morphine and Acidosis

Meconium stained amniotic fluid (MSAF) is common and associated with meconium aspiration syndrome (MAS). Other consequences of meconium passage before birth are less well understood.. We reviewed the literature for original papers reporting on outcomes associated with MSAF.. Among preterm infants MSAF is more prevalent than previously believed and is associated with higher neonatal morbidity. Intrauterine exposure to meconium is associated with inflammation of tissues of the lung, chorionic plate and umbilical vessels and through various mechanisms may contribute to neonatal morbidity, independent of MAS. No compelling evidence supported an association between MSAF and increased neurological impairment, including early seizure activity.

Topics: Acidosis; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Fetus; Humans; Infant, Newborn; Infant, Premature; Meconium; Meconium Aspiration Syndrome; Otitis Media; Pregnancy; Seizures; Sepsis

Intrapartum asphyxia is defined as metabolic acidemia measured at birth with pH less than 7.00 and base deficit greater or equal to 12 mmol/l. Neonatal complications of intrapartum asphyxia include multiorgan failure and neonatal encephalopathy. Most severe consequences are death and neurological or sensorial impairment. Cause of permanent neurological impairment can be attributed to intrapartum asphyxia if three criteria are met: intrapartum history of a threatening event with acute fetal heart rate deterioration, biological markers of asphyxia, neonatal encephalopathy. Moderate to severe neonatal encephalopathy in asphyxiated term infants is associated with a high risk of cerebral palsy (especially quadriplegic or dyskinetic type) and/or cognitive disorders. Prognosis of neonatal encephalopathy can be accurately assessed by MR imaging.

Topics: Acidosis; Apgar Score; Biomarkers; Brain Diseases; Cerebral Palsy; Female; Fetal Blood; Fetal Hypoxia; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lactic Acid; Magnetic Resonance Imaging; Meconium; Multiple Organ Failure; Nervous System Diseases; Pregnancy; Ultrasonography

There are conflicting opinions about the significance of 5 perinatal findings felt to be indicators of asphyxia (meconium staining of the amniotic fluid, abnormal fetal heart rate patterns, acidotic fetal scalp blood gases, low Apgar scores, and acidotic cord blood gases). A review of the literature was undertaken to determine the strength of association of each of these findings with adverse outcomes. Although all studies contained methodological problems, these indicators were found to have strong associations with one or more adverse outcomes such as perinatal death, low Apgar scores or cerebral palsy. The strength of the association (relative risk) was found to vary inversely with the prevalence of the outcome.

Topics: Acidosis; Apgar Score; Asphyxia Neonatorum; Fetal Blood; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Meconium; Prognosis; Risk

Topics: Acid-Base Equilibrium; Acidosis; Asphyxia Neonatorum; Blood Circulation; Blood Glucose; Body Temperature Regulation; Calcium; Central Nervous System Diseases; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Meconium; Oxygen Consumption; Pneumonia, Aspiration

Topics: Acidosis; Amniotic Fluid; Bicarbonates; Birth Weight; Carbon Dioxide; Estriol; Female; Fetal Diseases; Fetal Heart; Fetus; Growth; Heart Rate; Humans; Hydrogen-Ion Concentration; Hypoxia; Labor, Obstetric; Maternal-Fetal Exchange; Meconium; Muscle Contraction; Oxygen; Oxygen Consumption; Oxygen Inhalation Therapy; Oxytocin; Pregnancy; Pregnancy in Diabetics; Scalp; Ultrasonography; Uterus

Topics: Acidosis; Animals; Animals, Newborn; Asphyxia Neonatorum; Bacterial Infections; Cerebral Hemorrhage; Erythroblastosis, Fetal; Female; Fetal Diseases; Hepatitis, Animal; Horse Diseases; Horses; Humans; Hypoglycemia; Hypoxia; Infant, Newborn; Meconium; Nephritis; Pregnancy; Respiratory Insufficiency; Seizures; Syndrome; Virus Diseases

To investigate the effect of infusion of sodium bicarbonate in amniotic cavity and exchange of amniotic fluid for fetus with distress and acidosis.. The patients included 40 cases of oligohydramnios with mild and serious abnormality of fetal heart rate and amniotic fluid contamination of degree II or more during the labor. The 40 cases had exchange of amniotic fluid with infusion under continuous monitoring. Twenty of them had infusion with 5% sodium bicarbonate into amniotic cavity; the other 20 cases received 5% sodium bicarbonate intravenous in fusion. After the labor all the patients had test of arterial blood gas in umbilical cord and the fetuses were evaluated with Apgar score.. (1) the effective rate was 88% in the group of infusion into amniotic cavity and 85% in the group of exchange of amniotic fluid. (2) The arterial blood pH, PO(2), HCO(3)(-), ABE, SBE in the group of amniotic cavity infusion with 5% sodium bicarbonate were all higher than group of IV infusion, however PCO(2) was significantly lower than the group of IV (P < 0.05).. Infusion into amniotic cavity and exchange of amniotic fluid is effective therapy for fetal distress due to oligohydramnios and can prevent meconium aspiration syndrome; infusion of antacids medicine (5% sodium bicarbonate) into amniotic cavity is effective and safe therapy for fetus with acidosis.

