morphine and Fetal-Distress

The human placenta is known to calcify with advancing gestational age, and, in fact, the presence of significant calcifications is one of the components of grade III placenta, typical of late gestation. As such, the presence of significant placental calcifications often prompts obstetric providers to expedite delivery. This practice has been attributed, in part, to the presumed association between grade III placenta and adverse pregnancy outcomes. Such approach, however, can be the source of major anxiety and may lead to unnecessary induction of labor, with its associated predisposition to cesarean delivery as well as a myriad of maternal and neonatal morbidities. The objective of this study was to examine the association between grade III placental calcifications and pregnancy outcomes.. A systematic review of the literature was performed for studies evaluating the association between grade III placenta and a number of pregnancy outcomes, including labor induction, fetal distress (abnormal fetal heart tracing), low Apgar score (less than 7 at 5 min), need for neonatal resuscitation, admission to the Neonatal Intensive Care Unit, perinatal death, meconium liquor, and low birth weight.. There was a five-fold increase in risk of labor induction with the presence of grade III placenta (OR 5.41; 95% CI 2.98-9.82). There was no association between grade III placenta and the incidence of abnormal fetal heart tracing (OR 1.62; 95% CI 0.94-2.78), low Apgar score of less than 7 at 5 min (OR 1.68; 95% CI 0.84-3.36), need for neonatal resuscitation (OR 1.08; 95% CI 0.67-1.75), and admission to the Neonatal Intensive Care Unit (OR 0.90; 95% CI 0.21-3.74). In turn, the incidence of meconium liquor was higher in the setting of grade III placentae (OR 1.68; 95% CI 1.17-2.39). Similarly, a positive association between grade III placental calcifications and low birth weight (OR 1.63; 95% CI 1.19-2.22) and perinatal death (OR 7.41; 95% CI 4.94-11.09) was identified.. The study alerts us to a significant association between grade 3 placental calcifications and labor induction, although it demonstrates that these sonographic findings do not appear to predispose to fetal distress, low Apgar score, need for neonatal resuscitation, or admission to the NICU.

Topics: Apgar Score; Calcinosis; Female; Fetal Distress; Gestational Age; Humans; Infant, Low Birth Weight; Labor, Induced; Meconium; Perinatal Death; Placenta; Pregnancy; Resuscitation; Risk Factors; Ultrasonography, Prenatal

Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity.. To assess the effects of amnioinfusion for potential or suspected umbilical cord compression on maternal and perinatal outcome .. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011).. Randomised trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression in labour.. The original review had one author only (Justus Hofmeyr (GJH)). For this update, two authors (GJH and T Lawrie) assessed 13 additional trial reports for eligibility and quality. We extracted data and checked for accuracy.. We have included 19 studies, with all but two studies having fewer than 200 participants. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: caesarean section overall (13 trials, 1493 participants; average risk ratio (RR) 0.62, 95% confidence interval (CI) 0.46 to 0.83); fetal heart rate (FHR) decelerations (seven trials, 1006 participants; average RR 0.53, 95% CI 0.38 to 0.74); Apgar score less than seven at five minutes (12 trials, 1804 participants; average RR 0.47, 95% CI 0.30 to 0.72); meconium below the vocal cords (three trials, 674 participants, RR 0.53, 95% CI 0.31 to 0.92); postpartum endometritis (six trials, 767 participants; RR 0.45, 95% CI 0.25 to 0.81) and maternal hospital stay greater than three days (four trials, 1051 participants; average RR 0.45, 95% CI 0.25 to 0.78). Transabdominal amnioinfusion showed similar trends, though numbers studied were small.Mean cord umbilical artery pH was higher in the amnioinfusion group (seven trials, 855 participants; average mean difference 0.03, 95% CI 0.00 to 0.06) and there was a trend toward fewer neonates with a low cord arterial pH (less than 7.2 or as defined by trial authors) in the amnioinfusion group (eight trials, 972 participants, average RR 0.58, 95% CI 0.29 to 1.14).. The use of amnioinfusion for potential or suspected umbilical cord compression may be of considerable benefit to mother and baby by reducing the occurrence of variable FHR decelerations, improving short-term measures of neonatal outcome, reducing maternal postpartum endometritis and lowering the use of caesarean section, although there were methodological limitations to the trials reviewed here. In addition, the trials are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion. More research is needed to confirm the findings, assess longer-term measures of fetal outcome, and to assess the impact on caesarean section rates when the diagnosis of fetal distress is more stringent. Trials should assess amnioinfusion in specific clinical situations, such as FHR decelerations, oligohydramnios or prelabour rupture of membranes.

Topics: Amnion; Cesarean Section; Constriction, Pathologic; Endometritis; Female; Fetal Distress; Heart Rate, Fetal; Humans; Injections; Meconium; Oligohydramnios; Pregnancy; Randomized Controlled Trials as Topic; Umbilical Cord

Meconium passage in newborn infants is a developmentally programmed event normally occurring within the first 24 to 48 hours after birth. Intrauterine meconium passage in near-term or term fetuses has been associated with fetomaternal stress factors and/or infection, whereas meconium passage in postterm pregnancies has been attributed to gastrointestinal maturation. Despite these clinical impressions, little information is available on the mechanism(s) underlying the normal meconium passage that occurs immediately after birth or during the intrauterine period of fetal development. Birth itself is a stressful process and it is possible that fetal stress-mediated biochemical events may regulate the meconium passage occurring either during labor or after birth. Aspiration of meconium during intrauterine life may result in or contribute to meconium aspiration syndrome (MAS), representing a continued leading cause of perinatal death. This article reviews aspects of meconium passage in utero, its consequences, and management.

Topics: Adult; Digestive System; Female; Fetal Death; Fetal Development; Fetal Distress; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Obstetrics; Parturition; Pregnancy; Pregnancy Outcome; Risk Factors; Syndrome

The term 'fetal distress' should be replaced by 'suspected fetal compromise' because the diagnosis of 'fetal distress' is often unproven. Cardiotocography remains the cornerstone of making the diagnosis, but as a test it is renowned for its high sensitivity and low specificity. It has reduced intrapartum fetal mortality but not long-term neonatal morbidity or the incidence of cerebral palsy. There is no doubt that when obvious signs of fetal compromise, such as late decelerations in the presence of intrauterine growth retardation and oligohydramnios, are present, the diagnosis of fetal compromise is relatively simple. Often, however, the subtle signs of fetal compromise are missed; these are a change in the grade of meconium in the amniotic fluid, a rising base-line fetal heart rate, the absence of accelerations, the presence of 'atypical' variable decelerations or a combination of the above. To date, there is no test available to replace the cardiotocograph, although fetal pulse oximetry is the most promising adjunctive test. Above all, no test result obtained in isolation must detract from the whole clinical picture.

Topics: Biomarkers; Cardiotocography; Female; Fetal Blood; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Meconium; Pregnancy

Meconium-stained amniotic fluid might signify underlying acute or chronic fetal hypoxia with adverse perinatal outcome, especially if associated with cardiotocographic abnormality. Management requires awareness of this potential risk, appropriate intrapartum care and a combined obstetricneonatal approach. Amnioinfusion can be an effective preventative measure.

Topics: Administration, Intravaginal; Algorithms; Amniotic Fluid; Female; Fetal Distress; Humans; Infant, Newborn; Infusions, Parenteral; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Randomized Controlled Trials as Topic

It has been long known that the late gestation human fetus passes meconium in response to hypoxia. However, there is good evidence, from amniotic fluid studies measuring bile pigment and enteric enzyme content, to suggest that passage of meconium is a normal physiological event in the second trimester. Similarly there is some indirect evidence that fetal defaecation is a normal physiological process in the third trimester. However, this evidence is less strong, and it is safer to assume that in most cases meconium staining of liquor at this time is associated with fetal hypoxia. Dilation of the rectosigmoid portion of the distal bowel found in newborn infants with anorectal malformations supports the hypothesis that fetal colonic peristalsis and defaecation is a normal physiological process.

