morphine and Chorioamnionitis

morphine has been researched along with Chorioamnionitis* in 40 studies

Reviews

8 review(s) available for morphine and Chorioamnionitis

ArticleYear
Meconium-stained amniotic fluid.
    American journal of obstetrics and gynecology, 2023, Volume: 228, Issue:5S

    Green-stained amniotic fluid, often referred to as meconium-stained amniotic fluid, is present in 5% to 20% of patients in labor and is considered an obstetric hazard. The condition has been attributed to the passage of fetal colonic content (meconium), intraamniotic bleeding with the presence of heme catabolic products, or both. The frequency of green-stained amniotic fluid increases as a function of gestational age, reaching approximately 27% in post-term gestation. Green-stained amniotic fluid during labor has been associated with fetal acidemia (umbilical artery pH <7.00), neonatal respiratory distress, and seizures as well as cerebral palsy. Hypoxia is widely considered a mechanism responsible for fetal defecation and meconium-stained amniotic fluid; however, most fetuses with meconium-stained amniotic fluid do not have fetal acidemia. Intraamniotic infection/inflammation has emerged as an important factor in meconium-stained amniotic fluid in term and preterm gestations, as patients with these conditions have a higher rate of clinical chorioamnionitis and neonatal sepsis. The precise mechanisms linking intraamniotic inflammation to green-stained amniotic fluid have not been determined, but the effects of oxidative stress in heme catabolism have been implicated. Two randomized clinical trials suggest that antibiotic administration decreases the rate of clinical chorioamnionitis in patients with meconium-stained amniotic fluid. A serious complication of meconium-stained amniotic fluid is meconium aspiration syndrome. This condition develops in 5% of cases presenting with meconium-stained amniotic fluid and is a severe complication typical of term newborns. Meconium aspiration syndrome is attributed to the mechanical and chemical effects of aspirated meconium coupled with local and systemic fetal inflammation. Routine naso/oropharyngeal suctioning and tracheal intubation in cases of meconium-stained amniotic fluid have not been shown to be beneficial and are no longer recommended in obstetrical practice. A systematic review of randomized controlled trials suggested that amnioinfusion may decrease the rate of meconium aspiration syndrome. Histologic examination of the fetal membranes for meconium has been invoked in medical legal litigation to time the occurrence of fetal injury. However, inferences have been largely based on the results of in vitro experiments, and extrapolation of such findings to the clinical setting warrants caution. Fetal defecatio

    Topics: Amniotic Fluid; Chorioamnionitis; Female; Heme; Humans; Infant, Newborn; Inflammation; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Complications

2023
Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections.
    The Cochrane database of systematic reviews, 2014, Nov-06, Issue:11

    Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result from meconium aspiration syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity.. The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections.. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2014). . Randomised controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF.. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.. We included two studies with 362 pregnant women. Both studies compared ampicillin-sulbactam (N = 183) versus normal saline (N = 179) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, there was a significant decrease in the risk of chorioamnionitis (RR 0.36, 95% CI 0.21 to 0.62). No serious adverse effects were reported. Drug resistance, duration of mechanical ventilation and duration of admission to NICU/hospital were not reported. Most of the domains for risk of bias were at low risk of bias for one study and at unclear risk of bias for the other study. The quality of the evidence using GRADE was low for neonatal sepsis, postpartum endometritis, and neonatal mortality and morbidity prior to discharge (Neonatal intensive care admissions) and of moderate quality for chorioamnionitis.. Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.

    Topics: Amniotic Fluid; Ampicillin; Anti-Bacterial Agents; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Labor, Obstetric; Meconium; Pregnancy; Randomized Controlled Trials as Topic; Sepsis; Sulbactam

2014
Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections.
    The Cochrane database of systematic reviews, 2010, Dec-08, Issue:12

    Chorioamnionitis is more likely to occur when meconium-stained amniotic fluid (MSAF) is present. Meconium may enhance the growth of bacteria in amniotic fluid by serving as a growth factor, inhibiting bacteriostatic properties of amniotic fluid. Many adverse neonatal outcomes related to MSAF result from Meconium Aspiration Syndrome (MAS). MSAF is associated with both maternal and newborn infections. Antibiotics may be an effective option to reduce such morbidity.. The objective of this review is to assess the efficacy and side effects of prophylactic antibiotics for MSAF during labour in preventing maternal and neonatal infections.. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2010). . Randomized controlled trials (RCTs) comparing prophylactic antibiotics with placebo or no treatment during labour for women with MSAF.. Two review authors independently assessed the results of the only available trial and extracted data on maternal and neonatal outcomes.. We included one study with 120 pregnant women. It compared ampicillin-salbactam (N = 60) versus normal saline (N = 60) in pregnant women with MSAF. Prophylactic antibiotics appeared to have no statistically significant reduction in the incidence of neonatal sepsis (risk ratio (RR) 1.00, 95% CI 0.21 to 4.76), neonatal intensive care unit (NICU) admission (RR 0.83, 95% CI 0.39 to 1.78) and postpartum endometritis (RR 0.50, 95% CI 0.18 to 1.38). However, significant decrease in the risk of chorioamnionitis (RR 0.29, 95% CI 0.10 to 0.82). No serious adverse effects were reported.. Current evidence indicates that compared to placebo, antibiotics for MSAF in labour may reduce chorioamnionitis. There was no evidence that antibiotics could reduce postpartum endometritis, neonatal sepsis and NICU admission. This systematic review identifies the need for more well-designed, adequately powered RCTs to assess the effect of prophylactic antibiotics in the incidence of maternal and neonatal complications.

    Topics: Amniotic Fluid; Ampicillin; Anti-Bacterial Agents; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Labor, Obstetric; Meconium; Pregnancy; Randomized Controlled Trials as Topic; Sepsis; Sulbactam

2010
[Meconium and postnatal neurologic handicaps].
    Ceska gynekologie, 2001, Volume: 66, Issue:5

    A review of meconium pathophysiology and its contribution to the incidence of postnatal neurological handicap.. Reviewed article.. Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic.. Meconium can be a cause of infant neurological handicap. Two main pathogenetic pathways are mentioned. 1. Meconium (and its components: bile acids) may have a direct vasoconstrictive effect on umbilical and placental vessels. This way still remains controversial. 2. Meconium as a possible cause of intraamniotic infection results in a release of fetal cytokines (TNF alpha, IL-1 beta, IL-6), which can damage myelinogenesis in periventricular white matter.. Meconium in premature labour is a higher risk factor compared to term delivery. 41% of premature infants were diagnosed as having CP when meconium was present compared to 10% in the same group with clear amniotic fluid. The incidence in term pregnancy with meconium present is 0.4% compared to 0.3% in a population without any obstetrical risk.. Ultrasonographically found periventricular leukomalacia is the most reliable sign of subsequent cerebral palsy or other neurological sequelae.

    Topics: Amniotic Fluid; Brain Damage, Chronic; Cerebral Palsy; Chorioamnionitis; Female; Humans; Infant, Newborn; Leukomalacia, Periventricular; Meconium; Placenta; Pregnancy

2001
Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update.
    Pediatric clinics of North America, 1998, Volume: 45, Issue:3

    Over the past 5 years, increasing understanding about the pathophysiology of meconium-stained amniotic fluid (MSAF) and the meconium aspiration syndrome (MAS) has occurred. Many new therapies are being used in an attempt to prevent MAS and to treat the disorder. The authors review the current status of knowledge concerning the MSAF and MAS and management of these entities.

    Topics: Amniotic Fluid; Chorioamnionitis; Female; Humans; Infant, Newborn; Inflammation; Intensive Care, Neonatal; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn

1998
The placenta and its significance in neonatal outcome.
    Advances in pediatrics, 1998, Volume: 45

    The placenta should not be overlooked as a source of much valuable diagnostic information. Close evaluation of the placenta and its attached membranes may reveal further information. Essential data may be obtained from pathologic examination, and if questions exist, specimens should be retained with proper care.

