 11.1-11.4). Using white neonates born at 40 weeks as reference, the absolute risk of adverse outcome at 41 and 42 weeks were 2% and 5% in whites, 3% and 7%, in South Asians, and 7% and 11% in blacks. Meconium-stained AF rates are different among races and across gestational age, and overall risk of adverse outcomes in meconium stained AF is low. II.

Is meconium-stained amniotic fluid in near-term infants associated with increased rates of adverse maternal and neonatal outcomes?

WITH INCREASED RATES OF ADVERSE MATERNAL AND NEONATAL OUTCOMES? SUSAN TRAN, ANJALI KAIMAL, MICHAEL KUZNIEWICZ, AARON CAUGHEY, University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California, University of California, San Francisco, Pediatrics, San Francisco, California OBJECTIVE: To evaluate neonatal and maternal outcomes in near-term pregnancies complicated by meconium-stained amniotic fluid (MSAF). STUDY DESIGN: This is a retrospective cohort study of 3,480 deliveries between 32-0/7 and 36-6/7 weeks gestation. Neonatal outcomes included: Apgar scores, intensive care nursery (ICN) admission, sepsis, meconium aspiration syndrome (MAS), and respiratory distress syndrome (RDS). Maternal outcomes included: endomyometritis, postpartum hemorrhage, blood transfusion, operative vaginal delivery, and cesarean delivery. Bivariate and multivariate analyses were performed. RESULTS: MSAF was associated with an increased risk of adverse neonatal outcomes except RDS when compared to pregnancies with clear amniotic fluid in the bivariate analyses (Table). No differences were found in maternal outcomes, except for an increased risk of maternal transfusion in the MSAF group. Adjusting for ethnicity, maternal age, gestational age, birthweight, antenatal corticosteroid administration, year of delivery, and cesarean section, MSAF remained associated with increased risks of 5 minute Apgar score !7, sepsis, and maternal blood transfusion, and a decreased risk for RDS (Table). CONCLUSION: We found that MSAF occurring at 32 – 36-6/7 weeks’ gestation was only associated with 5 minute Apgar score !7 when controlling for potential confounding variables. MSAF in these near-term infants was inversely associated with RDS. This is consistent with the findings that with increasing gestational ages, rates of MSAF tend to increase, while rates of RDS tend to decrease. These findings differ somewhat in comparison to term infants with MSAF, suggesting that meconium passage at these earlier gestational ages may represent a different pathophysiologic process.

Meconium-Stained Amniotic Fluid Across Gestation and Neonatal Acid-Base Status

To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium-stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.