Topics: Acidosis; Adult; Amnion; Amniotic Fluid; Apgar Score; Dose-Response Relationship, Drug; Female; Fetal Distress; Fluid Therapy; Heart Rate, Fetal; Humans; Infant, Newborn; Infusions, Intravenous; Infusions, Parenteral; Labor, Obstetric; Meconium; Meconium Aspiration Syndrome; Oligohydramnios; Pregnancy; Sodium Bicarbonate

Our purpose was to evaluate the efficacy of prophylactic amnioinfusion in decreasing neonatal morbidity associated with labor complicated by particulate meconium-stained amniotic fluid and to assess potential complications of this procedure.. One hundred five laboring pregnant women with particulate (moderate or thick) meconium by subjective clinical analysis were randomly assigned to receive amnioinfusion or to receive standard obstetric care without amnioinfusion. Patients with any antepartum complications, other than the presence of meconium, were excluded from the study. Statistical analyses consisted of the two-tailed and paired Student t tests, Pearson chi 2 test, and Wilcoxon nonparametric test. Significance was set at p < 0.05.. The study included 47 patients in the study group and 58 patients in the control group. A significantly greater proportion of study patients demonstrated decreased meconium concentration between rupture of membranes and delivery (46 of 46 vs 15 of 58, p < 0.001). The relative dilution of meconium consistency by objective analysis was significantly different between the study group and the control group (77.1% decrease vs 9.3% increase, p < 0.001). The proportion of neonates with meconium below the vocal cords was reduced in the study group (two of 47 vs 36 of 58, p < 0.001). Umbilical artery pH was increased in the study group neonates (7.29 +/- 0.01 vs 7.25 +/- 0.009, p < 0.05). The rate of neonatal acidemia was reduced in the study group (4 of 45 vs 12 of 50, p < 0.05). The rate of meconium aspiration syndrome was reduced in the study group (1 of 47 vs 8 of 58, p < 0.05). Maternal and neonatal morbidity rates were similar.. Prophylactic amnioinfusion should be considered a possible addition to the intrapartum management of patients with particulate meconium-stained amniotic fluid.

Topics: Acidosis; Adult; Amnion; Amniotic Fluid; Female; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infusions, Parenteral; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Prospective Studies; Umbilical Arteries

To assess the correlation between total area under the Curve (AUC) of decelerations and accelerations and neonatal acidemia in pregnancies complicated with meconium-stained amniotic fluid (MSAF).. A retrospective cohort study was conducted among women who delivered with a diagnosis of MSAF. Electronic fetal monitoring (EFM) patterns 120 min before delivery were interpreted by a researcher blinded to fetal outcomes. The primary outcome was fetal acidemia, defined as umbilical artery pH below 7.10. The correlation was tested using the Spearman correlation coefficient.. A total of 102 women were included; 24 delivered infants with cord blood pH < 7.20, and only five delivered infants with cord blood pH < 7.10. A significant correlation was demonstrated between total AUC of decelerations and accelerations and cord blood pH (P = 0.02). A sub-analysis according to gestational age at delivery (up to and beyond 40 weeks) was conducted. A significant correlation was demonstrated (P = 0.02) only in the term group(n = 37).. A correlation was demonstrated between total AUC of decelerations and accelerations and cord blood pH in neonates with MSAF. This correlation was significant for neonates delivered before 40 weeks of gestation, but not for those delivered after 40 weeks of gestation.

Topics: Acidosis; Amniotic Fluid; Deceleration; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pregnancy; Pregnancy Complications; Retrospective Studies

To assess if a stained or meconial amniotic fluid during labor is correlated with a greater risk of neonatal metabolic acidosis.. In a retrospective case-control study carried out in a level 3 maternity from 1st of January to 31st of December 2014, all patients who delivered a singleton eutrophic fetus in cephalic presentation after 37WG and with a stained or meconial amniotic fluid during labor were included. Obstetrical and neonatal outcomes were compared according to the amniotic fluid's color.. At all, 302 patients in the group « Abnormal amniotic fluid» (198 patients with stained amniotic fluid, 104 with meconial amniotic fluid) vs. 302 in the group « clear amniotic fluid» were included. No significant difference on the rate of neonatal severe acidosis between the two groups were found. Fetal heart rhythm abnormalities were more frequent in case of meconial amniotic fluid (11,3% vs. 31,7%, P<0,0001). The composite endpoint, defined by the association of umbilical arterial pH <7,0±base excess ≥12mmol/L±Apgar score at 5min <7, was more frequent in case of meconial amniotic fluid (4,0% vs. 12,5%, P=0,0018).. The occurrence of severe neonatal metabolic acidosis was not more frequent in case of stained or meconial amniotic fluid, but with an increase in the use of fetal scalp pH and cesaerian deliveries when the fluid was meconial.