    Topics: Amniotic Band Syndrome; Chorioamnionitis; Decidua; Female; Humans; Infant, Newborn; Meconium; Placenta; Placenta Diseases; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Umbilical Arteries; Umbilical Cord

1998
Clinicopathologic implications of placental pathology.
    Clinical obstetrics and gynecology, 1996, Volume: 39, Issue:3

    Topics: Chorioamnionitis; Chorionic Villi; Cytomegalovirus Infections; Female; Humans; Inflammation; Meconium; Obstetric Labor, Premature; Placenta; Placenta Diseases; Placental Circulation; Pregnancy; Pregnancy Complications, Infectious; Syphilis

1996
A conceptual approach to placental pathology and pregnancy outcome.
    Seminars in diagnostic pathology, 1993, Volume: 10, Issue:3

    This report focuses on the relationship of placental pathology to unfavorable pregnancy outcome. Relevant literature is cited and data from the author's investigations are reported and tabulated. The reader will find detailed information on placental lesions that have not been completely investigated or discussed previously. Particular considerations include placental meconium staining, edema, acute and chronic intrauterine infections, placental fetal vasculopathy with fetal nucleated red blood cells, and chorangiosis or other placental dysmaturity. These pathologic changes often signify the pathogenesis of cerebral palsy and other developmental disorders. Almost 90% of neurodevelopmental disorders are initiated before the intrapartum period. Prenatal asphyxia or severe chronic fetal hypoxia are probably present therein. Most investigations of these afflictions are invalid because they do not include placental study with well-designed epidemiologic methods. The pathologic placental findings that are most strongly associated with perinatal asphyxia include chronic ischemic changes, fetal nucleated red blood cells, intravillous hemorrhage, fetal fibrin vascular intimal cushions, meconium staining, and placental intervillous fibrin. Chorioamnionitis is a pathologic entity rather than a clinical syndrome as defined by obstetricians. When it causes severe prematurity, chorioamnionitis is also associated with cerebral palsy.

    Topics: Asphyxia Neonatorum; Chorioamnionitis; Edema; Erythrocytes; Female; Fetal Diseases; Humans; Infant, Newborn; Meconium; Placenta; Pregnancy; Pregnancy Outcome; Specimen Handling

1993

Trials

2 trial(s) available for morphine and Chorioamnionitis

ArticleYear
Prophylactic cefazolin in amnioinfusions administered for meconium-stained amniotic fluid.
    Infectious diseases in obstetrics and gynecology, 1999, Volume: 7, Issue:3

    To determine if amnioinfusion with an antibiotic solution decreased the rate of clinical chorioamnionitis and puerperal endometritis in patients with meconium-stained amniotic fluid.. Patients in labor at 36 weeks of gestation or greater with singleton pregnancies and meconium-stained amniotic fluid were randomized to receive either cefazolin, 1 g/1,000 mL, of normal saline (n = 90) or normal saline (n = 93) amnioinfusion. Rates of clinically diagnosed chorioamnionitis and endometritis and of suspected and culture-proven neonatal infection were determined.. Between the study and control groups, the incidences of clinical chorioamnionitis (7.8% vs. 8.6%), endometritis (2.4% vs. 3.5%), aggregate intrauterine infection (10.0% vs. 11.8%), suspected neonatal infection (17.8% vs. 21.5%), and proven neonatal infection (0.0% vs. 2.2%) were not significantly different.. Prophylactic use of cefazolin in amnioinfusions did not significantly reduce rates of maternal or neonatal infection in patients with meconium-stained amniotic fluid.

    Topics: Adult; Amniotic Fluid; Cefazolin; Cephalosporins; Chorioamnionitis; Double-Blind Method; Drug Administration Schedule; Endometritis; Female; Humans; Meconium; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies

1999
Prophylactic amnioinfusion for meconium-stained amniotic fluid.
    American journal of obstetrics and gynecology, 1994, Volume: 171, Issue:4

    Previous studies have demonstrated reduced perinatal morbidity in patients receiving amnioinfusion for meconium-stained amniotic fluid compared with control patients receiving no amnioinfusion. Because amnioinfusion for variable fetal heart rate decelerations has become accepted care, we sought to determine the benefit of prophylactic amnioinfusion for meconium compared with standard care, incorporating therapeutic amnioinfusion for variable decelerations.. Ninety-three term patients with moderate to heavy meconium and no variable fetal heart rate decelerations were randomized to immediate prophylactic amnioinfusion (600 ml saline solution bolus followed by 3 ml/min) or to standard care (including therapeutic amnioinfusion for variable decelerations developing later). All babies had DeLee suctioning on delivery of the head. Laryngeal cords were visualized and tracheal suctioning performed when meconium was seen below the cords. Statistical comparisons were performed using Student t test, Fisher's exact test, or chi 2 analysis.. There were no significant differences in the incidence of operative delivery, fetal distress, or meconium below the cords or in newborn Apgar scores and umbilical artery gas values between the amnioinfusion (n = 43) and control (n = 50) patients. There were four cases of meconium aspiration, three in the amnioinfusion group, one in the standard care group. The rate of endometritis-chorioamnionitis was higher (p = 0.3) in the amnioinfusion (16%) than in the control group (8%), although time from ruptured membranes to delivery (8.5 hours vs 7.3 hours) and duration of intrauterine monitoring (6.1 hours vs 5.3 hours) were not different.. Although amnioinfusion does dilute amniotic meconium, prophylactic amnioinfusion for meconium in the absence of variable decelerations remains controversial. Prophylactic amnioinfusion in term pregnancies did not improve perinatal outcome and increased the risk for chorioamnionitis-endometritis. Together with recent reports, the current data suggest that the benefit of amnioinfusion for meconium-stained amniotic fluid is a result of the alleviation of variable fetal heart rate decelerations rather than meconium dilution.

    Topics: Adult; Amnion; Amniotic Fluid; Chi-Square Distribution; Chorioamnionitis; Endometritis; Female; Heart Rate, Fetal; Humans; Infant, Newborn; Infusions, Parenteral; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Prospective Studies; Sodium Chloride

1994

Other Studies

30 other study(ies) available for morphine and Chorioamnionitis

ArticleYear
Perinatal risk factors associated with the need for resuscitation in newborns born through meconium-stained amniotic fluid.
    Resuscitation, 2023, Volume: 185

    The Neonatal Life Support 2020 guidelines emphasize that meconium-stained amniotic fluid (MSAF) remains a significant risk factor for a newborn to receive advanced resuscitation, especially if additional risk factors are present at the time of birth. However, these additional perinatal risk factors are not clearly identified. The purpose of this study was to evaluate the importance of additional independent ante- and intrapartum risk factors in the era of no routine endotracheal suctioning that determine the need for resuscitation in newborns born through MSAF.. This retrospective cohort study included deliveries ≥ 35 weeks' gestation associated with MSAF that occurred between January 1, 2017 and December 31, 2019. The newborns needing resuscitation (any intervention beyond the initial steps) were compared to those not needing resuscitation. Among newborns needing resuscitation, those needing advanced resuscitation (continuous positive airway pressure/ positive pressure ventilation or beyond) were compared to those not needing advanced resuscitation.. Logistic regression analysis revealed that among various perinatal factors, primigravida, thick meconium, fetal distress, chorioamnionitis, rupture of membranes ≥ 18 hours, post-term (gestational age ≥ 42 weeks), cesarean section or shoulder dystocia independently significantly increased the odds of a meconium-stained newborn needing resuscitation. Among these factors, fetal distress, chorioamnionitis or cesarean section independently further increased the odds of needing advanced resuscitation.. Risk stratification of perinatal factors associated with the need for newborn resuscitation and advanced resuscitation in the deliveries associated with MSAF may help neonatal teams and resources to be appropriately prioritized and optimally utilized.

    Topics: Amniotic Fluid; Cesarean Section; Chorioamnionitis; Female; Fetal Distress; Humans; Infant; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Complications; Retrospective Studies; Risk Factors

2023
The effect of meconium-stained amniotic fluid on perinatal outcome in pregnancies complicated by preterm premature rupture of membranes.
    Archives of gynecology and obstetrics, 2020, Volume: 301, Issue:5

    To determine whether meconium-stained amniotic fluid (MSAF) encountered in pregnancies complicated by preterm premature rupture of membranes (PPROM) is associated with adverse maternal and perinatal outcome.. A retrospective cohort study of all singleton pregnancies with PPROM and MSAF who delivered in a tertiary hospital at 24 + 0-36 + 6 weeks of gestation between 2007 and 2017. Women with PPROM-MSAF (study group) were compared to women with PPROM and clear amniotic fluid (control group). Controls were matched to cases according to age, gravidity, parity and gestational age at delivery in a 3:1 ratio. Primary outcome was defined as neonatal intensive care unit admission. Secondary outcomes were neonatal adverse outcomes, chorioamnionitis and placental abruption diagnosed clinically or by placental cultures and histology.. Seventy-five women comprised the study group and were matched to 225 women representing the control group. A significantly higher rate of neonatal intensive care unit admissions was noted in the study group compared to controls (61.3% vs. 45.7%, p = 0.03). Multivariate analysis demonstrated that MSAF is an independent risk factor for neonatal intensive care unit admission (adjusted OR = 2.82, 95% CI 1.39-5.75, p = 0.004). MSAF was found to be associated to higher rates of cesarean and operative vaginal deliveries (30.7% vs. 24.4% and 5.3% vs. 2.7%, p = 0.057, respectively) as well as to chorioamnionitis and placental abruption (33.3% vs. 19.3%, p = 0.034 and 16.0% vs. 7.7%, p = 0.021, respectively).. MSAF is associated with higher frequencies of adverse perinatal outcome when compared to clear amniotic fluid in pregnancies complicated by PPROM.

