To determine the intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid (MSAF).
In a retrospective cohort study of all singleton deliveries over a period of one year (2015) in a tertiary hospital, we compared different degrees of MSAF (yellow, green and thick) to clear amniotic fluids, and analysed in each group maternal, intrapartum and neonatal variables as well as umbilical cord blood gas analysis.
Of the 3590 deliveries included, 503 (14%) had MSAF. The incidence of MSAF rises with gestational age at delivery, reaching 20.7% in gestations above 41 weeks compared to 4.3% below 37 weeks. As the amniotic fluid staining progresses we found a higher proportion of intrapartum fevers (p < 0.001), pathological fetal heart rate patterns (p < 0.05), operative vaginal deliveries and cesarean sections (p < 0.001), as well as the need for advanced neonatal resuscitation (p < 0.001). There was also a correlation between MSAF and low Apgar scores at five minutes (p < 0.001) and fetal-neonatal mortality (p < 0.001) but there was not a higher proportion of neonatal intensive care admissions (p > 0.05). We have observed a similar distribution of umbilical artery pH ranges in all groups (p > 0.05).
MSAF was associated with an increase in the rate of pathological fetal heart rate patterns, intrapartum fevers, operative vaginal and cesarean section deliveries, need for neonatal resuscitation, low Apgar scores and higher fetal-neonatal mortality. Moreover, we found that the risks increase as the staining and consistency of the amniotic fluid evolves so it should alert the obstetrician and paediatrician to the potential adverse outcomes.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to European Journal of Obstetrics and Gynecology and Reproductive Biology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Meconium stained amniotic fluid in very low risk pregnancies at term gestation.Eur J Obstet Gynecol Reprod Biol. 1998; 80: 169-173
- Pathophysiology of meconium passage into the amniotic fluid.Early Hum Dev. 2009; 85: 607-610
- Meconium stained amniotic fluid: increased risk for adverse outcome.Obstet Gynecol. 1994; 84: 115-120
- Obstetric and perinatal outcome of pregnancies with term labour and meconium-stained amniotic fluid.Arch Gynecol Obstet. 2000; 264: 84-87
- The effect of meconium on perinatal outcome: a prospective analysis.J Matern Fetal Neonatal Med. 2002; 11: 54-59
- Use of umbilical cord blood gas analysis in the assessment of the newborn.Arch Dis Child Fetal Neonatal Ed. 2007; 92: 430-434
- The 2008 National Institute of Child Health and Human Development workshop report on electronic fetal monitoring: update on definitions, interpretation, and research guidelines.Obstet Gynecol. 2008; 112: 661-666
- Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial.Lancet. 2004; 364: 597-602
- Meconium aspiration syndrome: historical aspects.J Perinatol. 2008; 28: S3
- Relevance of the gestational age distribution of meconium passage in utero.Pediatrics. 1979; 64: 30-31
- Neonatal outcome in meconium stained amniotic fluid–one year experience.J Pak Med Assoc. 2010; 60: 711-714
- Meconium-stained amniotic fluid and neonatal morbidity in low-risk pregnancies at term: the effect of gestational age.Am J Perinatol. 2017; 34: 183-190
- Meconium-induced vasoconstriction: a potential cause of cerebral and other fetal hypoperfusion and of poor pregnancy outcome.J Child Neurol. 1989; 4: 137-142
- Meconium-stained amniotic fluid: A risk factor for microbial invasion of the amniotic cavity.Am J Obstet Gynecol. 1991; 164: 859-862
- Evidence of a subclinical inflammatory process in patient meconium-stained amniotic fluid.Am J Obstet Gynecol. 1997; 176: 370
- Meconium-stained amniotic fluid and neonatal morbidity in near-term and term deliveries with acute histologic chorioamnionitis and/or funisitis.J Perinatol. 2001; 21: 537-540
- Meconium during labour–self-medication and other associations.S Afr Med J. 1987; 71: 431-433
- Comparison of Misoprostol versus Dinoprostone for pre-induction cervical ripening at-term.J Nepal Health Res Counc. 2012; 10: 10-15
- Effect of meconium-stained amniotic fluid on perinatal complications in low-risk pregnancies at term.Am J Perinatol. 2016; 33: 378-384
- Meconium stained fluid: approach to the mother and the baby.Clin Perinatol. 2007; 34: 653-665
- New onset of meconium during labor versus primary meconium-stained amniotic fluid – is there a difference in pregnancy outcome?.J Matern Fetal Neonatal Med. 2014; 27: 1361-1367
- Prognostic value of change in amniotic fluid color during labor.Fetal Diagn Ther. 2005; 20: 5-9
- Neonatal outcome after meconiumstained amniotic fluid.J Obstet Gynecol India. 1993; 44: 933-935
- Defecation in utero: a physiologic fetal function.Am J Obstet Gynecol. 2003; 188: 153-156
- Fetal gastrointestinal physiology.in: Eden R.D. Boehm F.H. Assessment and care of the fetus. Physiological, clinical and medicolegal principles. Prentice-Hall International Inc, East Norwalk, CT1990: 93-111
- In-utero defecation between weeks 14 and 22 of gestation: stools are whitish.Ultrasound Obstet Gynecol. 2004; 23: 94-95
- In utero defecation by the normal fetus: a radionuclide study in the rabbit.J Pediatr Surg. 1996; 31: 1409-1412
Published online: March 20, 2018
Accepted: March 19, 2018
Received: February 17, 2018
© 2018 Published by Elsevier B.V.