Topics: Adaptation, Physiological; Anal Canal; Animals; Defecation; Embryonic and Fetal Development; Female; Fetal Distress; Gestational Age; Humans; Male; Meconium; Pregnancy; Rectum; Sensitivity and Specificity

Meconium-stained amniotic fluid occurs in approximately 12% of live births. In approximately one third of these infants meconium is present below the vocal cords. However, meconium aspiration syndrome develops in only 2 of every 1000 live-born infants. Ninety-five percent of infants with inhaled meconium clear the lungs spontaneously. Recent investigations have suggested that a reexamination of our assumptions about the etiology of meconium aspiration syndrome is in order. Several authors have provided evidence that support the hypothesis that it is not the inhaled meconium which produces the primary pathologic condition of meconium aspiration syndrome but rather it is fetal asphyxia that is the etiologic agent. Asphyxia in utero produces pulmonary vasospasm and hyperreactivity of the pulmonary vessels. With severe asphyxia the fetal lungs undergo pulmonary vascular damage with pulmonary hypertension. The damaged lungs are then unable to clear the meconium. In the most severe cases there is right-to-left shunting and persistent fetal circulation with subsequent fetal death. The incidence of meconium aspiration may thus be essentially unaffected by current obstetric and pediatric interventions at birth. For the asphyxiated or distressed infant we recommend suctioning at birth and tracheal intubation. In the healthy fetus observation may be sufficient.

Topics: Asphyxia Neonatorum; Fetal Distress; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Respiratory Insufficiency; Syndrome

The pathogenesis of meconium passage and the pathophysiology of meconium aspiration are reviewed. Intrapartum and neonatal strategies for the prevention of meconium aspiration syndrome are presented in historical perspective, and newer interventions are appraised.

Topics: Amniotic Fluid; Delivery, Obstetric; Female; Fetal Distress; Humans; Infant Care; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy

Topics: Amniotic Fluid; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Pregnancy; Prenatal Diagnosis; Prognosis; Risk

The purpose of our study was to evaluate the safety and efficacy of transcervical amnioinfusion during labour complicated by meconium-stained amniotic fluid, in a setting with limited peripartum facilities, to lower the incidence of caesarean section.. A prospective study was conducted in a teaching hospital in north India, which enrolled 292 patients admitted in labour. Patients were randomly divided into two groups after taking their consent. One group received transcervical amnioinfusion, whilst in the other group amnioinfusion was not done. Caesarean sections were performed in either group if there were foetal heart rate abnormalities (bradycardia or irregularity for 10-20 min) or slow progress of labour. The outcomes studied were the incidence of caesarean sections, duration of maternal hospital stay, maternal febrile morbidity (temperature of >38 degrees C, 24 h after delivery), low Apgar score (at 1 and 5 min), respiratory death, MAS and perinatal mortality.. There was a statistically significant reduction in the incidence of caesarean sections in the study group compared to the control group (31 vs. 61%). Amnioinfusion was associated with improved neonatal outcome as evidenced by statistically improved Apgar score at 1 min in newborns in the study group compared to the control group (10 vs. 37.2%). Amnioinfusion during labour was not associated with any significant maternal and neonatal complications. The mean hospital stay of the mother was decreased significantly in the study group patients compared to the control group.. Transcervical amnioinfusion in labour for meconium-stained amniotic fluid is a simple, safe and easy-to-perform procedure. It can be performed safely in a setup with limited peripartum facilities, especially in developing countries, to decrease intrapartum operative intervention and reduce foetomaternal morbidity and mortality.

Topics: Adolescent; Adult; Amnion; Apgar Score; Cesarean Section; Female; Fetal Distress; Fever; Hospitals, Teaching; Humans; Incidence; India; Infant Mortality; Infant, Newborn; Infusions, Parenteral; Length of Stay; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prospective Studies; Young Adult

To determine whether intrapartum amnioinfusion (AI) relieves recurrent moderate and severe variable decelerations in laboring women with clear or grade I meconium-stained amniotic fluid and reduces cesarean section rate for fetal distress.. A randomized controlled trial was conducted in labor unit of Christian Medical College Hospital, Vellore, India, between October 2003 and September 2004. Women were randomized to receive AI (group I) and not to receive it (group II).. A total of 150 women (75 in each group) were included in the study. There was significant relief of variable decelerations in group I and no difference in overall cesarean section rate but significant reduction in cesarean section rate for fetal distress in group I, and significant reduction in cesarean section rate for fetal distress in nulliparous women of group I. Neonatal acidemia was also significantly reduced in the nulliparous women receiving AI. The duration of maternal postpartum hospital stay was significantly reduced in group I. There were no adverse maternal or neonatal outcomes.. AI was a beneficial therapeutic intervention in women patients showing fetal distress in first stage of labor, and it reduced cesarean section for fetal distress and neonatal acidemia.

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Distress; Fetal Membranes, Premature Rupture; Heart Rate, Fetal; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Length of Stay; Meconium; Oligohydramnios; Parity; Peroxisomal Disorders; Postpartum Period; Pregnancy; Recurrence

To assess the rates of cesarean deliveries and perinatal outcome following intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid (MSAF) in a setting with no electronic fetal monitoring or specialized neonatal care.. In this prospective comparative study with 150 women who were in labor and had MSAF, 50 of the women received a transcervical amnioinfusion and the remaining 100 women received standard care. The inclusion criteria were a pregnancy of at least 37 weeks' duration, a single live fetus in cephalic presentation, no major medical or obstetric complications, and no known fetal malformation. The amnioinfusion was performed with 1000 mL of normal saline solution through a red rubber catheter.. Amnioinfusion was associated with a significant decrease in the incidence of low Apgar score (<7) at 1 min (12% vs. 47%; relative risk [RR], 0.26; 95% confidence interval [CI], 0.12-0.56); low Apgar score at 5 min (4% vs. 23%; RR, 0.17; 95% CI, 0.04-0.71); and meconium aspiration syndrome (4% vs. 18%; RR, 0.22; 95% CI, 0.05-0.92). There was also a trend towards a lesser incidence of cesarean deliveries (18% vs. 30%; RR, 0.6; 95% CI, 0.31-1.16) and perinatal deaths (4% vs. 13%; RR, 0.31; 95% CI, 0.07-1.31). The incidence of maternal hospital stays longer than 3 days was significantly lower in the amnioinfusion than in the control group (24% vs. 48%; RR, 0.5; 95% CI, 0.29-0.85). There were no major complications related to amnioinfusion.. Intrapartum amnioinfusion for MSAF is a simple, safe, effective, and inexpensive procedure feasible in settings where intrapartum monitoring is limited. It is associated with improved perinatal outcome and could lower cesarean delivery rates in low-resource countries.

Topics: Amnion; Amniotic Fluid; Apgar Score; Cesarean Section; Developing Countries; Female; Fetal Distress; Hospitals, Teaching; Humans; India; Infant Mortality; Infant, Newborn; Infusions, Parenteral; Injections; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Prospective Studies; Rural Population; Sodium Chloride; Treatment Outcome

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

To assess the effect of amnioinfusion during labour with meconium stained amniotic fluid on caesarean section rate and perinatal outcome.. Prospective randomised controlled study.. A tertiary care teaching hospital in India.. Women in labour at term with meconium stained amniotic fluid.. Two hundred women in labour with > or = 37 weeks gestation, single cephalic presentation with moderate or thick meconium were randomised to control and amnioinfusion groups at a 1:1 ratio. Amnioinfusion was performed using 500 mL of normal saline over a period of 30 minutes in a study group. The control group received routine care. Both groups had intermittent auscultation of fetal heart rate during labour.. The primary outcome measure was caesarean section rate. Secondary outcome measures were meconium aspiration syndrome, 1 minute and 5 minute apgar < 7, hypoxic ischaemic encephalopathy, neonatal intensive care unit admission, meconium at the level of vocal cords.. The caesarean section rate in the amnioinfusion group was less than the control group (RR 0.47; 95% CI 0.24-0.93). Amnioinfusion was associated with a significant decrease in the incidence of meconium at the vocal cords (P = 0.001); improvement in 1 minute apgar scores (P < 0.05), respiratory distress (P = 0.002) and fewer admissions to nursery compared with the controls. This sample size was inadequate to study the impact on meconium aspiration syndrome.. Amnioinfusion in an under resourced labour ward decreases caesarean section rates and fetal morbidity.