Topics: Acidosis; Amniotic Fluid; Apgar Score; Case-Control Studies; Delivery, Obstetric; Female; Fetal Blood; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Meconium; Pregnancy; Retrospective Studies; Risk Factors; Umbilical Arteries

To identify peripartum events that may predict the development of short-term neurologic morbidity and mortality among acidemic neonates.. Retrospective case-control study conducted at a single-teaching hospital on data from January 2010 to December 2015. The study cohort group included all acidemic neonates (cord artery pH ≤ 7.1) born at ≥ 34 weeks. Primary outcome was a composite including any of the following: neonatal encephalopathy, convulsions, intra-ventricular hemorrhage, or neonatal death. The study cohort was divided to the cases group, i.e., acidemic neonates who had any component of the primary outcome, and a control group, i.e., acidemic neonates who did not experience any component of the primary outcome.. Of all 24,311 neonates born ≥ 34 weeks during the study period, 568 (2.3%) had a cord artery pH ≤ 7.1 and composed the cohort study group. Twenty-one (3.7%) neonates composed the cases group. Multivariate logistic regression analysis revealed that cases were significantly more likely to have experienced placental abruption (OR 18.78; 95% CI 5.57-63.26), born ≤ 2500 g (OR 13.58; 95% CI 3.70-49.90), have meconium (OR 3.80; 95% CI 1.20-11.98) and cord entanglement (OR 5.99; 95% CI 1.79-20.06). The probability for developing the composite outcome rose from 3.7% with isolated acidemia to 97% among neonates who had all these peripartum events combined with intrapartum fetal heart rate tracing category 2 or 3.. Neonatal acidemia carries a favorable outcome in the vast majority of cases. In association with particular antenatal and intrapartum events, the short-term outcome may be unfavorable.

Topics: Abruptio Placentae; Acidosis; Case-Control Studies; Cohort Studies; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Meconium; Parturition; Peripartum Period; Pregnancy; Retrospective Studies; Seizures

The Apgar score is universally used for fetal assessment at the time of birth, whereas, the collection of fetal cord blood gases is performed commonly in high-risk situations or in the setting of Apgar scores of <7, which is a less standardized approach. It has been well-established that neonatal acidemia at the time of delivery can result in significant neonatal morbidity and death. Because of this association, knowledge of the fetal acid-base status and detection of acidemia at the time of delivery can serve as a sensitive and useful component in the assessment of a neonate's risk. Umbilical cord blood gas analysis is an accurate and validated tool for the assessment of neonatal acidemia at the time of delivery. Because the collection of fetal cord blood gases is not a standardized practice, it is possible that, with such a varied approach, some cases of neonatal acidemia are not detected, particularly in the setting of reassuring Apgar scores.. In a setting of universally obtained cord blood gases, we sought to identify the rates of acidemia and associated factors in neonates with 5-minute Apgar scores of ≥7.. This retrospective cohort study identified all term, singleton, nonanomolous neonates with 5-minute Apgar scores of ≥7. The incidence of umbilical artery pH ≤7.0 or ≤7.1 and base excess ≤-12 mmol/L or ≤-10 mmol/L were examined overall and in association with obstetric complications and adverse neonatal outcomes. Chi-squared tests were used to compare proportions, and multivariable logistic regression was used to control for potential confounders.. In this cohort, the incidence of an umbilical artery pH of ≤7.0 was 0.5%, of a pH ≤7.1 was 3.4%, of a base excess ≤-12 mmol/L was 1.4%, and of ≤-10 mmol/L was 4.0%. Rates of neonatal acidemia were greater in the setting of meconium (4.3% vs 3.2%; P<.001), placental abruption (13.2% vs 3.4%; P<.001), and cesarean deliveries (5.8% vs 2.8%; P<.001), despite normal 5-minute Apgar scores. Additionally, umbilical artery pH ≤7.0 was associated with an increased risk of respiratory distress syndrome (adjusted odds ratio, 6.5; 95% confidence interval, 2.9-14.3) and neonatal intensive care unit admission (adjusted odds ratio, 10.8; 95% confidence interval, 6.8-17.4). Base excess of ≤-12 mmol/L was also associated with an increased risk of neonatal sepsis (adjusted odds ratio, 4.7; 95% confidence interval, 1.9-12.1). Finally, when examined together, neonates with both a pH of ≤7.0 and base excess of ≤-12 mmol/L continued to demonstrate an increased risk of neonatal intensive care unit admission and respiratory distress syndrome, with adjusted odds ratios of 9.6 and 6.0, respectively. This risk persisted in neonates with a pH of ≤7.1 and base excess of ≤-10 mmol/L as well, with adjusted odds ratios of 4.5 and 1.1, respectively.. Because neonates with reassuring Apgar scores have a residual risk of neonatal acidemia that is associated with higher rates of adverse outcomes, the potential utility of obtaining universal cord blood gases should be further investigated.