    Topics: Abruptio Placentae; Adult; Amniotic Fluid; Case-Control Studies; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Meconium; Perinatal Mortality; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pregnancy Outcome; Retrospective Studies; Risk Factors

2020
Isolated acute funisitis in the absence of acute chorioamnionitis: What does it mean?
    Placenta, 2019, Volume: 75

    Acute funisitis (AF) is most commonly associated with acute chorioamnionitis (AC) and ascending infection. The significance of cases of AF without associated AC or isolated funisitis (IF) is unknown. Our objective was to evaluate clinical and pathologic features of IF and to determine its significance.. This was a retrospective review of placentas of patients delivering at our institution from 1997 to 2017. Placentas with the diagnosis of IF comprised the study population and placentas without either AF or AC served as controls.. There were 156 cases and 181 controls identified. Maternal age, gestational age, birthweight and mode of delivery were similar in both groups. 132 (84.6%) of cases of IF had meconium, with 62 (47.0%) having meconium only in the membranes, 36 (27.3%) in the membranes and cord and 34 (25.6%) in the membranes and cord with associated myonecrosis. 72 (38.7%) of controls had microscopically identified meconium, with only one (1.4%) showing meconium in the cord. None had myonecrosis (p < .001). There was also a significantly higher rate of intrauterine fetal demise (IUFD) in the IF group (p = .027). but the rate of suspected Intrauterine growth restriction (IUGR) was significantly greater in the controls (p = .014).. IF is highly associated with the presence of meconium discharge and meconium-associated myonecrosis of umbilical vessels. The inflammation in IF may be the result of damage to the muscle fibers of the cord due to meconium but additional studies are necessary to understand the significance of these findings.

    Topics: Chorioamnionitis; Female; Humans; Meconium; Placenta; Pregnancy; Retrospective Studies

2019
Unexpected term NICU admissions: a marker of obstetrical care quality?
    American journal of obstetrics and gynecology, 2019, Volume: 220, Issue:4

    Unexpected admissions of term neonates to the neonatal intensive care unit and unexpected postnatal complications have been proposed as neonatal-focused quality metrics for intrapartum care. Previous studies have noted significant variation in overall hospital neonatal intensive care unit admission rates; however, little is known about the influence of obstetric practices on these rates or whether variation among unanticipated admissions in low-risk, term neonates can be attributed to systemic hospital practices.. The objective of the study was to examine the relative effects of patient characteristics and intrapartum events on unexpected neonatal intensive care unit admissions and to quantify the between-hospital variation in neonatal intensive care unit admission rates among this group of neonates.. We performed a retrospective cross-sectional study using data collected as part of the Consortium for Safe Labor study. Women who delivered term (≥37 weeks), singleton, nonanomalous, liveborn infants without an a priori risk for neonatal intensive care unit admission were included. The primary outcome was neonatal intensive care unit admission among this population. Multilevel mixed-effect models were used to calculate adjusted odds ratios for demographics (age, race, insurer), pregnancy characteristics (parity, gestational age, tobacco use, birthweight), maternal comorbidities (chronic and pregnancy-induced hypertension), hospital characteristics (delivery volume, hospital and neonatal intensive care unit level, academic affiliation), and intrapartum events (prolonged second stage, induction of labor, trial of labor after cesarean delivery, chorioamnionitis, meconium-stained amniotic fluid, and abruption). Intraclass correlation coefficients were used to estimate the between-hospital variance in a series of hierarchical models.. Of the 143,951 infants meeting all patient and hospital inclusion criteria, 7995 (5.6%) were admitted to the neonatal intensive care unit after birth. In the fully adjusted model, the factors associated with the highest odds for neonatal intensive care unit admission included: nulliparity (adjusted odds ratio, 1.62 [95% confidence interval, 1.53-1.71]), large for gestational age (adjusted odds ratio, 1.59 [95% confidence interval, 1.47-1.71]), and small for gestational age (adjusted odds ratio, 1.60 [95% confidence interval, 1.47-1.73]). Induction of labor (adjusted odds ratio, 0.95 [95% confidence interval, 0.89-1.01]) was not associated with increased odds of neonatal intensive care unit admission compared with women who labored spontaneously. The events associated with higher odds of neonatal intensive care unit admission included: prolonged second stage (adjusted odds ratio, 1.66 [95% confidence interval, 1.51-1.83]); chorioamnionitis (adjusted odds ratio, 3.89 [95% confidence interval, 3.42-4.44]), meconium-stained amniotic fluid (adjusted odds ratio, 1.96 [95% confidence interval, 1.82-2.10]), and abruption (adjusted odds ratio, 2.64 [95% confidence interval, 2.16-.21]). Compared with women who did not labor, the odds of neonatal intensive care unit admission were lower for women who labored: adjusted odds ratio, 0.48 (95% confidence interval, 0.45-0.52) for women with no uterine scar and adjusted odds ratio, 0.83 (95% confidence interval, 0.73-0.94) for women with a uterine scar. There was significant variation in neonatal intensive care unit admission rates by hospital, ranging from 2.9% to 11.2%. After accounting for case mix and hospital characteristics, the between-hospital variance was 1.9%, suggesting that little of the variation was explained by the effect of the hospital.. This study contributes to the currently limited understanding of term, neonatal intensive care unit admission rates as a marker of obstetrical care quality. We demonstrated that significant variation exists in hospital unexpected neonatal intensive care unit admission rates and that certain intrapartum events are associated with an increased risk for neonatal intensive care unit admission after delivery. However, the between-hospital variation was low. Unmeasured confounders and extrinsic factors, such as neonatal intensive care unit bed availability, may limit the ability of unexpected term neonatal intensive care unit admissions to meaningfully reflect obstetrical care quality.

    Topics: Abruptio Placentae; Adult; Amniotic Fluid; Chorioamnionitis; Cross-Sectional Studies; Female; Fetal Macrosomia; Hospitalization; Humans; Infant, Newborn; Infant, Small for Gestational Age; Intensive Care Units, Neonatal; Labor, Induced; Male; Meconium; Obstetrics; Parity; Pregnancy; Quality Indicators, Health Care; Quality of Health Care; Retrospective Studies; Risk Factors; Term Birth; Young Adult

2019
Meconium staining of the amniotic fluid and the presence and severity of acute placental inflammation: a study of term deliveries in a predominantly African-American population.
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2018, Volume: 31, Issue:23

    To determine frequency, stage and grade of placental histologic acute maternal inflammatory response (MIR) and fetal inflammatory response (FIR) in meconium-stained amniotic fluid (MSAF) in our predominantly African-American population.. Term placentas with MSAF (n = 310) were evaluated for MIR/FIR, including stage/grade, and compared with placentas with clear amniotic fluid (AF) (n = 250). MIR/FIR were also evaluated in thick compared to thin MSAF subgroups. Selected demographic and clinical features were compared.. MIR and FIR were present in 57.7 and 40.3% of the MSAF compared to 44.0 and 29.2% of the clear AF group, respectively (p = .001 and .008). MIR with FIR was present in 35.8% of the MSAF compared to 25.2% of the clear AF group (p = .008); however, there was no significant difference in frequency of MIR without FIR between groups. There was no significant difference in frequency of MIR/FIR in thick compared to thin MSAF; however, thick MSAF was associated with higher FIR stage compared to thin MSAF (29.2 versus 5.4%, p = .004). This association was not seen with MIR stage or MIR/FIR grade.. Histologic MIR and FIR are frequent findings in MSAF. Thick MSAF is associated with higher FIR stage when compared to thin MSAF.