Topics: Adult; Amnion; Cesarean Section; Extraction, Obstetrical; Female; Fetal Distress; Fever; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Prospective Studies; Puerperal Disorders; Risk Factors

To investigate the effect of amnioinfusion in women with meconium-stained amniotic fluid on the rate of cesarian sections and on neonatal morbidity.. A randomized controlled trial. A total of 206 women with meconium-stained amniotic fluid were assigned to receive amnioinfusion via two-way catheter or no amnioinfusion (control group). The catheter was inserted and other treatment was the same in both groups.. Amnioinfusion decreased the rate of cesarian sections for fetal distress (RR 0.23, 95% CI 0.07-0.79) and increased mean pH at birth (7.24+/-0.1 versus 7.21+/-0.1, P<0.05). It also decreased the frequency of variable fetal heart rate decelerations (RR 0.74, 95% CI 0.59-0.92), and of meconium below the vocal cords in neonates (RR 0.37, 95% CI 0.19-0.69).. Amnioinfusion improves the neonatal outcome and reduces the frequency of cesarian sections.

Topics: Adult; Amniotic Fluid; Cesarean Section; Delivery, Obstetric; Female; Fetal Distress; Heart Rate, Fetal; Humans; Infant, Newborn; Infusions, Parenteral; Labor, Obstetric; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome

We hypothesized that prophylactic intrapartum amnioinfusion in pregnancies complicated by thick meconium will not decrease the incidence of fetal distress, cesarean section for fetal distress, or meconium below the cords.. Patients with thick meconium were randomized to amnioinfusion (n = 65) or control (n = 59). The amnioinfusion group received an 800 ml bolus of normal saline solution followed by a continuous infusion at 180 ml/hr. Continuous variables were compared by Student t test, and discrete variables were compared by chi 2 analysis and Fisher's exact test as appropriate.. The incidence of fetal distress (16 of 65 vs 8 of 59) and cesarean section for fetal distress (seven of 65 vs seven of 59) was not significantly different between the amnioinfusion and control groups, respectively. The rate of meconium below the cords (one of 65 vs eight of 59) was significantly lower in patients receiving amnioinfusion (relative risk 0.09, confidence interval 0.01 and 0.82, p = 0.02). Two cases of meconium aspiration syndrome occurred in control patients but in none receiving amnioinfusion (p = 0.22).. Prophylactic amnioinfusion in patients with thick meconium decreases the incidence of meconium below the cords and may subsequently have an impact on the incidence of meconium aspiration syndrome in larger series.

Topics: Adolescent; Adult; Amnion; Cesarean Section; Chi-Square Distribution; Female; Fetal Distress; Humans; Incidence; Infant, Newborn; Infusions, Parenteral; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Sodium Chloride

The null hypothesis is that the use of intrapartum amnioinfusion in labors complicated by the presence of thick meconium and oligohydramnios will not decrease the incidence of fetal distress, cesarean delivery, meconium aspiration, or meconium aspiration syndrome.. One hundred seventy term and postterm patients with thick meconium and oligohydramnios were randomly chosen to receive amnioinfusion or standard obstetric care without amnioinfusion. The frequency of fetal distress, cesarean section, meconium aspiration, and meconium aspiration syndrome were subject to chi 2 analysis, Student's t test, or Fisher's exact test.. The rate of fetal distress was significantly reduced in the amnioinfusion group compared with controls (three of 85 vs 19 of 85, relative risk 0.15, 95% confidence interval 0.06 to 0.42). The rate of cesarean section for fetal distress was significantly reduced in the amnioinfusion group (two of 85 vs 17 of 85, relative risk 0.118, confidence interval 0.03 to 0.49). The rates of meconium aspiration (four of 85 vs 33 of 85, relative risk 0.12, confidence interval 0.0449 to 0.327) and meconium aspiration syndrome (0 of 85 vs five of 85, relative risk 0.09, confidence interval 0.009 to 0.872) were significantly reduced by amnioinfusion.. Amnioinfusion improves the outcome in pregnancies complicated by thick meconium and oligohydramnios.

Topics: Amnion; Cesarean Section; Female; Fetal Distress; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Oligohydramnios; Pregnancy; Prospective Studies; Sodium Chloride; Solutions; Syndrome; Umbilical Arteries

The frequency of complications and fetal macrosomia occurring in 243 patients with excellent dates indicating that their pregnancy was prolonged beyond 40 weeks (280 days) was analyzed and compared with that from a control group of 250 normal patients whose pregnancy ended spontaneously between 38 and 40 weeks of gestation. Complications (intrapartum fetal distress, traumatic deliveries, meconium aspiration, postmaturity syndrome) were significantly more frequent in patients in the study group (25.1%) than in the controls (5.6%). Similarly, fetal macrosomia occurred significantly more often in the study patients (29.6%) than in the controls (10.4%). To study the efficacy of antepartum surveillance in predicting these abnormal events, the postterm patients were randomized between two plans of management: 126 were followed with weekly nonstress testing (NST), and 117 with NST plus weekly ultrasound evaluation of fetal size, amniotic fluid volume, and placental grade. Contraction stress testing (CST) was used if the NST was nonreactive. Electronic monitoring had positive and negative predictive values of 42.8 and 87.7%, respectively, whereas ultrasound-plus-electronic monitoring had values of 50 and 65.3%, respectively. These results indicate that the increased incidence of complications in pregnancy prolonged beyond 40 weeks cannot be adequately predicted with antepartum electronic monitoring and ultrasound evaluation of fetal size, placental grade, and amniotic fluid volume.

Topics: Adult; Female; Fetal Distress; Fetal Macrosomia; Fetal Monitoring; Humans; Meconium; Pneumonia, Aspiration; Pregnancy; Pregnancy, Prolonged; Probability; Prospective Studies; Random Allocation; Ultrasonography

Prolonged pregnancy was rigorously defined in 180 gravid women without other complications. Patients were randomly assigned to be serially followed, either by amniocenteses or by oxytocin challenge tests (OCT's). Induction of labor, based upon only (1) a finding of meconium in the amniocentesis group or (2) a positive test in the OCT group, was nearly three times more frequent in the amniocentesis group. The incidence of meconium, which overall was 22% initially and 44% at delivery, as well as the frequencies of obstetric and perinatal complications, were similar in both management groups. Although meconium was significantly associated with abnormal labor progression, intrapartum fetal distress, and low 1 and 5 minute Apgar scores, induction of labor after discovery of meconium, when compared to nonintervention, did not improve perinatal outcome. It is concluded that a search for meconium is of little value in the management of prolonged pregnancy.

Topics: Amniocentesis; Amniotic Fluid; Apgar Score; Female; Fetal Distress; Fetal Monitoring; Humans; Infant, Newborn; Labor, Induced; Meconium; Obstetric Labor Complications; Oxytocin; Pregnancy; Pregnancy, Prolonged; Risk

To quantify the incidence of intrapartum risk factors in labours with an adverse outcome, and compare them with the incidence of the same indicators in a series of consecutive labours without adverse outcome.. Case-control study.. Twenty-six maternity units in the UK.. Sixty-nine labours with an adverse outcome and 198 labours without adverse outcome.. Observational study.. Incidence of risk factors in hourly assessments for 7 hours before birth in the two groups.. A risk score combining suspected fetal growth restriction, tachysystole, meconium in the amniotic fluid and fetal heart rate abnormalities (baseline rate and variability, presence of decelerations) gave the best indication of likely outcome group.. Accurate risk assessment in labour requires fetal heart rate abnormalities to be considered in context with additional intrapartum risk factors.