Topics: Abruptio Placentae; Acidosis; Apgar Score; Blood Gas Analysis; Cesarean Section; Cohort Studies; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Intensive Care, Neonatal; Meconium; Neonatal Sepsis; Patient Outcome Assessment; Pregnancy; Prognosis; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Term Birth; Umbilical Arteries

To externally validate two previously developed prognostic models that predict the risk for developing metabolic acidosis in newborns using both antepartum (model 1) and intrapartum (combined with antepartum, model 2) risk factors: parity, previous cesarean section, maternal diabetes mellitus, gestational age, induced onset of labor, meconium-stained amniotic fluid, and use of ST analysis.. The two prediction models were applied in women in active labor at more than 36 gestational weeks with singleton fetuses in cephalic presentation and with high-risk pregnancies (n = 5049) who were included in a Swedish randomized trial between December 1, 1998, and June 4, 2000. The prognostic ability of the models was determined using calibration and discrimination measures.. Of 5049 infants in the validation population, 54 (1.1%) suffered from metabolic acidosis. After adjustment for incidence differences between the Dutch and Swedish cohorts, the prognostic models showed good calibration and moderate overall discrimination (C statistic 0.63, 95% confidence interval [CI] 0.55 to 0.71; and 0.64, 95% CI 0.55 to 0.72), for models 1 and 2, respectively).. External validation of the clinical prediction models for metabolic acidosis in Swedish infants showed good calibration and moderate discriminative ability. Updating of the models to enhance their predictive abilities seems indicated.

Topics: Acidosis; Amniotic Fluid; Cesarean Section; Diabetes Mellitus; Female; Gestational Age; Humans; Infant, Newborn; Labor Presentation; Labor, Induced; Meconium; Models, Statistical; Parity; Pregnancy; Pregnancy, High-Risk

Neonatal asphyxia may have severe consequences in term newborns. Our purpose was to identify possible risk factors of severe acidosis during pregnancy and labor.. In a case-control study from January 2003 to December 2008 in three university perinatal centers (two French and one Canadian hospitals), we analyzed 226 women with term pregnancies complicated by severe neonatal acidosis (umbilical artery pH less than 7.00). Cases were individually matched with controls with a normal acid-base status (pH 7.15 or greater) paired by parity. Groups were compared for differences in maternal, obstetric, and fetal characteristics. Univariable and logistic conditional regression were used to identify possible risk factors.. Among 46,722 births after 22 weeks, 6,572 preterm births and 829 stillbirths or terminations of pregnancy were excluded. From the 39,321 live term births, 5.30% of pH values were unavailable. Severe acidosis complicated 0.63% of 37,235 term structurally normal pregnancies. By using multivariate conditional regression, maternal age 35 years or older (35.0% compared with 15.5%; odds ratio [OR] 5.58, 95% confidence interval [CI] 2.51-12.40), prior neonatal death (3.5% compared with 0%), prior cesarean delivery (24.7% compared with 6.6%; OR 4.08, 95% CI 1.71-9.72) even after excluding cases of uterine rupture, general anesthesia (8.4 compared with 0.9%; OR 8.04, 95% CI 1.26-50.60), thick meconium (6.4% compared with 2.8%; OR 5.81, 95% CI 1.72-19.66), uterine rupture (4.4% compared with 0%), and abnormal fetal heart rate (66.1% compared with 19.8%; OR 8.77, 95% CI 3.72-20.78) were independent risk factors of severe neonatal acidosis.. Prior cesarean delivery, maternal age 35 years or older, prior neonatal death, general anesthesia, thick meconium, uterine rupture, and abnormal fetal heart rate are independent risk factors of severe neonatal acidosis.. II.

Topics: Acidosis; Adult; Anesthesia, General; Apgar Score; Asphyxia Neonatorum; Case-Control Studies; Cesarean Section; Female; Heart Rate, Fetal; Humans; Infant Mortality; Infant, Newborn; Male; Meconium; Pregnancy; Risk Factors; Severity of Illness Index; Uterine Rupture

To assess the validity of cardiotocography and meconium staining of amniotic fluid, as a predictor of neonatal acidaemia.. It was a cross sectional analytical study, carried out at a tertiary care private hospital from 1st Jan 2006-31st Dec 2006. After due exclusion 122 cords samples were selected for study. Classification of foetal heart patterns were from FIGO-Guidelines (1987) and grading of meconium staining of amniotic fluid as thin, moderate and thick on subjective assessment. Cord samples collected at birth and subsequent analysis was usually achieved within 30 minutes of delivery.. Total deliveries during the study period were 960. One hundred and twenty two (12.7%) cord results were studied. Umbilical cord arterial base excess (> or = 12 mmol/L) at birth was used as gold standard to determine the validity of cardiotocography and meconium staining of amniotic fluid. Validity tests of cardiotocography: Sensitivity 15.38%, Specificity 86%, Positive predictive value 11.76%. Negative predictive value 89%. Validity tests of meconium staining of amniotic fluid: Sensitivity 18.75%, Specificity 79.2%, Positive predictive value 12%, Negative predictive value 86%.. Electronic foetal monitoring (cardiotocography) is an objective assessment of foetal well being. Normal reactive trace correlates highly with absence of acidaemia at birth. However cardiotocography alone is not a diagnostic test for detecting foetal distress. Similarly clear liquor is an indication of foetal well being and meconium staining of amniotic fluid is not always associated with an ill infant.

