Effect of Meconium-Stained Amniotic Fluid on Perinatal Complications in Low-Risk Pregnancies at Term

Abstract

Objective This study aims to determine the impact of meconium-stained amniotic fluid (MSAF) in low-risk pregnancies at term on pregnancy outcome.

Study Design A retrospective cohort study of women with MSAF during labor who delivered in a tertiary hospital at 37 to 41⁺⁶ weeks of gestation (2007–2013). Exclusion criteria included: multiple gestations, noncephalic presentation, fetal structural/chromosomal anomalies, hypertensive disorders, diabetes, oligohydramnios, or small for gestational age. Pregnancy outcome of women with MSAF (N = 4,893) was compared with a control group of women without MSAF (N = 39,651). Neonatal respiratory morbidity was defined as the presence of any of the following: respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, or need for ventilatory support.

Results Overall, 10.9% of low-risk pregnancies at term were diagnosed with MSAF. Compared with the controls, women with MSAF had higher rates of nulliparity, gestational age at delivery ≥ 41 weeks, induction of labor, nonreassuring fetal heart rate, and operative deliveries. In multivariate analysis MSAF was associated with operative delivery (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.63–2.09; p < 0.001), cesarean section (OR, 1.48; 95% CI, 1.31–1.69; p < 0.001), respiratory morbidity (OR, 4.74; 95% CI, 3.87–5.82; p < 0.001), and increased risk for short-term neonatal morbidity.

Conclusions MSAF is associated with a higher rate of adverse perinatal outcome even in low-risk pregnancies at term.