Topics: Amniotic Fluid; Case-Control Studies; Female; Fetal Distress; Fetal Growth Retardation; Heart Rate, Fetal; Humans; Infant, Newborn; Meconium; Pregnancy

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

Stillbirth is one of the most devastating adverse pregnancy outcome, but it is often associated with a missing post-mortem histological examination. We aimed at evaluating whether the staining of amniotic fluid reflects the fetal conditions surrounding the death and if it correlates with any histologic sign of fetal distress.. Terminal gasping (represented by the massive presence of intra-alveolar squamous cells), thymic and adrenal cortex modifications were evaluated as histologic signs of fetal distress in stillbirths, and stratified according to the degree of staining of the amniotic fluid.. The presence of meconium-stained amniotic fluid did not correlate with the presence of gasping and/or thymic and/or adrenal cortex changes. Clear amniotic fluid was not associated with the absence of histologic signs of distress.. The evaluation of the staining of the amniotic fluid fails to identify distressed fetuses. A histologic evaluation of fetal organs provides detailed information, irrespective of the presence/absence of meconium-stained amniotic fluid.

Topics: Amniotic Fluid; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Stillbirth

A baseline fetal heart rate between 110 and 160 bpm is considered normal. However, among normal fetuses the average baseline heart rate has been shown to diminish progressively and the 90th centile of the fetal heart rate at 40 weeks of gestation has been consistently found at around 150 bpm. The aim of our study was to assess the labor and neonatal outcome of fetuses at 40 gestational weeks or beyond, whose intrapartum baseline fetal heart rate was between 150 and 160 bpm.. In all, 1004 CTG traces were included in the analysis, 860 in Group 110-149 bpm and 144 in Group 150-160 bpm. Group 150-160 bpm had a significantly higher incidence of meconium-stained amniotic fluid (odds ratio [OR] 2.6; 95% CI 1.8-3.8), maternal intrapartum hyperpyrexia (OR 4.7; 95% CI 1.1-14.6), urgent/emergent cesarean section for suspected fetal distress (OR 13.4; 95% CI 3.3-54.3), Apgar <7 at 5th min (OR 9.13; 95% CI 1.5-55.1) and neonatal acidemia (OR 3.5; 95% CI 1.5-55.1). Logistic regression including adjustiing for potential confounders showed that fetal heart rate between 150 and 160 bpm is an independent predictor of meconium-stained amniotic fluid (adjusted odds ratio [aOR] 2.2; 95% CI 1.5-3.3), cesarean section during labor for fetal distress (aOR 10.7; 95% CI 2.9-44.6), neonatal acidemia (aOR 2.6; 95% CI 1.1-6.7) and adverse composite neonatal outcome (aOR 2.6; 95% CI 1.2-5.6).. In fetuses at 40 weeks or beyond, an intrapartum fetal heart rate baseline ranging between 150 and 160 bpm seems associated with a higher incidence of labor complications.

Topics: Adult; Cesarean Section; Female; Fetal Distress; Fever; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, Third; Pregnancy, Prolonged; Retrospective Studies

The aim of this study was to asses the correlation of middle cerebral artery pulsatility index (MCA-PI) and perinatal outcomes in prolonged pregnancies.. This was a prospective study of all consecutive pregnant women beyond 41 weeks' gestation attending for obstetric surveillance during a two years period. We evaluated the predictive value of MCA-PI lower than the 5th percentile (

Topics: Adult; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Middle Cerebral Artery; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Pulsatile Flow; Spain; Ultrasonography, Doppler

Meconium passage during labour is a quite common finding. Studies describing correlation between meconium stained liquor, fetal distress and specific placental pathology are sparse. This case control study had been designed to ascertain these lacunae of knowledge.. Placentae from 41 cases of otherwise uncomplicated antenatal and intranatal pregnancies with meconium stained liquor at 37 completed weeks of gestation were studied, both grossly and microscopically, comparing them with controls of 41 cases of clear liquor. Apgar score of all newborns at 1 minute and 5 minutes were recorded and correlated with histopathological findings.. Both cases and controls were found to be age matched. Meconium stained liquor was associated with more caesarian section than the clear ones. Significant correlation was found with meconium stained liquor and low Apgar scores. Histopathology of placenta revealed many statistically significant associations between specific placental histopathology in meconium stained liquor and depressed Apgar score. Evidence of placental vasculopathy rather than meconium induced placental damage came out as the potential culprit in causing a low Apgar score in this case control study.. Placental vascular changes have a role in meconium staining of liquor. If timely interventions are taken, the chance of development of fetal distress is low.

Topics: Adult; Amniotic Fluid; Apgar Score; Birth Weight; Case-Control Studies; Cesarean Section; Emergencies; Female; Fetal Blood; Fetal Distress; Fetal Mortality; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Morbidity; Placenta; Pregnancy; Pregnancy Complications; Risk Factors; Young Adult

To determine the relationship between the colour of liquor and the trace of cardiotocography to see whether it is reactive or non-reactive... This cross-sectional study was conducted at Obstetrics and Gynaecology department, Dar-ul-Sehat Hospital, Karachi from June 2015 to March 2016, and comprised women in labour who delivered singleton babies and had >37 weeks of gestation. Intrapartum monitoring by cardiotocography was conducted. The status of the amniotic membranes, colour and amount of liquor observed were recorded. Cardiotocography was performed for 30 minutes in the left lateral position on admission as well as a monitoring tool in labour at an interval of less than 4 hours. Foetal heart transducer and uterine pressure transducers were applied and the readings were recorded. SPSS 21 was used for statistical analysis.. Of the total 200 subjects, 183(91.5%) were reactive and 17(8.5%) were non-reactive women. Overall mean age was 27.39±4.40 years. Most commonly noted risk factor were post-date 53(26.5%), anaemia 35(17.5%), premature rupture of membranes 28(14%) and pregnancy-induced hypertension 10(5%). Insignificant difference was observed in between Cardiotocography findings and risk factors of the women (p>0.05)... Significant change was seen in cardiotocography of clear liquor which needs more evaluation to rule out ongoing hypoxia.

Topics: Adult; Amniotic Fluid; Cardiotocography; Cross-Sectional Studies; Female; Fetal Distress; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Obstetric; Meconium; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Diagnosis; Retrospective Studies

To investigate the associations of fetal colon-rectum diameters with labor and fetal distress or meconium passage in healthy pregnancies in the late 3rd trimester.. A total of 162 healthy, singleton pregnant women at ≥36. Fetal colon-rectum diameters were smaller in women in labor compared to controls (p = 0.001). Positive correlations were observed between fetal colon-rectum diameters and interval between ultrasound and labor onset in the control group except for those who had scheduled cesarean sections (C/S) (p = 0.001). Similar colon-rectum measurements were obtained in fetuses delivered via cesarean section due to fetal distress or to other indications (p > 0.05). In women who had uterine contractions during ultrasound examination; later delivered by vaginal route, no association was observed between Apgar scores and colon-rectum diameters during latent-phase (p > 0.05), and also there were significant positive correlations between different segments of colon-rectum diameters and duration of neonatal meconium passage (p < 0.05).. Fetal colon and rectum diameters are smaller during labor and the measurements tend to diminish as the labor approaches, but do not indicate fetal distress.

Topics: Adult; Cesarean Section; Colon; Female; Fetal Distress; Humans; Labor, Obstetric; Male; Meconium; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Rectum; Ultrasonography, Prenatal

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

Topics: Amniotic Fluid; Cohort Studies; Ethnicity; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Logistic Models; Meconium; Meconium Aspiration Syndrome; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prenatal Care; Retrospective Studies; Risk Assessment

There is little evidence linking meconium stained liquor to poor perinatal outcome and clear amniotic fluid is frequently considered a reassuring sign during labour.. To determine whether there are any differences in cardiotocography (CTG) tracings and perinatal outcomes in women with meconium stained compared with those with clear liquor in labour.. A prospective cohort study.. The Aga Khan University Hospital, Nairobi.. Seventy seven women presenting in labour were studied. Thirty six had meconium stained liquor and 41 had clear liquor.. Initial and intrapartum CTG was done. Perinatal and maternal outcomes determined were birth weights, Apgar scores, admission due to foetal indications and puerperal sepsis. CTG interpretation was based on RCOG/NICE guidelines-2001. SPSS 12.0.1 was used for all analyses.. Variable decelerations were the most common foetal heart rate patterns. In the initial CTG, suspicious (RR 1.033, 95% CI: 0.515 - 2.073), and pathologic (RR 1.490, 95% CI: 0.928-2.393) patterns were increased in the meconium stained group. In the intrapartum CTG, pathologic pattern was increased in women with meconium stain liquor (RR 1.096, 95% CI: 0.650-1.847). Apgar score of <7 was likely if the initial base line rate was abnormal (RR 1.357, 95% CI: 0.139 -1.009, irrespective of the state of liquor. Meconium staining of liquor was associated with Caesarean delivery (RR = 1.357, 95% CI: 1.010-1.823; P-value 0.042). There was no significant difference in the mean birth weights of the infants born to women in both groups (3359.72 grams and 3260.24 grams respectively, P = 0.282). One minute Apgar score in both groups was not significantly (RR 0.390, 95% CI:0.131-1.1611).. The suspicious and pathologic tracings were increased in the meconium stained liquor group. There was no significant difference in the Apgar scores in both groups of women. Meconium staining of liquor was significantly associated with Caesarean delivery.