Topics: Acidosis; Adult; Amniotic Fluid; Cardiotocography; Cross-Sectional Studies; Female; Fetal Blood; Fetal Monitoring; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Meconium; Pakistan; Pregnancy; Reproducibility of Results; Sensitivity and Specificity; Young Adult

To evaluate the immediate neonatal outcome and the presence of various placental lesions in 96 pregnancies with meconium-stained amniotic fluid.. The patients were divided into a group with acute (N = 41) and subacute and chronic (N = 55) meconium staining of the placenta. Apgar scores, arterial cord pH and admission to the neonatal intensive care unit (NICU) were determined in addition to the findings on gross and microscopic examination of the placentas.. Of the 53 live births with subacute and chronic meconium staining, 13% had Apgar Scores < or = 7 at 5 minutes compared to 7% with acute meconium staining. Similarly, a significantly lower umbilical artery pH was determined in the former group [(32%) versus (7%)], (p < 0.01). When 9 different pathologic lesions of the placenta were evaluated microscopically, the frequency of villous vascular thrombosis (25.4%), infarcts (38%), acute chorioamnionitis (20%), villous edema (9.1%) and villitis (14.5%) was significantly higher in the group with longer meconium exposure compared to the other group (2.4%), (9.7%), (7.3%), (0%), and 1 (2.4%), respectively. In addition, when tested for 4 different lesions, cases with acute meconium were less likely to have one or more lesions. When one or more placental lesions were found, NICU admission rate was significantly higher in the patients with subacute and chronic meconium.. Subacute and chronic meconium discharge is associated with significant placental lesions and an increased risk of adverse pregnancy outcome in the immediate neonatal period.

Topics: Acidosis; Adolescent; Adult; Female; Fetal Hypoxia; Humans; Meconium; Placenta; Placenta Diseases; Pregnancy; Pregnancy Outcome; Thrombosis; Time Factors

Our objective was to evaluate individualized growth assessment using the Rossavik growth model for detection of small-for-gestational-age (SGA) infants with a poor perinatal outcome.. Rossavik growth models derived from second-trimester ultrasound measurements were used to predict birth characteristics of 47 singleton SGA infants. Individual fetal growth curve standards for head and abdominal circumference, and weight were determined from the data of two scans obtained before 25 weeks' menstrual age and separated by an interval of at least 5 weeks. Comparisons between actual and predicted birth characteristics were expressed by the Growth Potential Realization Index (GPRI) and Neonatal Growth Assessment Score (NGAS). The proportions of perinatal outcomes [mechanical delivery, low Apgar score, abnormal fetal heart rate (FHR) patterns, neonatal acidosis, meconium staining of amniotic fluid, neonatal intensive care unit (NICU) admission and maternal complications] were compared between SGA infants with normal NGAS and those with abnormal NGAS.. Of the 47 fetuses studied, 27 had normal growth outcomes at birth and 20 showed evidence of intrauterine growth restriction, based on NGAS. There were significant increases in mechanical deliveries, abnormal FHR patterns and meconium staining of amniotic fluid in cases of growth-restricted neonates, determined using the NGAS classification, when compared with events related to normally grown infants. However, there were no significant differences in low Apgar score, neonatal acidosis, NICU admission and maternal complications between the 2 groups.. Individualized growth assessment should be useful for detection of SGA infants with poor perinatal outcomes.

Topics: Abdomen; Acidosis; Apgar Score; Body Weight; Cephalometry; Embryonic and Fetal Development; Female; Fetal Growth Retardation; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Infant, Small for Gestational Age; Intensive Care, Neonatal; Meconium; Pregnancy; Pregnancy Outcome; Ultrasonography, Prenatal