Keywords

adverse outcome - low-risk pregnancy - meconium - term pregnancy

• References

• 1 Nathan L, Leveno KJ, Carmody III TJ, Kelly MA, Sherman ML. Meconium: a 1990s perspective on an old obstetric hazard. Obstet Gynecol 1994; 83 (3) 329-332
• 2 Alchalabi H, Abu-Heija AT, El-Sunna E, Zayed F, Badria LF, Obeidat A. Meconium-stained amniotic fluid in term pregnancies-a clinical view. J Obstet Gynaecol 1999; 19 (3) 262-264
• 3 David AN, Njokanma OF, Iroha E. Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hospital. J Obstet Gynaecol 2006; 26 (6) 518-520
• 4 Lee KA, Mi Lee S, Jin Yang H , et al. The frequency of meconium-stained amniotic fluid increases as a function of the duration of labor. J Matern Fetal Neonatal Med 2011; 24 (7) 880-885
• 5 Maymon E, Chaim W, Furman B, Ghezzi F, Shoham Vardi I, Mazor M. Meconium stained amniotic fluid in very low risk pregnancies at term gestation. Eur J Obstet Gynecol Reprod Biol 1998; 80 (2) 169-173
• 6 Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011; 117 (4) 828-835
• 7 Ahanya SN, Lakshmanan J, Morgan BL, Ross MG. Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv 2005; 60 (1) 45-56 , quiz 73–74
• 8 Poggi SH, Ghidini A. Pathophysiology of meconium passage into the amniotic fluid. Early Hum Dev 2009; 85 (10) 607-610
• 9 Schuit E, Kwee A, Westerhuis ME , et al. A clinical prediction model to assess the risk of operative delivery. BJOG 2012; 119 (8) 915-923
• 10 Berkus MD, Langer O, Samueloff A, Xenakis EM, Field NT, Ridgway LE. Meconium-stained amniotic fluid: increased risk for adverse neonatal outcome. Obstet Gynecol 1994; 84 (1) 115-120
• 11 Becker S, Solomayer E, Dogan C, Wallwiener D, Fehm T. Meconium-stained amniotic fluid—perinatal outcome and obstetrical management in a low-risk suburban population. Eur J Obstet Gynecol Reprod Biol 2007; 132 (1) 46-50
• 12 Walsh MC, Fanaroff JM. Meconium stained fluid: approach to the mother and the baby. Clin Perinatol 2007; 34 (4) 653-665 , viii
• 13 Hutton EK, Thorpe J. Consequences of meconium stained amniotic fluid: what does the evidence tell us?. Early Hum Dev 2014; 90 (7) 333-339
• 14 Karabayir N, Demirel A, Bayramoglu E. Blood lactate level and meconium aspiration syndrome. Arch Gynecol Obstet 2015; 291 (4) 849-853
• 15 Maayan-Metzger A, Leibovitch L, Schushan-Eisen I, Strauss T, Kuint J. Meconium-stained amniotic fluid and hypoglycemia among term newborn infants. Fetal Pediatr Pathol 2012; 31 (5) 283-287
• 16 Wong SF, Chow KM, Ho LC. The relative risk of ‘fetal distress’ in pregnancy associated with meconium-stained liquor at different gestation. J Obstet Gynaecol 2002; 22 (6) 594-599
• 17 McCormick MC. The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 1985; 312 (2) 82-90
• 18 Saigal S, Doyle LW. An overview of mortality and sequelae of preterm birth from infancy to adulthood. Lancet 2008; 371 (9608) 261-269
• 19 Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birth weight standards in the live-born population in Israel. Isr Med Assoc J 2005; 7 (5) 311-314
• 20 Maisels MJ. Jaundice in healthy newborns-redefining physiologic jaundice. West J Med 1988; 149 (4) 451
• 21 American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric care consensus no. 1: safe prevention of the primary cesarean delivery. Obstet Gynecol 2014; 123 (3) 693-711
• 22 Monen L, Hasaart TH, Kuppens SM. The aetiology of meconium-stained amniotic fluid: pathologic hypoxia or physiologic foetal ripening? (Review). (Review) Early Hum Dev 2014; 90 (7) 325-328
• 23 Ramón y Cajal CL, Martínez RO ; Ramón y. Defecation in utero: a physiologic fetal function. Am J Obstet Gynecol 2003; 188 (1) 153-156
• 24 Kizilcan F, Karnak I, Tanyel FC, Büyükpamukçu N, Hiçsönmez A. In utero defecation of the nondistressed fetus: a roentgen study in the goat. J Pediatr Surg 1994; 29 (11) 1487-1490
• 25 Altshuler G, Hyde S. Meconium-induced vasocontraction: a potential cause of cerebral and other fetal hypoperfusion and of poor pregnancy outcome. J Child Neurol 1989; 4 (2) 137-142
• 26 Keski-Nisula L, Aalto ML, Katila ML, Kirkinen P. Intrauterine inflammation at term: a histopathologic study. Hum Pathol 2000; 31 (7) 841-846
• 27 de Beaufort AJ, Pelikan DM, Elferink JG, Berger HM. Effect of interleukin 8 in meconium on in-vitro neutrophil chemotaxis. Lancet 1998; 352 (9122) 102-105
• 28 Torricelli M, Voltolini C, Conti N , et al. Histologic chorioamnionitis at term: implications for the progress of labor and neonatal wellbeing. J Matern Fetal Neonatal Med 2013; 26 (2) 188-192
• 29 Mazor M, Hershkovitz R, Bashiri A , et al. Meconium stained amniotic fluid in preterm delivery is an independent risk factor for perinatal complications. Eur J Obstet Gynecol Reprod Biol 1998; 81 (1) 9-13
• 30 Low JA. Intrapartum fetal asphyxia: definition, diagnosis, and classification. Am J Obstet Gynecol 1997; 176 (5) 957-959
• 31 Altshuler G, Arizawa M, Molnar-Nadasdy G. Meconium-induced umbilical cord vascular necrosis and ulceration: a potential link between the placenta and poor pregnancy outcome. Obstet Gynecol 1992; 79 (5 ( Pt 1)): 760-766
• 32 Romero R, Hanaoka S, Mazor M , et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991; 164 (3) 859-862
• 33 Mazor M, Furman B, Wiznitzer A, Shoham-Vardi I, Cohen J, Ghezzi F. Maternal and perinatal outcome of patients with preterm labor and meconium-stained amniotic fluid. Obstet Gynecol 1995; 86 (5) 830-833
• 34 Siriwachirachai T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections. Cochrane Database Syst Rev 2014; 11: CD007772
• 35 Hiersch L, Melamed N, Rosen H, Peled Y, Wiznitzer A, Yogev Y. 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 (13) 1361-1367
• 36 Locatelli A, Regalia AL, Patregnani C, Ratti M, Toso L, Ghidini A. Prognostic value of change in amniotic fluid color during labor. Fetal Diagn Ther 2005; 20 (1) 5-9