Topics: Amniotic Fluid; Cardiotocography; Case-Control Studies; Cohort Studies; Female; Fetal Distress; Heart Rate, Fetal; Humans; Infant, Newborn; Kenya; Meconium; Pregnancy; Pregnancy Complications

The objective of the study was to evaluate, in labors complicated by thick meconium-stained amniotic fluid, the association between specific fetal heart rate (FHR) patterns and adverse perinatal outcomes.. A retrospective cohort study of patients with FHR tracing data (n = 1638) from a previously reported randomized controlled trial of amnioinfusion for the prevention of meconium aspiration syndrome.. The presence of FHR tracing abnormalities was associated with an increased risk of perinatal mortality and/or neonatal morbidity (moderately abnormal: adjusted odds ratio [OR], 1.67; 95% confidence interval [CI], 1.18-2.37; markedly abnormal: adjusted OR, 2.97; 95% CI, 1.88-4.67). Specific abnormalities that were associated with the risk of perinatal mortality and/or neonatal morbidity included prolonged decelerations (OR, 1.22; 95% CI, 1.02-1.48), severe variable decelerations (OR, 1.08; 95% CI, 1.00-1.16), bradycardia (OR, 2.49; 95% CI, 1.02-6.11), and tachycardia (OR, 2.43; 95% CI, 1.49-3.94).. The presence of abnormal FHR tracing patterns in meconium-stained amniotic fluid patients is associated with an increased risk of adverse perinatal outcomes.

Topics: Adult; Amniotic Fluid; Bradycardia; Cohort Studies; Female; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Meconium; Morbidity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Tachycardia; Young Adult

Meconium may normally be passed by term fetuses during labour. Common after 40 weeks and not a sign of fetal distress Before 40 weeks can implicate fetal distress If occurring in preterm fetuses or if present prior to labour, it may be considered a possible indication of fetal distress. Histopathology may estimate the duration of meconium passage. Macrophages containing meconium are present at the chorionic surface or deeper portions of the membrane and can be easily identified not only on routine hematoxylin-eosin staining but also with the help of immunohistochemistry.

Topics: Female; Fetal Distress; Fetal Hypoxia; Fetus; Humans; Immunohistochemistry; Infant, Newborn; Macrophages; Meconium; Placenta; Pregnancy

The effects of meconium-stained amniotic fluid (MSAF) on cord blood vascular endothelial growth factor (VEGF) levels have not been explored. The aim of this study was to verify whether MSAF influences cord blood VEGF levels in healthy term neonates and we can use cord blood VEGF levels in infants with MSAF as an indicator of fetal distress.. Using an enzyme-linked immunosorbent assay double sandwich method, plasma VEGF levels were determined in 18 healthy term neonates with MSAF and in 16 healthy term neonates without MSAF.. VEGF plasma levels were not significantly different between healthy term neonates with or without MSAF.. Intrauterine meconium passage could not affect VEGF levels on cord blood in term newborn infants and VEGF level may not be used as an indicator of fetal distress in infants with MSAF.

Topics: Amniotic Fluid; Asphyxia Neonatorum; Biomarkers; Diagnosis, Differential; Fetal Blood; Fetal Distress; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Vascular Endothelial Growth Factor A

Passage of fetal bowel movement (meconium) is common (in about one out of six births), and in some the staining of the amniotic fluid is a sign of fetal distress. Inhalation of meconium (aspiration syndrome, in upto one out of five to eight such births) just before or at birth may be preventable by a coordinated approach by well-trained and informed birth attendants. Respiratory failure secondary to meconium aspiration syndrome (MAS) remains a major cause of morbidity and mortality in the neonatal population. Infants with hypoxemic respiratory failure because of MAS, persistent pulmonary hypertension of the newborn and pneumonia/sepsis have an increased survival with extracorporeal membrane oxygenation (ECMO). Other treatment options earlier limited to inotropic support, continuous airway pressure (CPAP), conventional ventilatory management, respiratory alkalosis, paralysis and intravenous vasodilators have been replaced by synchronized intermittent mandatory ventilation (SIMV), high-frequency oscillatory ventilation (HFOV), surfactant and inhaled nitric oxide (iNO). HFOV has been advocated for use to improve lung inflation while potentially decreasing lung injury through volutrauma. Other reports describe the enhanced efficacy of HFOV when combined with iNO. Subsequent to studies reporting that surfactant deficiency or inactivation may contribute to neonatal respiratory failure, exogenous surfactant therapy has been implemented with apparent success. Recent studies have shown that iNO therapy in the neonate with hypoxemic respiratory failure can result in improved oxygenation and decreased need for ECMO. However, these innovative interventions are costly, require a sophisticated infrastructure and are not universally accessible. In this paper, a context of systems-approach for prenatal, natal and postnatal management of babies delivered through meconium stained amniotic fluid (MSAF) so that adverse outcomes are minimized and the least number of babies require innovative ventilatory support is described. Previously reported data from a single urban perinatal center (Philadelphia, PA, USA), over a 6-year period (1995-2000), demonstrated that 14.5% (3370/23175 of live births babies were delivered with MSAF. These data also showed that 4.6% of babies (155/3370) with MSAF sustained MAS. Overall, 26% of babies (40/155) with MAS needed ventilatory support (or 0.17% of all live births); of these, only 20% (8/40 or 0.035% of live births) needed innovative ventila

Topics: Amniotic Fluid; Fetal Distress; Humans; Infant Mortality; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Perinatal Care

To assess the usefulness of amniotic fluid index (AFI) in the assessment of postdate pregnancies.. A prospective, observational study was carried out on the AFI of 118 well-dated postdate pregnancies at 41 weeks within 2 days of delivery. The AFI quartile distribution was determined and correlated with the risk of thick meconium-stained liquor (MSL), intervention for fetal distress and admission to the special care baby unit (SCBU).. The median AFI was 8 cm, with a range from 1-33 cm. There was a significant inverse correlation between the occurrence of thick MSL, intervention for fetal distress and SCBU admission. Logistic regression analysis, upon adjusting for possible confounding factors, showed that only AFI in the 2 lower quartiles combined (< or = 8 cm) had a significant association with the risk of thick MSL (adjusted OR 11.0, 95th CI 2.43-49.8) but not admission to the SCBU. AFI in the lowest quartile (< or = 5 cm) had a significant association with the risk of intervention for fetal distress only (adjusted OR 7.95, 95th CI 1.67-37.7).. Although AFI may be used to predict the occurrence of thick MSL and the need for intervention for fetal distress in postdate pregnancies, its role on its own is limited.