To evaluate the obstetric antecedents of cystic periventricular leukomalacia and transient echodense periventricular lesions among preterm infants.. A cohort study of preterm singleton infants born between 25 and 33 weeks gestation.. Pavia, Italy.. Three hundred and forty-nine infants admitted to a Division of Neonatal Intensive Care who were screened for periventricular leukomalacia.. The obstetric factors in infants with either cystic periventricular leukomalacia or transient echodense periventricular lesions were compared to those in infants with negative cranial ultrasonographic findings. Stepwise multiple logistic regression analysis was used to evaluate the association between risk factors and outcomes adjusting for confounders.. The prevalence of cystic periventricular leukomalacia and transient echodense lesions was 5.7% (20/349) and 14% (49/349), respectively. The main risk factors for cystic leukomalacia were first trimester haemorrhage (OR 4.49; 95% CI 1.63-12.39), maternal urinary tract infection on admission (OR 5.71; 95% CI 1.91-17.07), and neonatal acidosis (pH < 7.2) at birth (OR 5.97; 95% CI 1.93-18.52). Meconium-stained amniotic fluid (OR 3.95; 95% CI 1.42-10.98) and long term (> 72 hours) ritodrine tocolysis (OR 2.54; 95% CI 1.28-5.05) were associated with an increased risk of echodense lesions. The likelihood of overall leukomalacia (cystic plus echodense periventricular lesions) was increased among cases with meconium-stained amniotic fluid (OR 4.06; 95% CI 1.65-10.0), long-term ritodrine tocolysis (OR 2.56; 95% CI 1.38-4.72), maternal infection (OR 1.73; 95% CI 1.0-3.0), and acidosis at birth (OR 1.98; 95% CI 1.0-3.98).. This study confirms that maternal infection, acidosis at birth, and meconium-stained amniotic fluid increase the risk of periventricular leukomalacia in preterm infants. Long-term ritodrine use seems to increase the risk for transient echodense lesions.

Topics: Acidosis; Adult; Cerebral Hemorrhage; Cerebral Palsy; Cohort Studies; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Leukomalacia, Periventricular; Meconium; Obstetric Labor, Premature; Pregnancy; Risk Factors; Ritodrine; Tocolytic Agents; Urinary Tract Infections

To determine if meconium in the amniotic fluid (AF) can cause cerebral palsy by stimulating umbilical and placental blood vessels to constrict.. Brain injury patterns were analyzed in 43 children whose exposure to meconium in the AF was their only identified risk for quadriplegic cerebral palsy. The times their injuries occurred were established by following lymphocyte counts in their blood after birth.. All 43 had cerebral cortical and subcortical brain damage of the type produced by late gestational ischemia and hypoxemia. The time between the onset of injury and birth ranged from 2-38 hours. The neonates were severely acidotic at birth when birth occurred within 12-14 hours after ischemia and hypoxemia began. Thereafter, the acidosis receded as the time between its start and birth increased, presumably because vasoconstriction had ended. Severe acidosis did not recede in nine children whose cerebral palsy was due to disorders that kept them hypoxemic until birth.. Meconium in the AF may sometimes initiate vasoconstriction that leads to ischemic, hypoxemic cerebral palsy.

Topics: Acidosis; Amniotic Fluid; Brain Ischemia; Cerebral Palsy; Erythroblasts; Erythrocyte Count; Fetal Blood; Fetal Diseases; Humans; Hydrogen-Ion Concentration; Hypoxia; Infant, Newborn; Lymphocyte Count; Meconium; Time Factors; Umbilical Cord; Vasoconstriction

The various physiologic factors which might influence the time of first meconium passage were studied in 62 healthy full-term newborn infants. Thirty-two babies were born vaginally and 30 by elective cesarean section. Infants born vaginally were more acidotic and passed first stool earlier compared to those born by cesarean section. The same applies to vaginally delivered babies when comparing babies born to primipara and others. Acidosis is a presumed mechanism, and a role of gastrointestinal hormones is suggested to be the possible mediator of increased motility in these babies.

Topics: Acidosis; Cesarean Section; Delivery, Obstetric; Female; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Parity; Pregnancy; Umbilical Veins

Although the significance of meconium in the amniotic fluid diagnosed during labor remains problematic, there is little information regarding the significance of meconium discovered prior to labor. The present study consisted of 40 term pregnancies with meconium found at amniocentesis for lung maturity (n = 7) or elective cesarean section (n = 33) and 40 uncomplicated, control pregnancies with clear amniotic fluid at elective cesarean section. The mean umbilical artery (UA) blood pH was 7.26 in the meconium group and 7.28 in the control group. Overall, the frequency of fetal acidemia (UA pH < 7.20) was 15% (6 of 40) of the infants in the meconium group versus 8% (3 of 40) in the control group (p = 0.24). All nine of these infants had a respiratory acidosis defined as a UA blood pH less than 7.20 with normal bicarbonate and elevated carbon dioxide pressure. Importantly, none of the neonates had metabolic acidemia and all had uncomplicated hospital courses. All of the pregnancies reported were promptly delivered because of meconium and we therefore cannot recommend nonintervention when meconium is diagnosed in the antepartum period. Meconium discovered prior to labor is not necessarily a marker of immediate or chronic fetal compromise.