    Topics: Adult; Amniotic Fluid; Black or African American; Case-Control Studies; Chorioamnionitis; Female; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Placenta; Pregnancy; Retrospective Studies

2018
Preterm meconium-stained amniotic fluid is an ominous sign for the development of chorioamnionitis and for in utero cord compression.
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2017, Volume: 30, Issue:17

    Meconium-stained amniotic fluid (MSAF) is rarely observed in preterm pregnancies, and its clinical significance is undetermined. We evaluated the correlation between MSAF and obstetrical and perinatal complications prior to 34 weeks' gestation.. Pregnancies complicated with MSAF between 24 and 34 weeks of gestation were compared with same gestational age-matched controls. The variables measured were: obstetrical complications: clinical chorioamnionitis, Intrahepatic Cohlestasis of Pregnancy - ICP, Intra Uterine Growth Restriction - IUGR, preeclampsia, gestational diabetes; nonobstetrical complications; and perinatal complications: cord around neck/body, Apgar <7 at 5 min, cord pH, Neonatal Intensive Care Unit - NICU admission, complications during NICU hospitalization, and composite outcome.. Higher incidence of clinical chorioamnionitis (15% versus 4.3%; p = 0.041) and higher incidence of cord around the neck/body were found in the MSAF group in comparison with the clear AF group (27.4% versus 18.4%; p = 0.04). No significant differences between the study's groups were found in nonobstetrical complications or other perinatal complications investigated in our study.. MSAF in preterm pregnancy is an ominous sign for the occurrence of chorioamnionitis and for in utero cord compression. Therefore, MSAF in preterm pregnancies should be considered as a non-reassuring sign.

    Topics: Adult; Amniotic Fluid; Biomarkers; Case-Control Studies; Cholestasis, Intrahepatic; Chorioamnionitis; Constriction; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Male; Meconium; Nuchal Cord; Pregnancy; Pregnancy Complications; Retrospective Studies; Risk Factors; Umbilical Cord

2017
A Necrotizing Enterocolitis-Associated Gut Microbiota Is Present in the Meconium: Results of a Prospective Study.
    Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2016, Apr-01, Volume: 62, Issue:7

    Anomalous intestinal microbiota development is supposedly associated with development of necrotizing enterocolitis (NEC). Our aim in this study was to identify the intestinal microbiota of patients at risk for NEC.. In a prospective trial that investigated prognostic factors for development of NEC in high-risk neonates (NTR4153), 11 NEC cases were gestational age/birthweight matched with controls (ratio of 1:2). Feces were collected twice a week. We used the first feces sample of each patient (meconium), as well as the last 2 feces samples prior to development of NEC. DNA was extracted, and the bacterial 16S rRNA genes were analyzed on a MiSeq sequencer.. The presence and abundance of Clostridium perfringens (8.4%) and Bacteroides dorei (0.9%) in meconium were increased in neonates who developed NEC compared with controls (0.1% and 0.2%; both species, P < .001). In post-meconium samples, the abundance of staphylococci became negatively associated with NEC development (P = .1 and P = .01 for consecutive samples); Clostridium perfringens continued to be more prevalent in NEC cases. Early enteral feeding and, in particular, breast milk were correlated with an increase in lactate-producing bacilli in post-meconium samples (ρ = -0.45; P = .004).. A NEC-associated gut microbiota can be identified in meconium samples; C. perfringens continues to be associated with NEC from the first meconium till just before NEC onset. In contrast, in post-meconium, increased numbers of staphylococci were negatively associated with NEC. These findings suggest causality but this causality should be verified in trials of induced infection in animals, targeted antibiotics, and/or probiotics.. CALIFORNIA trial, registered under trial number NTR4153 in the Dutch Trial Registry.

    Topics: Adult; Cesarean Section; Chorioamnionitis; DNA, Bacterial; Enterocolitis, Necrotizing; Female; Gastrointestinal Microbiome; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Pregnancy; Principal Component Analysis; Prospective Studies; Risk Factors; Young Adult

2016
Bacteria and endotoxin in meconium-stained amniotic fluid at term: could intra-amniotic infection cause meconium passage?
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2014, Volume: 27, Issue:8

    Meconium-stained amniotic fluid (MSAF) is a common occurrence among women in spontaneous labor at term, and has been associated with adverse outcomes in both mother and neonate. MSAF is a risk factor for microbial invasion of the amniotic cavity (MIAC) and preterm birth among women with preterm labor and intact membranes. We now report the frequency of MIAC and the presence of bacterial endotoxin in the amniotic fluid of patients with MSAF at term.. We conducted a cross-sectional study including women in presumed preterm labor because of uncertain dates who underwent amniocentesis, and were later determined to be at term (n = 108). Patients were allocated into two groups: (1) MSAF (n = 66) and (2) clear amniotic fluid (n = 42). The presence of bacteria was determined by microbiologic techniques, and endotoxin was detected using the Limulus amebocyte lysate (LAL) gel clot assay. Statistical analyses were performed to test for normality and bivariate comparisons.. Bacteria were more frequently present in patients with MSAF compared to those with clear amniotic fluid [19.6% (13/66) versus 4.7% (2/42); p < 0.05]. The microorganisms were Gram-negative rods (n = 7), Ureaplasma urealyticum (n = 4), Gram-positive rods (n = 2) and Mycoplasma hominis (n = 1). The LAL gel clot assay was positive in 46.9% (31/66) of patients with MSAF, and in 4.7% (2/42) of those with clear amniotic fluid (p < 0.001). After heat treatment, the frequency of a positive LAL gel clot assay remained higher in the MSAF group [18.1% (12/66) versus 2.3% (1/42), p < 0.05]. Median amniotic fluid IL-6 concentration (ng/mL) was higher [1.3 (0.7-1.9) versus 0.6 (0.3-1.2), p = 0.04], and median amniotic fluid glucose concentration (mg/dL) was lower [6 (0-8.9) versus 9 (7.4-12.6), p < 0.001] in the MSAF group, than in those with clear amniotic fluid.. MSAF at term was associated with an increased incidence of MIAC. The index of suspicion for an infection-related process in postpartum women and their neonates should be increased in the presence of MSAF.

    Topics: Adolescent; Adult; Amniotic Fluid; Bacteria; Chorioamnionitis; Cross-Sectional Studies; Endotoxins; Female; Humans; Incidence; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pregnancy; Pregnancy Complications, Infectious; Puerperal Disorders; Term Birth; Young Adult

2014
Serial neutrophil values facilitate predicting the absence of neonatal early-onset sepsis.
    The Journal of pediatrics, 2014, Volume: 164, Issue:3

    To validate established neonatal neutrophil reference ranges (RRs) and determine the utility of serial measurements of neutrophil values in the first 24 hours to predict the absence of neonatal early-onset sepsis (EOS).. Retrospective study of 2073 admissions to the neonatal intensive care unit (2009-2011). Neonates were classified as blood culture-positive, proven EOS (n = 9), blood culture-negative but clinically suspect EOS (n = 292), and not infected (n = 1292). Neutrophil values from 745 not-infected neonates without perinatal complications were selected to validate RR distributions. Positive and negative predictive values were calculated; area under receiver operating characteristic curves (AUCs) were constructed to predict the presence or absence of EOS. Neutrophil value scores were established to determine whether serial neutrophil values predict the absence of EOS.. Seventy-seven percent of admissions to the neonatal intensive care unit were evaluated for EOS: 9 (0.56%) had proven EOS with positive blood culture ≤ 37 hours; 18% had clinically suspect EOS. Neutropenia occurred in preterm neonates, and nonspecific neutrophilia was common in uninfected neonates. The distribution of neutrophil values differed significantly between study groups. The specificity for absolute total immature neutrophils and immature to total neutrophil proportions was 91% and 94%, respectively, with negative predictive value of 99% for proven and 78% for proven plus suspect EOS. Absolute total immature neutrophils and immature to total neutrophil proportions had the best predictability for EOS >6 hours postnatal with an AUC ∼ 0.8. Neutrophil value scores predicted the absence of EOS with AUC of 0.9 and 0.81 for proven and proven plus suspect EOS, respectively.. Age-dependent neutrophil RRs remain valid. Serial neutrophil values at 0, 12, and 24 hours plus blood culture and clinical evaluation can be used to discontinue antimicrobial therapy at 36-48 hours.

    Topics: Apgar Score; Asphyxia Neonatorum; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Meconium; Neutrophils; Predictive Value of Tests; Pregnancy; Reference Values; Resuscitation; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Sepsis

2014
Immunohistochemical detection of meconium in the fetal membrane, placenta and umbilical cord.
    Placenta, 2012, Volume: 33, Issue:1

    To develop the immunohistochemistry specific for meconium in the placenta, fetal membrane and umbilical cord.. We previously reported the specific presence of zinc coproporphyrin I (ZnCP-I) in human meconium and demonstrated the possible diagnostic use of an elevation in maternal plasma ZnCP-I levels in cases of amniotic fluid embolism. In this study, we developed a new specific monoclonal antibody for ZnCP-I and applied it to the immunostaining of meconium in the placenta, fetal membrane, and umbilical cord.. Immunoreactivity of ZnCP-I clearly and specifically identified meconium in the placenta, fetal membrane, and umbilical cord. It was especially useful in cases of severe chorioamnionitis to detect meconium in the macrophages surrounded by numerous neutrophils. In more than half of the cases, meconium was detected in clear amniotic fluid at delivery, suggesting previous exposure.. Immunohistochemical detection of ZnCP-I is a highly sensitive histological diagnosis of meconium.