Topics: Adult; Amniotic Fluid; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Logistic Models; Meconium; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third; Pregnancy, Prolonged; Prospective Studies

Evaluation of the relationship between umbilical coiling index (UCI) and adverse perinatal outcome.. A prospective study was performed on 699 pregnant women who were 37-40 weeks. UCI was determined by dividing the total number of the complete vascular coiling by the total umbilical cord length in centimeters. Then the relationship between UCI and neonatal weight, amniotic fluid index, meconium, Apgar score, and fetal distress were evaluated.. There was a significant difference between normo- and hypocoiled groups according to the Apgar score less than 7 in minute 5, AFI

Topics: Adolescent; Adult; Amniotic Fluid; Birth Weight; Cross-Sectional Studies; Diabetes, Gestational; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Multivariate Analysis; Obstetric Labor Complications; Pregnancy; Pregnancy in Diabetics; Pregnancy Outcome; Prospective Studies; Regression Analysis; Risk Factors; Umbilical Cord

Clinical diagnosis of acute foetal distress (AFD) is based on several parameters such as abnormal foetal heart rate (FHR) pattern and/or meconium liquid staining (MLS). Standards for cord blood (CB) banking indicate that AFD should be considered as exclusion criteria for CB collection, but precise guidelines on how to proceed with CB collection in the presence of AFD signs during labour are not available. We evaluated whether the presence of FHR abnormality and/or MLS during labour 1) reduced the CB collection activity; 2) were associated with the infant's acidaemia or asphyxia and 3) deteriorated the biological characteristics of CB units. Thirty-three units of CB were evaluated for biological parameters, gas values and newborn's Apgar score. The results were compared with a control group of 33 consecutive units previously banked. No differences were observed between the two groups and all but one newborn showed normal Apgar score and absence of metabolic acidaemia. The results showed that 1) AFD reduced the CB collection activity by 10% each year; 2) the majority of CB units collected in the presence of abnormal FHR and/or meconium have biological characteristics eligible for banking; 3) FHR alterations or meconium in the presence of normal gas analysis do not represent certain diagnosis of AFD.

Topics: Apgar Score; Asphyxia Neonatorum; Blood Donors; Blood Preservation; Blood Specimen Collection; Contraindications; Cryopreservation; Donor Selection; Female; Fetal Blood; Fetal Distress; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Outcome

The purpose of this study was to compare the umbilical arterial 8-iso-prostaglandin F2alpha, concentrations between pregnancies that were complicated by moderate or thick meconium-stained liquor and those with clear liquor.. Umbilical cord arterial blood samples were collected from 247 singleton pregnancies with either moderate or thick meconium-stained liquor at any stage of labor or clear liquor at all stages of labor for the determination of the total 8-iso-prostaglandins F2alpha concentration.. The median total 8-iso-prostaglandins F2alpha concentration of the meconium-stained liquor group was significantly higher than that of the control group (719.2 vs 115.8 pg/mL). Among the meconium-stained liquor group, those who had a change from "clear liquor" at early labor to "moderate/ thick meconium-stained liquor" at late first stage or at delivery (late meconium-stained liquor group) had higher 8-iso-prostaglandins F2alpha concentration, compared with those who had moderate/ thick meconium-stained liquor since early labor (early meconium-stained liquor group; 959.8 vs 499.9 pg/mL). With the use of multiple regression analysis, meconium-stained liquor, duration of second stage of labor, and abnormal fetal heart tracings were independent determinants of cord blood 8-iso-prostaglandins F2alpha concentration.. Moderate or thick meconium-stained liquor is an independent factor for increased oxidative stress in pregnancy.

Topics: Adult; Amniotic Fluid; Biomarkers; Case-Control Studies; Dinoprost; Female; Fetal Blood; Fetal Distress; Humans; Meconium; Oxidative Stress; Pregnancy; Prospective Studies

To determine whether there is a difference in maternal and neonatal outcomes if a sequential operative vaginal or cesarean delivery follows failed vacuum delivery.. A cross sectional study. We have analyzed maternal and neonatal outcomes of 215 vacuum extractions (group 1), 106 forceps assisted deliveries (group 2), 28 deliveries in which failed vacuum extraction were followed by forceps delivery (group 3) and 22 deliveries in which failed vacuum extraction were followed by cesarean delivery (group 4).. Compared to other groups, patients in group 4 had significantly more post partum anemia, meconium stained amniotic fluid and hospital stay (both maternal and neonatal) as well as lower pH. Apgar scores were similar in groups 3 and 4. Incidence of respiratory distress syndrome, cephalhematoma and jaundice were similar in neonates of all groups.. If an attempted vacuum delivery has failed, the risk of adverse neonatal outcome is increased with either subsequent forceps or cesarean delivery. It should remain in the judgment of the attending obstetrician to choose the method most suitable under the given circumstances.

Topics: Adult; Amniotic Fluid; Anemia; Apgar Score; Cesarean Section; Cross-Sectional Studies; Delivery, Obstetric; Dystocia; Female; Fetal Distress; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor Stage, Second; Length of Stay; Meconium; Obstetrical Forceps; Pregnancy; Pregnancy Outcome; Respiratory Distress Syndrome, Newborn; Shoulder; Time Factors; Treatment Failure; Vacuum Extraction, Obstetrical

Clear amniotic fluid is frequently considered a reassuring sign during labor. Our aim was to examine the incidence of meconium that can only have been passed intrapartum and to determine its neonatal associations and whether its absence is a useful sign.. This was a prospective cohort study of 8394 "low risk" laboring women at term with clear amniotic fluid at early amniotomy.. Meconium was passed in 5.2% of labors but was not detected until delivery of the fetal head in 51.5% of these. It was associated with moderate-severe acidosis (odds ratio [OR] 4.40; 95% confidence interval [CI] 3.21, 6.03), low Apgar score at 5 minutes (OR 6.49; 95% CI 2.73, 15.44), and neonatal seizures (OR 4.33; 95% CI 3.17, 5.93). However, the sensitivity for these outcomes of the intrapartum passage of meconium and, particularly, its detection before delivery was very poor.. Although correlated with adverse neonatal outcomes, most affected infants had clear amniotic fluid throughout labor. The presence of clear amniotic fluid is an unreliable sign of fetal well-being.

Topics: Adult; Amniotic Fluid; Cohort Studies; Confidence Intervals; Delivery, Obstetric; Female; Fetal Distress; Fetal Monitoring; Gestational Age; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Odds Ratio; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prevalence; Prospective Studies; Reference Values; Risk Assessment

To explore the epidemiology of meconium stained amniotic fluid pero-delivery.. 6,206 one-fetal delivery cases were divided into meconium stained amniotic fluid and normal amniotic fluid groups. Statistics were analysed on two groups using Cohort study.. Incidence of meconium stained amniotic fluid was 16.4%. There was no significant difference on maternal medical complication between two groups. The percentage of parity, gestational week > or = 42 weeks and big birth weight were higher in meconium stained amniotic fluid group than that in normal amniotic fluid group (P < 0.001). The average Apgar score in meconium stained amniotic fluid group was lower than that in normal amniotic fluid group (P = 0.001). The percentage of stillbirth, low birth weight and transferred newborn care unit in meconium stained amniotic fluid group were higher than that in normal amniotic fluid group (P < 0.001).. The relative factors on meconium stained amniotic fluid were maternal parity, gestational weeks > or = 42 weeks and big birth weight. No correlation between meconium stained amniotic fluid and maternal medical complication. Morbidity of newborn baby was higher in meconium stained amniotic fluid. Meconium stained amniotic fluid is a important clinical factor on evaluating pregnancy outcome.

Topics: Adult; Amniotic Fluid; Apgar Score; China; Cohort Studies; Female; Fetal Distress; Fetal Weight; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome

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

Pregnancies complicated with meconium-stained liquor are regarded as at risk of fetal distress. Evidence from animal and human studies indicate that passage of meconium may be related to fetal maturity. This retrospective study attempts to quantify the relative risk of non-reassuring cardiotocography or 'fetal distress' in pregnant women complicated by meconium-stained liquor for preterm, term and post-term pregnancies. A total of 9542 singleton pregnancies, delivered in a tertiary obstetric unit in Hong Kong between 1 July 1996 and 31 June 1999, were included in the study. Of these pregnancies, 1946 (20.4%) were identified as having meconium-stained liquor, ranging from thin to thick staining. There was a strong association between incidence of meconium-stained liquor (P < 0.0005) and moderate/thick meconium-stained liquor with advanced gestational age. The incidence of non-reassuring cardiotocography in women presenting with meconium-stained liquor was significantly higher (9.8% vs. 6.4%). The relative risk of non-reassuring cardiotocography in women with meconium-stained liquor increased with more advanced gestation. Close fetal surveillance during labour is required among these pregnancies. Premature labour is associated with higher incidence of fetal distress but the presence of meconium did not pose an additional risk.