Topics: Acid-Base Equilibrium; Acidosis; Acidosis, Respiratory; Amniocentesis; Amniotic Fluid; Case-Control Studies; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Meconium; Pregnancy

A prospective study of the relationships among fetal heart rate pattern, meconium staining of the amniotic fluid, umbilical cord artery pH, and Apgar score was carried out in 1219 consecutive births. Interpretable cardiotocogram patterns and cord arterial pH and blood gas analysis were obtained in 698 cases. The sensitivity of an abnormal cardiotocogram at any time for acidosis (more than 1 SD below the mean, pH less than 7.17) was 80%, and for severe acidosis (more than 2 SDs below the mean, pH less than 7.085) was 83%. However, the predictive value was low, and 32% of fetuses had an abnormal cardiotocogram but no acidosis. If only cardiotocogram abnormality in the first stage of labor was considered, sensitivity was still 47% for acidosis and 67% for severe acidosis, and the false-positive rate was reduced to only 14%. We attempted to improve the prediction of acidosis by including meconium staining of the amniotic fluid, but 65% of the variation in umbilical cord artery pH and 72 and 86% of the variation in 1- and 5-minute Apgar scores, respectively, remained unexplained. In light of these poor correlations, the current practice of considering cardiotocogram abnormality, meconium staining of the amniotic fluid, acidosis, and low Apgar scores as indicating one single disorder, "fetal distress," is not valid.

Topics: Acidosis; Apgar Score; Cardiotocography; Female; Fetal Blood; Fetal Diseases; Fetal Distress; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pregnancy; Prospective Studies

Fifty-six postterm fetuses with intrapartum meconium passage underwent routine scalp stimulation and scalp blood sampling. Fetal heart rate (FHR) patterns were compared with blood pH. Nine fetuses (16%) had a scalp pH less than 7.20. Twenty-nine fetuses (54%) demonstrated spontaneous or induced FHR accelerations; none were acidemic. Acidemia with normal variability was found only in conjunction with severe variable decelerations, and may represent respiratory acidosis. In this group, two of nine acidemic fetuses demonstrated no decelerations (pH 7.04) or mild variable decelerations only (pH 7.19). The absence of late decelerations was not as reliable as the presence of accelerations in the prediction of fetal well-being. Thirty-three percent of the fetuses who failed to exhibit spontaneous or provoked FHR accelerations were acidemic. These findings suggest that in this high-risk group of fetuses, the absence of spontaneous FHR accelerations should be followed by an attempt to induce accelerations, scalp pH assessment, or cesarean section.

Topics: Acidosis; Female; Fetal Diseases; Fetal Monitoring; Heart Rate, Fetal; Humans; Meconium; Pregnancy; Pregnancy, Prolonged; Tachycardia

Topics: Acidosis; Female; Fetal Diseases; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pneumonia, Aspiration; Pregnancy

The relation between Apgar score, meconium and acidaemia at birth and neonatal neurological morbidity was investigated in 805 vaginally born term infants whose birthweight was appropriate-for-dates (AFD). Presence or absence of meconium stained amniotic fluid was not related to the neonatal neurological condition. The 1-min and 3-min Apgar scores and the umbilical artery pH were related, but the variances explained in neonatal neurological optimality score were very low (0.9 and 0.5% respectively). Combination of Apgar score and pH slightly increased these percentages to 1.5. The highest frequency of neurologically deviant infants was, on the other hand, found in the group with a normal pH but low Apgar score. It is concluded that in AFD term infants nowadays the predictive value of a low Apgar score, acidaemia at birth and/or presence of meconium for the neonatal neurological morbidity is poor. Most neonatal neurological abnormalities must be due to other factors.

Topics: Acidosis; Amniotic Fluid; Apgar Score; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Nervous System Diseases; Risk

Meconium in labor is associated with increased perinatal morbidity and mortality. To identify the infants at risk, 53 women with moderate-to-thick meconium were followed in labor after obtaining baseline fetal scalp blood pH levels. Although 28 of the newborns (53%) exhibited an arterial cord pH of less than 7.25 at delivery, there were no significant predictive variables found in the electronic fetal monitoring score, Apgar score, or mode of delivery. Nine of the infants with a pH value of less than 7.25 had meconium below the vocal cords at delivery, but none in the infants with pH levels greater than or equal to 7.25. The P50 value for cumulative acidosis is 55 minutes, indicating a more rapid deterioration than an average-for-gestational-age fetus without meconium. Therefore, the presence of thick meconium implies that fetal stress must be avoided during labor, and early intervention is warranted when there is deviation from normal labor progress or fetal heart rate pattern.

Topics: Acidosis; Adult; Female; Fetal Blood; Fetal Diseases; Fetal Heart; Fetal Monitoring; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Inhalation; Meconium; Pneumonia, Aspiration; Pregnancy; Prenatal Diagnosis; Respiration

The experienced obstetrician knows that depressed neonates do not always herald their coming, and that the potential liability for failure to intervene promptly is great. It is imperative that all personnel involved in the delivery and care of newborns be familiar with these principles of newborn resuscitation.