    Topics: Adult; Antibodies, Monoclonal; Antibody Specificity; Chorioamnionitis; Coproporphyrins; Embolism, Amniotic Fluid; Extraembryonic Membranes; Female; Humans; Immunohistochemistry; Infant, Newborn; Macrophages; Mass Screening; Meconium; Meconium Aspiration Syndrome; Neonatal Screening; Placenta; Pregnancy; Severity of Illness Index; Staining and Labeling; Umbilical Cord

2012
Ectopic decidua in abdominal washings found intraoperatively at cesarean section.
    Diagnostic cytopathology, 2010, Volume: 38, Issue:10

    Topics: Abdominal Cavity; Adult; Cesarean Section; Chorioamnionitis; Choristoma; Decidua; Female; Humans; Intraoperative Period; Meconium; Pregnancy; Therapeutic Irrigation

2010
Maternal death following cardiopulmonary collapse after delivery: amniotic fluid embolism or septic shock due to intrauterine infection?
    American journal of reproductive immunology (New York, N.Y. : 1989), 2010, Aug-01, Volume: 64, Issue:2

    The amniotic fluid embolism (AFE) syndrome is a catastrophic complication of pregnancy frequently associated with maternal death. The causes and mechanisms of disease responsible for this syndrome remain elusive.. We report two cases of maternal deaths attributed to AFE: (1) one woman presented with spontaneous labor at term, developed intrapartum fever, and after delivery had sudden cardiovascular collapse and disseminated intravascular coagulation (DIC), leading to death; (2) another woman presented with preterm labor and foul-smelling amniotic fluid, underwent a Cesarean section for fetal distress, and also had postpartum cardiovascular collapse and DIC, leading to death.. Of major importance is that in both cases, the maternal plasma concentration of tumor necrosis factor-alpha at the time of admission to the hospital and when patients had no clinical evidence of infection was in the lethal range (a lethal range is considered to be above 0.1 ng/mL).. We propose that subclinical intraamniotic infection may be a cause of postpartum cardiovascular collapse and DIC and resemble AFE. Thus, some patients with the clinical diagnosis of AFE may have infection/systemic inflammation as a mechanism of disease. These observations have implications for the understanding of the mechanisms of disease of patients who develop cardiovascular collapse and DIC, frequently attributed to AFE. It may be possible to identify a subset of patients who have biochemical and immunological evidence of systemic inflammation at the time of admission, and before a catastrophic event occurs.

    Topics: Adult; Chorioamnionitis; Diagnosis, Differential; Disseminated Intravascular Coagulation; Embolism, Amniotic Fluid; Fatal Outcome; Female; Humans; Meconium; Postpartum Period; Pregnancy; Sepsis; Shock; Shock, Septic; Tumor Necrosis Factor-alpha

2010
The association between meconium-stained amniotic fluid and chorioamnionitis or endometritis.
    Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2007, Volume: 90, Issue:3

    Assess the association between meconium-stained amniotic fluid and chorioamnionitis or endometritis in term pregnant women.. A five-year retrospective study was undertaken between January 1, 1999 and December 31, 2003. One thousand seventy-nine pregnant women who delivered at the Department of Obstetrics & Gynecology, Phramongkutklao Hospital were included in the present study.. Five hundred andfifty-three pregnant women (51.25%) had meconium-stained amniotic fluid (group 1) and 526 (48.75%) pregnant women were clear of amniotic fluid (group 2). Two pregnant woman in group 1 (0.36%) and eight pregnant women in group 2 (1.52%) were found to have chorioamnionitis (OR = 0.235). Postpartum endometritis was detected in only one (0.18%) pregnant women in group 1 and nine (1.71%) pregnant women in group 2 (OR = 0.104).. No association was found between meconium-stained amniotic fluids and chorioamnionitis or endometritis.

    Topics: Adult; Amniotic Fluid; Chorioamnionitis; Endometritis; Female; Humans; Meconium; Pregnancy; Pregnancy Complications; Retrospective Studies

2007
Duration of the second stage of labor in multiparous women: maternal and neonatal outcomes.
    American journal of obstetrics and gynecology, 2007, Volume: 196, Issue:6

    This study was undertaken to examine perinatal outcomes associated with the second stage of labor in multiparous women.. This is a retrospective cohort study of all term, cephalic, singleton births delivered by multiparous women between 1991 and 2001. Duration of the second stage of labor was stratified into hourly intervals: 0-1 hour, 1-2 hours, 2-3 hours, and 3 hours or longer. Perinatal outcomes were analyzed by using chi2 test and multivariable logistic regression models, by using P<.05 and 95% CI to indicate statistical significance.. Compared with women who delivered between the 0- and 2-hour interval, women with a second stage more than 3 hours had higher risks of operative vaginal deliveries (odds ratio = 13.27; 95% CI [9.38-18.8]), cesarean deliveries (odds ratio = 6.00; [4.06-8.86]), and maternal morbidity including third- or fourth-degree perineal lacerations, postpartum hemorrhage, and chorioamnionitis. Their neonates had higher risks of 5-minute Apgar score less than 7 (odds ratio = 3.63; 95% CI [1.77-7.43]), meconium stained amniotic fluid (odds ratio = 1.44; 95% CI [1.07-1.94]), admission to intensive care nursery (odds ratio = 2.08; 95% CI [1.15-3.77]), composite neonatal morbidity (odds ratio = 1.85; 95% CI [1.23-2.77]), and longer neonatal stay in the hospital (odds ratio = 1.67; 95% CI [1.11-2.51]).. Multiparous women with a second stage of 3 hours or greater are at increased risks for operative deliveries, peripartum morbidity, and undesirable neonatal outcomes. These outcomes should be considered in the management of multiparous women with a second stage of labor beyond 3 hours.

    Topics: Adult; Apgar Score; California; Cesarean Section; Chorioamnionitis; Cohort Studies; Endometritis; Extraction, Obstetrical; Female; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Intensive Care Units, Neonatal; Labor Stage, Second; Length of Stay; Meconium; Multivariate Analysis; Parity; Patient Admission; Perineum; Postpartum Hemorrhage; Pregnancy; Retrospective Studies; Time Factors; Umbilical Arteries

2007
The association of placental abnormalities with maternal and neonatal clinical findings: a retrospective cohort study.
    Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, 2003, Volume: 25, Issue:2

    (1) To determine the nature and extent of placental pathologic findings; (2) to associate placental pathologic findings with clinical indicators of infection; (3) to evaluate placental pathology in the context of the guidelines outlined by the College of American Pathologists (CAP).. A retrospective cohort study, through review of maternal and neonatal charts and placental pathology, of 100 sequential pregnancies in which placentas were submitted to pathology. Data were examined using descriptive statistics, and proportional differences were compared using the chi-square test and Fisher's exact test.. Overall, 75% of placentas submitted for pathology review had pathologic abnormalities. Fifty percent had findings consistent with inflammation, 38% had findings consistent with vascular abnormalities, and 18% had findings consistent with meconium. Fetal clinical indicators of infection were associated with placental findings of chorioamnionitis (p < or = 0.01), while maternal clinical indicators were not. Similarly, fetal clinical indicators were associated with placental findings of fetal inflammation (p < or = 0.025), whereas maternal indicators were not associated with placental findings of maternal inflammation. A diagnosis of chorioamnionitis in labour by the attending physician was associated with pathologic findings (p < or = 0.05). A CAP indication was found in 75% of the placentas. There was no difference in incidence of placental pathology between those placentas submitted with and without a CAP indication.. Placental findings of inflammation or infection were associated with fetal clinical indicators of infection, but not with maternal indicators. Placental pathology is very useful in identifying undiagnosed maternal infection or inflammation.

    Topics: Adult; Chorioamnionitis; Cohort Studies; Congenital Abnormalities; Female; Fetal Growth Retardation; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Inflammation; Meconium; Obstetric Labor Complications; Obstetric Labor, Premature; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Retrospective Studies

2003
Preterm premature rupture of membranes and neonatal outcome prior to 34 weeks of gestation.
    International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2003, Volume: 82, Issue:2

    To investigate the impact of preterm premature rupture of membranes on neonatal outcome.. A retrospective study was conducted among singleton pregnancies with or without intact amniochorional membranes. The impact of maternal age, gestational age at birth, 1- and 5-min Apgar scores, birthweight, presence of meconium, use of tocolytics, corticosteroids and antibiotics, mode of delivery, umbilical artery pH, histologic presence of chorioamnionitis, and state of the membranes were analyzed in relation to neonatal outcome. Neonatal outcomes were categorized into: none, presence of respiratory distress syndrome, early neonatal sepsis, neonatal death, and days at neonatal intensive care unit.. A total of 180 preterm deliveries with ruptured (n=80) and intact membranes (n=100) constituted the study group (group 1) and the control group (group 2), respectively. Compared with group 2, there were more cases in group 1 of maternal antibiotic use (P<0.001), short-term tocolysis (P=0.03), and histologic chorioamnionitis (P<0.001). Multiple logistic regression analysis showed that gestational age at delivery (P=0.009), 1-min Apgar score (P=0.013), and umbilical artery pH (P=0.05) were the independent factors affecting neonatal outcome.. Neonatal outcome was mainly affected by prematurity rather than by preterm premature rupture of membranes.