Topics: Amniotic Fluid; Cardiotocography; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Meconium; Pregnancy; Risk Factors

This study is aimed to determine the clinical significance of echogenic amniotic fluid.. I surveyed 9 at term pregnancies in which the amniotic fluid was echogenic. Morphologic characteristics of amniotic fluid were assessed from samples taken at amniocentesis or upon delivery within one day after last sonographic examination.. In pregnancies with echogenic amniotic fluid, assessment revealed clear fluid in 4 cases (44.5%), vernix caseosa in 4 (44.5%), and meconium in 1 (11.0%).. Echogenic amniotic fluid on prenatal sonography is not predictive of fetal distress.

Topics: Adult; Amniocentesis; Amniotic Fluid; Female; Fetal Distress; Humans; Male; Meconium; Predictive Value of Tests; Pregnancy; Ultrasonography, Prenatal

To determine obstetrical risk factors and pregnancy outcome of fetuses with true knot of the umbilical cord.. Study population included 69,139 singleton deliveries occurring between the years 1990-1997. Data were retrieved from the database of the Soroka University Medical Center. Fetuses with malformations were excluded.. The incidence of true knots was 1.2% (841/69,139). In a multivariate analysis the following factors were found to be significantly associated with true knot of cord: grandmultiparity, chronic hypertension, hydramnios, patients who undergone genetic amniocentesis, male gender and cord problems (prolapse of cord and cord around the neck). The incidence of fetal distress and meconium stained amniotic fluid was significantly higher among patients with true knots of cord (7% versus 3.6%, P<0.001 and 22% versus 16%, respectively, P<0.0001). Moreover, there was a four-fold higher rate of antepartum fetal death among those fetuses (1.9% versus 0.5%, P<0.0001). In addition, fetuses with true knots of the umbilical cord were more often delivered by a cesarean section (130/841 versus 711/68,298, P<0.0001). The following obstetrical factors were found to be significantly correlated to true knots of the umbilical cord in a multiple logistic regression model: gestational diabetes, hydramnios, patients undergoing genetic amniocentesis, male fetuses.. Patients with hydramnios, who underwent genetic amniocentesis and those carrying male fetuses are at an increased risk for having true knots of the umbilical cord. Thus, careful sonographic and Doppler examinations should be seriously performed in these patients for detection of the complication of the umbilical cord.

Topics: Adult; Amniocentesis; Amniotic Fluid; Cesarean Section; Diabetes, Gestational; Female; Fetal Death; Fetal Diseases; Fetal Distress; Humans; Logistic Models; Male; Meconium; Polyhydramnios; Pregnancy; Risk Factors; Sex Characteristics; Torsion Abnormality; Umbilical Cord

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

The authors have had the opportunity to do research on an embryonic pulsoxymetre in twenty cases when traditional cardiotocographic observation and clinical symptoms had indicated intrauterine risk. The results obtained have been compared with those of a control group where embryonic pulsoxymetrical observation was not effected. The comparison was effected using the same criteria. The experiment aimed at defining how specific embryonic pulsoxymetrical observation may be if used as a screening method as well as whether its application would decrease the number of Cesarian sections. During the process of pulsoxymetrical observation, with positive change of the embryonic heart function with clear as well as meconium stained amniotic fluid, if the embryonic oxygen saturation reached levels over 30%, no Cesarian section was performed. At a saturation level under 30%, two Cesarian sections were required. In the control group without pulsoxymetrical analysis four Cesarian sections had to be performed. The oxygen saturation level of the umbilical cord artery blood of babies who underwent pulsoxymetrical observation and of those born with a Cesarian delivery were almost the same, the blood pH level was acidotic. On conclusion uterine pulsoxymetrical observation objectively reflects the intrauterine distress through fetal blood oxygenation and consequently, influences the number of Cesarian sections.

Topics: Amniotic Fluid; Case-Control Studies; Cesarean Section; Fetal Distress; Heart Rate, Fetal; Humans; Meconium; Oximetry; Oxygen; Pulse; Umbilical Arteries

Misoprostol, the prostaglandin E1 analog, is increasingly used for cervical ripening and induction of labor. We evaluated our experience with misoprostol in an open-label setting.. Patients were selected for cervical ripening based on clinical profile. At 3 cm cervical dilation, misoprostol was discontinued and other means of labor augmentation were used. Over 13 months, 470 inductions of labor occurred, and 455 charts were available; 254 patients (56%) received misoprostol for cervical ripening, and 144 (32%) received dinoprostone (prostaglandin E2).. With misoprostol, mean time from beginning of contractions until delivery was 7 hours, 30 minutes; vaginal birth occurred in 85% of cases, and spontaneous labor occurred in 38%. Hyperstimulation occurred in 4 cases (1.6%) and precipitate labor in 7 (3%). All infants were discharged in excellent condition; one had a 5-minute Apgar score <7, and 33 (13%) had meconium, none with aspiration. Twenty-three patients who had had a previous cesarean section received misoprostol and delivered vaginally.. Misoprostol was found to be a safe and effective agent for cervical ripening as part of labor induction.

Topics: Adolescent; Adult; Apgar Score; Cervical Ripening; Cervix Uteri; Delivery, Obstetric; Dinoprostone; Female; Fetal Distress; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Meconium; Misoprostol; Oxytocics; Oxytocin; Pregnancy; Pregnancy Outcome; Retrospective Studies; Safety; Time Factors; Treatment Outcome; Uterine Contraction; Vaginal Birth after Cesarean

In order to evaluate the presence of nuchal cord entanglement and to measure resistance index with Doppler color ultrasonography, a prospective, observational, cross-sectional study was carried out, 132 low risk term pregnant women were included, 50 of them had umbilical cord encirclement (37%), the sensitivity, specificity, positive predictive and negative predictive values were 92%, 87%, 81% and 95%, respectively. McNemar'test for discordance had a p = 0.121 in comparing ultrasonography result with the gold standard. Patients with nuchal cord entanglement had higher frequency of cesarean section (70%, p < 0.05) than those without it. On the other hand, normal vaginal delivery was more common (46%, p < 0.05) in patients without nuchal coiling of the umbilical cord. There were no significant difference in evaluating acute fetal distress, meconium stained amniotic fluid, newborn Apgar scores at one and five minutes, birth weight, neonatal intensive care unit admissions and intrapartum stillbirths. In our patients with nuchal cord entanglement the resistance index average values were 0.59 and those without nuchal cord were 0.60 (p = 0.712). We concluded that color flow Doppler ultrasonography is a reliable tool to detect nuchal coiling of the umbilical cord, and therefore Doppler color waveforms assessment in nuchal cord entanglements might helpful for clinicians to decide a closer surveillance in labor by using intrapartum cardiotocography.

Topics: Adolescent; Adult; Apgar Score; Birth Weight; Cesarean Section; Cross-Sectional Studies; Delivery, Obstetric; Female; Fetal Distress; Fetus; Humans; Infant, Newborn; Meconium; Neck; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prospective Studies; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal; Umbilical Cord; Vascular Resistance

To discuss the significance of amnioinfusion and amniotic fluid exchange under continuous internal fetal heart rate (FHR) monitoring for management of fetal distress during labor.. 136 cases with frequent variable deceleration (VD) and meconium stained amniotic fluid during labor were divided into two groups: the study group (68 cases) and the control group (68 cases). The former were treated by amnioinfusion and amniotic fluid exchange, while oxygen inhalation, change of body position, and intravenous infusion for the control group.. In the study group, VD disappeared or relieved in 62 cases obviously, and the efficacy rate reached 91.2% (62/68). 48 cases with II degree meconium stained amniotic fluid were treated by amniotic fluid exchange, amniotic fluid became clear or turned to I degree stained in 39 cases. In the control group, VD relieved in 20 cases, the efficacy rate was 19.4%, significantly lower than that of the study group (P < 0.01). In the study group, cesarean section rate was 14.7% neonatal asphyxia 7.4% while they were 47.1% and 48.5% in the control group respectively (P < 0.01; P < 0.01). Neonatal pneumonia caused by meconium aspiration occurred in 13 cases, meconium aspiration syndrome (MAS) 8 cases, with 5 newborns died in the control group, while there was no neonatal death in the study group. There was no significant difference on puerperal morbidity between the 2 groups (P > 0.05).. Amnioinfusion and AF exchange during labor are one of the effective treatment methods for fetal distress and prevention for MAS.