Topics: Acidosis; Animals; Animals, Newborn; Apgar Score; Asphyxia Neonatorum; Central Nervous System; Emergencies; Female; Glycolysis; Heart Rate; Humans; Infant, Newborn; Infant, Premature; Macaca mulatta; Meconium; Pregnancy; Respiration, Artificial; Resuscitation; Risk

A prospective study was undertaken to determine if the passage of meconium during the early intrapartum period (cervical dilatation 3 cm or less), the type of meconium passed (thick versus thin), and fetal pH values could be correlated with Apgar scores as a predictor of neonatal outcome. One hundred seventy-seven patients had meconium-stained amniotic fluid and a cervical dilatation of 3 cm or less at admission. Group 2 (thick meconium) had significantly lower 1- and 5-minute Apgar scores, lower scalp pH values, and increased risk factors, such as prolonged pregnancy, small-for-gestational-age fetus, and fetal heart rate abnormalities. Group 2 (thin meconium) and the control group (nonmeconium) appeared to have no increased associated risks. Thick meconium as a single variable appeared to be the most significant factor influencing fetal outcome; however, if an associated fetal heart rate abnormality was present, perinatal morbidity was greatly increased as indicated by fetal acidosis and lower 1- and 5-minute Apgar scores. It thus appears that early passage of thick meconium does correlate with fetal outcome and increased perinatal morbidity. The significance of meconium passage is discussed and a modern obstetric management scheme for these high-risk patients is presented.

Topics: Acidosis; Adult; Amniotic Fluid; Apgar Score; Blood; Delivery, Obstetric; Female; Fetal Diseases; Fetal Heart; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor Stage, First; Meconium; Pregnancy; Pregnancy, Prolonged; Prospective Studies; Risk; Scalp

Topics: Acidosis; Adult; Apgar Score; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Infant, Newborn; Meconium; Pregnancy

Intrapartum electronic fetal monitoring tracings from 620 women monitored internally over 60 minutes were analyzed. Fetal heart rate patterns were statistically analyzed against four variables of labor: 1) the presence of meconium; 2) fetal acidosis; 3) 1-minute Apgar score; and 4) clinical correlates considered as etiologic factors in FHR decelerations. No significant etiologic correlation was found between these clinical correlates and FHR deceleration patterns. Statistically significant correlations were established between poor neonatal outcome and fetal acidosis (P less than 0.01) and the presence of meconium (P less than 0.05). No correlation was found between FHR patterns and fetal acidosis. Variable deceleration showed no significant relation to low Apgar score (less than or equal to 6). Late deceleration showed a significant correlation with depressed infants. FHR patterns are best used as an alarm system of fetal difficulty than as an absolute measure of fetal distress.

Topics: Acidosis; Adult; Amniotic Fluid; Apgar Score; Female; Fetal Diseases; Fetal Heart; Heart Rate; Humans; Labor, Obstetric; Meconium; Monitoring, Physiologic; Pregnancy

Topics: Abruptio Placentae; Acidosis; Amniotic Fluid; Apgar Score; Female; Fetal Death; Fetal Diseases; Fetoscopy; Humans; Hydrogen-Ion Concentration; Infant Mortality; Infant, Newborn; Labor, Induced; Labor, Obstetric; Meconium; Obstetric Labor Complications; Placenta; Pregnancy; Pregnancy, Prolonged; Umbilical Cord

Topics: Acid-Base Equilibrium; Acidosis; Alberta; Amniotic Fluid; Anesthesia, Obstetrical; Apgar Score; Autonomic Nerve Block; Blood; Carbon Dioxide; Delivery, Obstetric; Female; Fetal Heart; Fetus; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Meperidine; Oxygen; Partial Pressure; Pregnancy; Promethazine; Sweden

Topics: Acid-Base Equilibrium; Acidosis; Female; Fetal Diseases; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pregnancy; Tachycardia; Uterine Inertia

Topics: Acidosis; Apgar Score; Blood Specimen Collection; Bradycardia; Carbon Dioxide; Delivery, Obstetric; Female; Fetal Diseases; Gestational Age; Heart Rate; Humans; Hydrogen-Ion Concentration; Hypoxia; Infant, Newborn; Inhalation; Meconium; Methods; Monitoring, Physiologic; Oxygen; Pregnancy; Prognosis; Prospective Studies; Scalp; Tachycardia

Topics: Acidosis; Diagnosis, Differential; Female; Fetal Diseases; Heart Auscultation; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Maternal-Fetal Exchange; Meconium; Physical Examination; Pregnancy; Statistics as Topic

Topics: Acidosis; Amniotic Fluid; Asphyxia; Asphyxia Neonatorum; Endoscopy; Erythroblastosis, Fetal; Female; Fetal Diseases; Hemoglobinometry; Humans; Infant, Newborn; Infant, Newborn, Diseases; Maternal-Fetal Exchange; Meconium; Pregnancy; Pregnancy Complications; Serum Albumin, Radio-Iodinated; Spectrophotometry; Tromethamine

Topics: Acid-Base Equilibrium; Acidosis; Adult; Amniotic Fluid; Female; Fetal Diseases; Fetal Heart; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Umbilical Arteries

Topics: Acid-Base Equilibrium; Acidosis; Amniotic Fluid; Blood Chemical Analysis; Blood Gas Analysis; Female; Fetus; Humans; Hydrogen-Ion Concentration; Lactates; Meconium; Oximetry; Pre-Eclampsia; Pregnancy