    Topics: Adult; Apgar Score; Case-Control Studies; Chorioamnionitis; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Gestational Age; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Length of Stay; Logistic Models; Maternal Age; Meconium; Obstetric Labor, Premature; Pregnancy; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn; Retrospective Studies; Risk Factors; Sepsis; Tocolysis

2003
Meconium-stained amniotic fluid is associated with puerperal infections.
    American journal of obstetrics and gynecology, 2003, Volume: 189, Issue:3

    The purpose of this study was to determine whether meconium-stained amniotic fluid is associated with puerperal infection and whether the quality of the meconium is further associated with this risk.. We designed a retrospective cohort study of all deliveries beyond 37 weeks gestational age from 1992 to 2002 at a single community hospital. Data were collected on rates of chorioamnionitis, endomyometritis, quality of amniotic fluid, and length of labor and analyzed with bivariate and multivariate analyses.. We found that, among the 43,200 women who were delivered at term, 18.9% of the women had meconium staining (8.8% thin, 5.5% moderate, 4.6% thick). Compared with deliveries with clear amniotic fluid, those with meconium-stained amniotic fluid had higher rates of chorioamnionitis (2.3% vs 4.1%, P<.001) and endomyometritis (1.0% vs 1.7%, P<.001). Further, the severity of meconium staining was associated with increased rates of infection.. We found that the presence and severity of meconium-stained amniotic fluid is associated with puerperal infection even when being controlled for confounders.

    Topics: Adult; Amniotic Fluid; Analysis of Variance; Birth Weight; Cesarean Section; Chorioamnionitis; Delivery, Obstetric; Educational Status; Endometritis; Ethnicity; Female; Gestational Age; Humans; Maternal Age; Meconium; Obstetric Labor Complications; Odds Ratio; Parity; Pregnancy; Pregnancy Outcome; Puerperal Infection

2003
[Meconium-stained amniotic fluid and intra-amniotic infection].
    Hunan yi ke da xue xue bao = Hunan yike daxue xuebao = Bulletin of Hunan Medical University, 2003, Volume: 28, Issue:6

    To explore the relationship between meconium-stained amniotic fluid and Fifty-six women of cesarean section with intact membrane and intra-amniotic infection.. without parturient were divided into 3 groups according to the property of amniotic fluid (no meconium, I to approximately II degree meconium stainedness, and III degree mecomium stainedness). The content of interleukin-6 in amniotic fluid was measured with ELISA. The infiltration of inflammatory cells in the placenta and its membrane was determined by the pathological diagnosis. The neonatal Apgar score and puerperial infection after the surgery were analyzed.. There were no significant differences in the content of IL-6 in amniotic fluid and in the infiltration of inflammatory cells among the 3 groups. But the rate of neonatal asphyxia in the meconium-stained cases was significantly higher than that without meconium.. Meconium-stained amniotic fluid is a marker of fetal distress, but it is not related to intra-amniotic infection.

    Topics: Adult; Amniotic Fluid; Bacterial Infections; Cesarean Section; Chorioamnionitis; Female; Fetal Distress; Fetal Monitoring; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Complications, Infectious

2003
Is meconium passage a risk factor for maternal infection in term pregnancies?
    Obstetrics and gynecology, 2002, Volume: 99, Issue:4

    To study the association between meconium and maternal infection.. This was a retrospective cohort study of 678 pregnant women. All term deliveries during a 31-month period with meconium passage were included. Each meconium delivery was matched with a consecutive delivery without meconium at the same gestational age.. The overall infection rate was 16%, with 13% of the infections directly related to the pregnancy, labor, and delivery. The endometritis rate was 5%, with 7.1% and 3% in the meconium and no-meconium group, respectively. The chorioamnionitis rate was 8.3%, with 9.5% in the meconium and 7.1% in the no-meconium group. Factors found to be associated with overall obstetric infections had the following odds ratios (ORs) and 95% confidence intervals (CIs): meconium (OR 1.8, 95% CI 1.1, 2.8), internal monitoring (OR 3.4, 95% CI 1.9, 5.9), amnioinfusion (OR 2.0, 95% CI 1.3, 3.3), number of vaginal exams (OR 4.5, 95% CI 2.8, 7.1), length of labor (OR 2.8, 95% CI 1.8, 4.4), and cesarean (OR 3.1, 95% CI 1.9, 5.1). Logistic regression analyses revealed the following ORs and 95% CIs: 1) for endometritis-cesarean (OR 4.2, 95% CI 1.9, 8.9), internal monitoring (OR 2.5, 95% CI 1.1, 5.9), and meconium (OR 2.5, 95% CI 1.1, 5.5), and 2) for chorioamnionitis-length of labor greater than 10 hours (OR 2.7, 95% CI 1.4, 5.6), number of vaginal exams greater than seven (OR 3.4, 95% CI 1.7, 6.6), and use of internal monitors (OR 2.5, 95% CI 1.2, 5.3).. Meconium passage increases the risk of postpartum endometritis but not chorioamnionitis. Length of labor, internal monitoring, and number of vaginal exams are risk factors for chorioamnionitis.

    Topics: Adult; Case-Control Studies; Chorioamnionitis; Cohort Studies; Endometritis; Female; Gestational Age; Humans; Labor, Obstetric; Logistic Models; Mastitis; Meconium; Obstetric Labor Complications; Otitis Media; Pregnancy; Respiratory Tract Infections; Retrospective Studies; Risk Factors; Urinary Tract Infections

2002
Meconium aspiration syndrome in term neonates with normal acid-base status at delivery: is it different?
    American journal of obstetrics and gynecology, 2001, Volume: 184, Issue:7

    Our aim was to compare the clinical characteristics of meconium aspiration syndrome in cases with pH > or =7.20 and in those with pH <7.20.. Medical records of diagnostic codes from the International Classification of Diseases, Ninth Revision, were used to identify neonates with severe meconium aspiration syndrome who had been delivered at our institution from 1994 through 1998. Severe meconium aspiration syndrome was defined as a mechanical ventilator requirement of >48 hours. Clinical data including neonatal outcomes of cases of meconium aspiration syndrome associated with umbilical pH > or =7.20 at delivery were compared with data on outcomes of cases with pH <7.20.. During this 4-year study period, 4985 singleton term neonates were delivered through meconium-stained amniotic fluid. Forty-eight cases met all study criteria, and pH values at delivery were as follows: pH > or =7.20, n = 29, and pH <7.20, n = 19. There were no differences between groups in the incidence of clinical chorioamnionitis, in the presence of meconium below the vocal cords, or in birth weight. Neonates with meconium aspiration syndrome and umbilical pH > or =7.20 at delivery developed seizures as often as those with pH <7.20 (20.1% vs 21.1%; P = 1.0).. Normal acid-base status at delivery is present in many cases of severe meconium aspiration syndrome, which suggests that either a preexisting injury or a nonhypoxic mechanism is often involved.

    Topics: Acid-Base Equilibrium; Adult; Birth Weight; Chorioamnionitis; Delivery, Obstetric; Female; Humans; Hydrogen-Ion Concentration; Incidence; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Seizures; Vocal Cords

2001
Meconium-stained amniotic fluid and neonatal morbidity in near-term and term deliveries with acute histologic chorioamnionitis and/or funisitis.
    Journal of perinatology : official journal of the California Perinatal Association, 2001, Volume: 21, Issue:8

    To determine the incidence of meconium-stained amniotic fluid (MSAF) and neonatal morbidity in near-term and term deliveries with histologic acute chorioamnionitis and/or funisitis compared to those with normal placental histology.. In a retrospective case-control design, we compared the incidence of MSAF and neonatal outcome in 45 cases of acute histologic chorioamnionitis and/or funisitis with 89 cases of normal placental histology. We reviewed the obstetric and neonatal records for perinatal complications and neonatal morbidity.. Mean birthweights (3372+/-473 vs 3287+/-518 g) were similar in infants born to mothers with histologic chorioamnionitis and/or funisitis compared to infants born to mothers with normal placental histology. The incidence of MSAF was significantly higher in the group with acute chorioamnionitis/funisitis (p<0.05). Similarly, the incidence of admissions to newborn intensive care unit, respiratory distress, meconium aspiration syndrome, and presumed sepsis was also significantly higher (p<0.05) in this group.. The incidence of MSAF and neonatal morbidity is higher in the presence of acute inflammation of placental membranes. The presence of meconium in the amniotic fluid should alert the physician to the potential for infection and increased neonatal morbidity.

    Topics: Acute Disease; Amniotic Fluid; Birth Weight; Case-Control Studies; Chorioamnionitis; Female; Fetal Distress; Hospitalization; Humans; Infant, Newborn; Meconium; Morbidity; Pregnancy; Pregnancy Outcome; Retrospective Studies; Umbilical Cord

2001
Obstetric and perinatal outcome of pregnancies with term labour and meconium-stained amniotic fluid.
    Archives of gynecology and obstetrics, 2000, Volume: 264, Issue:2

    The purpose of this study was to evaluate the meconium staining of amniotic fluid (AF) in term of fetal distress, meconium aspiration syndrome, and perinatal morbidity and mortality. In a prospective study at Princess Badeea Teaching Hospital from April to November 1999, women with a singleton cephalic pregnancy of completed 37-42 weeks and with no pre-defined risk factor were recruited into the study. Study patients comprised 390 (10%) patients with meconium and 400 patients as controls but with clear amniotic fluid. Virtually meconium staining of the amniotic fluid was significantly associated with poor neonatal outcome in all outcomes measures assessed. Perinatal mortality increased from 2 per 1000 births with clear AF to 10 per 1000 with meconium (P<0.001). Other adverse outcomes also increased; e. g., severe fetal acidemia, Apgar score < or = 3 at 1 min and 5 min, and meconium aspiration syndrome. Delivery by cesarean section also increased with meconium from 7-14% (P<0.001). We concluded that meconium in the amniotic fluids associated with an obstetric hazard and significantly increase risks of adverse neonatal outcomes. Women with thin meconium in the presence of normal fetal heart rate can be safely managed at the clinical level. Mod-thick meconium alone should alert the obstetrician to a high risk fetal condition. Continuous fetal heart rate monitoring during labour and reassurance of fetal well-being by acid-base assessment were most significant factors in the reduction of meconium aspiration syndrome.

    Topics: Adult; Amniotic Fluid; Birth Weight; Cesarean Section; Chorioamnionitis; Female; Fetal Blood; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Induced; Labor, Obstetric; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Suction

2000
[Meconium and its significance].
    Ceska gynekologie, 2000, Volume: 65, Issue:6

    A review of meconium patophysiology and its contribution to the incidence of perinatal infection.. Review article.. Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic.. The reported incidence of meconium-stained amniotic fluid varies between 7 and 22%. The patophysiology of the presence of meconium in the amniotic fluid is not sufficiently explained. Meconium in fetal bowels is under hormonal and neurol control. The presence of the meconium-stained amniotic fluid was always considered to be a potential risk for the fetal and neonatal well-being. The review is further divided in to three chapters. (II. Meconium and meconium aspiration syndrome, III. Meconium and postnatal neurological handicap).. The first chapter on deals with meconium risk in the development of perinatal infection: intraamniotic infection/chorioamnionitis, postnatal endometritis, infection of the abdominal wound after Caesarean and neonatal infection. The incidence of clinical chorioamnionitis is 15% with the presence of meconium compared to 3% in controls. The incidence of puerperal endometritis is 10% in comparison to 3% under normal conditions. Two main mechanisms of development (or coincidence) of intraamniotic infection in the presence of meconium exist. 1) Infection may be a cause of meconium passage. 2A) Alteration of Zn/P ratio in the amniotic fluid can promote bacterial growth. 2B) Meconium attached to macrophages or absorbed by phagocytosis can impair cellular immune response. The antibiotic prophylaxis is discussed.

    Topics: Amniotic Fluid; Cesarean Section; Chorioamnionitis; Endometritis; Female; Humans; Infant, Newborn; Infections; Meconium; Pregnancy; Puerperal Infection; Risk Factors; Surgical Wound Infection

2000
Meconium stained amniotic fluid in very low risk pregnancies at term gestation.
    European journal of obstetrics, gynecology, and reproductive biology, 1998, Volume: 80, Issue:2

    To determine the prevalence and clinical significance of meconium stained amniotic fluid (MSAF) in a low risk population at term gestation and to investigate whether MSAF is a predictor for intrapartum and neonatal morbidity.. A very low risk population including 37 085 consecutive deliveries at term composed the study population. A cross-sectional study was conducted and two groups of patients were identified according to the presence (n=6164) or absence (n=30921) of meconium in the amniotic fluid at delivery and the outcomes of the two groups compared.. The prevalence of MSAF was 16.6%. The incidence of cesarean section (5.6% vs 2.3% P<0.01), instrumental deliveries (3.2% vs 1.8% P<0.01), fetal distress (6.5% vs. 2.1% P<0.01), clinical chorioamnionitis (0.2% vs. 0.1% P<0.01), post-partum infection (0.5% vs. 0.2% P<0.01), 1-minute Apgar score <3 (1.9% vs. 1.1% P<0.01), small for gestational age (7.4% vs. 6.4% P<0.01). was significantly higher in the MSAF compared with the clear amniotic fluid group. Intrapartum and neonatal mortality in this low risk population was significantly higher in the MSAF group (1.7/1000) compared with women with clear AF (0.3/1000).. MSAF in a low risk population at term gestation is a predictor for adverse perinatal outcome and peripartum complications.

    Topics: Amniotic Fluid; Apgar Score; Cesarean Section; Chorioamnionitis; Delivery, Obstetric; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Infections; Meconium; Pregnancy; Pregnancy Outcome; Puerperal Disorders; Risk Factors

1998
Meconium stained amniotic fluid in preterm delivery is an independent risk factor for perinatal complications.
    European journal of obstetrics, gynecology, and reproductive biology, 1998, Volume: 81, Issue:1

    To determine the prevalence and clinical significance of meconium stained amniotic fluid (MSAF) in women with preterm delivery.. The study population consisted of consecutive patients who arrived with intact membranes and delivered preterm, singleton neonates at the Soroka Medical Center between 1 January 1985 and 31 December 1995. Only vertex presentation was included. Antepartum death was excluded from the study. Patients were classified according to the color of amniotic fluid into two groups: MSAF and clear amniotic fluid. Maternal puerperal complications were defined in our study as the presence of at least one of the next variables: clinical chorioamnionitis; major puerperal infection including endometritis, cesarean section or postpartum hemorrhage. Perinatal complications were defined in our study as: (1) intrapartum death (IPD) or postpartum death (PPD); (2) one or more of the following: 1-min Apgar score <3, 5-min Apgar score <7 or small for gestational age. Rates of perinatal complications were assessed at: (1) 24-27 weeks; (2) 28-31 weeks; (3) 32-36 weeks. Logistic regression was used to investigate the relationship of MSAF to perinatal complications and maternal morbidity in a multivariate model.. During the study period, a total of 96 566 deliveries occurred in our institution and 4872 (5.0%) deliveries were preterm. Among the women delivering preterm meeting eligibility criteria, 276 (5.7%) women had intrapartum MSAF. A higher rate of IPD and PPD was observed only between 32 and 36 weeks' gestation in patients with MSAF in comparison with patients with clear amniotic fluid [6.1% (14/230) vs. 2.1% (85/4045), respectively, P=0.0001]. A statistically significant higher rate of perinatal complications was found between 28 and 31 weeks' gestation, and even a higher rate was noted between 32 and 36 weeks' gestation in the MSAF group in comparison with patients with clear amniotic fluid [51% (18/35) vs. 27.2% (93/341), respectively, P=0.003; 20% (46/230) vs. 9.8% (396/4045), respectively, P=0.0004].. (1) MSAF is an independent risk factor for perinatal complications in preterm deliveries (OR=1.73, CI: 1.057-2.43, P=0.001; OR=2.35, CI:1.34-4.12, P=0.002, respectively). (2) MSAF was not found to be an independent risk factor for maternal morbidity.

    Topics: Adult; Amniotic Fluid; Apgar Score; Cesarean Section; Chorioamnionitis; Endometritis; Female; Fetal Death; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Infant, Premature; Infant, Small for Gestational Age; Infections; Logistic Models; Meconium; Postpartum Hemorrhage; Pregnancy; Puerperal Disorders; Risk Factors

1998
Increased intrapartum antibiotic administration associated with epidural analgesia in labor.
    American journal of perinatology, 1997, Volume: 14, Issue:2

    To determine whether women who receive continuous epidural analgesia for labor and delivery are more likely to receive antibiotic therapy compared to those parturients who do not use epidural analgesia, a chart review was performed for 300 women 100 in each group using narcotics alone epidural alone, or parenteral narcotics followed by epidural analgesia. While only 2% of women with narcotics alone developed an intrapartum temperature > or = 37.8 degrees C, 16% and 24% of women with epidural use alone or in addition to narcotics did so, respectively. Antibiotic administration was increased among women utilizing epidural analgesia, exclusively or following parenteral narcotics. No parturient with culture or pathological evidence of chorioamnionitis had maternal temperature elevation as an isolated finding. A probable causal relationship between maternal temperature elevation and epidural use in labor is supported. Rather than treating all women with temperature elevations and epidurals for presumed chorioamnionitis, it is reasonable to target treatment to those with fetal tachycardia, meconium stained fluid, or abnormal amniotic fluid studies.

    Topics: Adult; Amniotic Fluid; Analgesia, Epidural; Analgesia, Obstetrical; Analgesics, Opioid; Anti-Bacterial Agents; Chorioamnionitis; Delivery, Obstetric; Female; Fetal Diseases; Fever; Humans; Injections, Intravenous; Labor, Obstetric; Meconium; Placenta; Pregnancy; Probability; Retrospective Studies; Tachycardia

1997
Inhibition of neutrophil oxidative burst and phagocytosis by meconium.
    American journal of obstetrics and gynecology, 1995, Volume: 173, Issue:4

    Meconium in amniotic fluid has been associated with an increased prevalence of chorioamnionitis. In an effort to delineate the mechanism of this association, we determined the effect of meconium on the neutrophil's capacity for phagocytosis and microbial killing by oxidative burst in vitro.. Sterile meconium samples were obtained from four fetuses at the time of breech delivery and were then pooled and lyophilized. Neutrophils were purified from whole blood of each of 13 pregnant nonlaboring patients. Phagocytosis and the oxidative burst of neutrophils in the presence and absence of meconium were assessed by single-cell analysis with flow cytometry. Phagocytosis was measured as the mean fluorescence intensity produced after 30 minutes of incubation with fluorescein-labeled Escherichia coli. Oxidative burst was measured as the mean fluorescence intensity resulting from the oxidation of internalized reduced dichlorodihydrofluorescein after 15 minutes of stimulation with phorbol myristate acetate. Oxidative burst was expressed as the neutrophil oxidative index and the net fluorescence intensity. Neutrophil oxidative index was equivalent to the quotient of the mean fluorescence intensity for phorbol myristate acetate-stimulated and unstimulated cells. Net fluorescence intensity was equivalent to the absolute difference between stimulated and unstimulated cells.. Exposure of neutrophils to light and very light meconium each resulted in significantly lower mean neutrophil oxidative index compared with unexposed controls (3.2 +/- 4.9 and 4.2 +/- 5.9 vs 16.2 +/- 7.5, p = 0.00002 and p = 0.0007, respectively) and significantly lower mean net fluorescence intensity than that of control cells (112 +/- 220 and 188 +/- 294 vs 613 +/- 328, p = 0.0001 and p = 0.005, respectively). Phagocytosis was significantly impaired in the presence of moderate meconium compared with control cells (2239 +/- 393 vs 4645 +/- 2071, p = 0.0001). Light meconium did not significantly affect phagocytosis.. Meconium has significant effects on neutrophil function in vitro. Both light and very light meconium inhibit the oxidative burst. Moderate meconium inhibits phagocytosis.

    Topics: Chorioamnionitis; Female; Flow Cytometry; Humans; Meconium; Neutrophils; Phagocytosis; Pregnancy; Respiratory Burst

1995
Maternal and perinatal outcome of patients with preterm labor and meconium-stained amniotic fluid.
    Obstetrics and gynecology, 1995, Volume: 86, Issue:5

    To determine the clinical significance of meconium-stained amniotic fluid (AF) observed at amniocentesis in patients with preterm labor.. A nested case-control study was constructed based on the color of AF during amniocentesis. Forty-five women admitted with preterm labor and meconium-stained AF were matched for gestational age at admission and compared with 135 women with preterm labor and clear AF. All AF samples were cultured for aerobic and anaerobic bacteria and mycoplasma.. The rates of positive AF cultures for microorganisms, overall preterm birth (before 36 weeks), preterm birth before 32 weeks, and clinical chorioamnionitis were all significantly higher in patients with meconium-stained AF than in those with clear AF (positive AF cultures, 38 versus 11%, P < .001; preterm delivery before 36 weeks, 73 versus 41%, P < .001; preterm delivery before 32 weeks, 51 versus 17%, P < .001; and clinical chorioamnionitis, 22 versus 6%, P = .003). In contrast, no significant differences were observed between groups with respect to maternal age, gravidity, parity, abruptio placentae, placenta previa, fetal distress, cesarean rate, or puerperal morbidity.. Patients with preterm labor and meconium-stained AF had higher rates of microbial invasion of the amniotic cavity, clinical chorioamnionitis, and premature deliveries than those with clear AF.

    Topics: Adult; Amniotic Fluid; Apgar Score; Bacteria; Birth Weight; Case-Control Studies; Chorioamnionitis; Female; Gestational Age; Humans; Infant, Newborn; Meconium; Obstetric Labor, Premature; Pregnancy; Pregnancy Complications; Pregnancy Outcome

1995
Possible causes linking asphyxia, thick meconium and respiratory distress.
    The Australian & New Zealand journal of obstetrics & gynaecology, 1991, Volume: 31, Issue:2

    The cause of fetal distress and neonatal respiratory distress (RD) in association with meconium-stained liquor is not always clear. To clarify this, a prospective study was undertaken in a tertiary referral maternity hospital for 1 year. In all infants born after meconium-stained liquor who developed RD, evidence was sought for 1) fetal distress (from the cardiotocograph (CTG), the cord blood pH, the Apgar score and the asphyxial complications in the neonate) 2) causes of fetal distress (including maternal risk factors, fetal infection and fetal malnutrition) 3) causes of respiratory distress (including meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN) and infection). Of 4,026 livebirths, 717 (17.8%) had meconium-stained liquor and 44 term and 5 preterm infants developed RD. In the 44 term infants, there was frequent evidence of fetal distress possibly caused by previously unrecognized factors such as fetal malnutrition with reduced neonatal skinfold thickness in 35% triceps and 41% subscapular measurements, and histological chorioamnionitis (CA) in 74%. The cause for respiratory distress was identified in only 48% of infants, and included clinical evidence of PPHN (41%), MAS (16%) and infection (2%). However in preterm infants, 80% had definite or suspected infection. The findings indicate that fetal distress is common in infants who develop respiratory distress after meconium-stained liquor. A role for histological CA and reduced nutrition in the fetus, as factors contributing to the vulnerability of the term infant to intrapartum fetal distress, is suggested.

    Topics: Apgar Score; Chorioamnionitis; Female; Fetal Blood; Fetal Diseases; Fetal Distress; Heart Rate, Fetal; Hospitals, Maternity; Humans; Infant, Newborn; Infant, Premature; Kidney Diseases; Meconium; Meconium Aspiration Syndrome; New South Wales; Nutritional Status; Persistent Fetal Circulation Syndrome; Pregnancy; Prospective Studies; Radiography; Respiratory Distress Syndrome, Newborn; Risk Factors; Sepsis; Skinfold Thickness

1991
Placenta within the medicolegal imperative.
    Archives of pathology & laboratory medicine, 1991, Volume: 115, Issue:7

    Bad pregnancy outcome includes abortion, stillbirth, neonatal death, morbidity, malformation, cerebral palsy, and mental retardation. These afflictions cause devastating personal impact. In the United States, almost 10% of all school-aged children are handicapped. Neurologic and communicative disorders affect 42 million people and cost $114 billion each year. The cause of cerebral palsy is known in less than 10% of these cases. Enormous litigations have threatened clinicians, paramedical personnel, hospitals, and insurance carriers. The placenta is an important potential means of establishing that fetal damage causes bad pregnancy outcome independently of clinical care. All pathologists serve an important role in the documentation of gross placental features and in the procurement of appropriate light microscopic slides. Pathologic placentas are common. Only an expert can determine whether an abnormal placenta represents the probable cause of bad pregnancy outcome.

    Topics: Chorioamnionitis; Costs and Cost Analysis; Expert Testimony; Female; Fetal Diseases; Humans; IgA Vasculitis; Infant, Newborn; Infections; Malpractice; Meconium; Pathology; Placenta; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple

1991