Topics: Adult; Amnion; Amniotic Fluid; Female; Fetal Distress; Fluid Therapy; Heart Rate, Fetal; Humans; Infant, Newborn; Labor, Obstetric; Meconium; Meconium Aspiration Syndrome; Pregnancy; Sodium Chloride

An experimental study was performed to evaluate the effect of fetal distress on in utero defecation and clearance of amniotic fluid (AF).. Sixteen pregnant New Zealand white rabbits underwent laparotomy at 25 days' gestation (full term, 31 to 32 days) as group A (n = 8) and B (n = 8). Uteroplacental ischemia was achieved by constriction of the aorta below the renal arteries to cause fetal distress in group B, whereas sham operation was done in group A. In both groups, 0.1 mL of technetium-99m (99mTc)-HIDA containing 1 mCi of radioactivity was injected into the gluteus muscle of each fetus, which had been exposed through the uterus. Beginning 2 hours after injection, a live fetus was killed every 2 hours for 48 hours in both groups. Tissue samples from the reference organs (lung, heart, stomach, kidney, bladder) and liver, meconium in proximal, mid and distal bowels, AF, and maternal blood were taken. The radioactivity of each sample was determined by a gamma counter and the percentage injected dose (uptake) per gram of tissue (%ID/g) was calculated. The total uptake and mean transit time (MTT) showing intestinal transport were calculated using the linear trapezoidal approximation and extrapolation. The peak concentration (Cmax, %ID/g) and time corresponding to the peak (tmax, h) were obtained.. (1) Significant difference was noted between the groups with regard to uteroplacental perfusion pressure and blood pH (51.0+/-2.6 mm Hg; pH, 6.9+/-0.1 in group B; 80.1+/-2.7 mm Hg, pH, 7.3+/-0.1 in group A; P < .05). (2) 99mTc-HIDA was predominantly trapped by the liver and excreted into the gastrointestinal tract and AF in both groups. (3) In liver and bowel, shape of the profile was bimodal because of fetal swallowing and similar in both groups, tmax was the same in both groups, Cmax was lower in group B than in group A, the total uptake was smaller in group B than in group A, and intestinal transport time was similar (44.2 hours in group A and 43.0 hours in group B). In amniotic fluid, shape of the profile was sigmoidal in group B and reached a Cmax value of 11.6% ID/g, whereas unimodal profiles were observed in group A with a Cmax value of 12.6% ID/g; radioactivity was eliminated from the AF with a rate constant of 0.48% ID/g h in group A (AUC, 273% ID/g h); whereas accumulation of radioactivity was noted in group B (AUC, 308% ID/g h). (5) In maternal blood, shape of the profile was sigmoidal in group A with a Cmax value of 2.9% ID/g and unimodal in group B (Cmax, 1.6% ID/g), accumulation of radioactivity was noted in group A (AUC, 93% ID/g h), whereas a rapid decline of radioactivity (k, 0.06% ID/g h) was noted in group B (AUC, 47% ID/g h).. Fetal distress did not affect the intestinal transport dynamics and in utero defecation but impaired the clearance of AF and the passage into the maternal circulation, which was shown by the accumulation of radioactivity in AF only in group B and in maternal blood only in group A without any elimination rate. This finding suggests that meconium-stained AF is not related to meconium passage after fetal distress; rather, it reflects impaired clearance of AF, which already has containing meconium caused by physiological in utero defecation.

Topics: Amniotic Fluid; Animals; Area Under Curve; Defecation; Female; Fetal Distress; Gastrointestinal Motility; Meconium; Organotechnetium Compounds; Pregnancy; Rabbits; Radionuclide Imaging; Regression Analysis

The purpose of this study was to investigate whether the prenatal diagnosis of a 'lean' umbilical cord in otherwise normal fetuses identifies fetuses at risk of being small for gestational age (SGA) at birth and of having distress in labor. The umbilical cord was defined as lean when its cross-sectional area on ultrasound examination was below the 10th centile for gestational age.. Pregnant women undergoing routine sonographic examination were included in the study. Inclusion criteria were gestational age greater than 20 weeks, intact membranes, and singleton gestation. The sonographic cross-sectional area of the umbilical cord was measured in a plane adjacent to the insertion into the fetal abdomen. Umbilical artery Doppler waveforms were recorded during fetal apnea and fetal anthropometric parameters were measured.. During the study period, 860 patients met the inclusion criteria, of whom 3.6% delivered a SGA infant. The proportion of SGA infants was higher among fetuses who had a lean umbilical cord on ultrasound examination than among those with a normal umbilical cord (11.5% vs. 2.6%, p < 0.05). Fetuses with a lean cord had a risk 4.4-fold higher of being SGA at birth than those with a normal umbilical cord. After 25 weeks of gestation, this risk was 12.4 times higher when the umbilical cord was lean than when it was of normal size. The proportion of fetuses with meconium-stained amniotic fluid at delivery was higher among fetuses with a lean cord than among those with a normal umbilical cord (14.6% vs. 3.1%, p < 0.001). The proportion of infants who had a 5-min Apgar score < 7 was higher among those who had a lean cord than among those with normal umbilical cord (5.2% vs. 1.3%, p < 0.05). Considering only patients admitted in labor with intact membranes and who delivered an appropriate-for-gestational-age infant, the proportion of fetuses who had oligohydramnios at the time of delivery was higher among those who had a lean cord than among those with a normal umbilical cord (17.6% versus 1.3%, p < 0.01).. We conclude that fetuses with a lean umbilical cord have an increased risk of being small for gestational age at birth and of having signs of distress at the time of delivery.

Topics: Adult; Amniotic Fluid; Anatomy, Cross-Sectional; Apgar Score; Confidence Intervals; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Infant, Small for Gestational Age; Labor, Obstetric; Meconium; Oligohydramnios; Pregnancy; Risk Factors; Sensitivity and Specificity; Ultrasonography, Doppler; Ultrasonography, Prenatal; Umbilical Arteries; Umbilical Cord

Our goal was to compare the accuracy of the amniotic fluid index and the 2-diameter pocket technique with respect to accuracy in predicting an adverse pregnancy outcome among patients at high risk undergoing antenatal testing.. All women with high-risk pregnancies and intact membranes who underwent antenatal testing during an 18-month period were prospectively enrolled. Ultrasonographic estimates of amniotic fluid volume were performed by means of the amniotic fluid index and the 2-diameter pocket technique. Relative risks with 95% confidence intervals and receiver operator characteristic curves were calculated for patients with an ultrasonographic estimate of oligohydramnios (amniotic fluid index of 5 cm or 2-diameter pocket of >15 cm2). Outcome variables studied were intrapartum and neonatal complications.. Among 1001 patients the mean (+/-SD) amniotic fluid index was 10.5 +/- 5 cm and the mean (+/-SD) 2-diameter pocket was 18.7 +/- 13.6 cm2. Significantly more patients (46%) were considered to have oligohydramnios according to the 2-diameter pocket criteria than according to the amniotic fluid index (21%, P <.0001, relative risk 1.7, 95% confidence interval 1.5-1.8). No significant differences in the incidences of nonreactive nonstress test results, meconium-stained amniotic fluid, cesarean delivery for fetal distress, low Apgar scores, or infants with cord pH of <7.10 were observed between the oligohydramnios and normal amniotic fluid groups (P >.05) when assessed by relative risk with confidence interval and by receiver operator characteristic curves.. Current ultrasonographic measurements with the amniotic fluid index and the 2-diameter pocket technique are poor diagnostic tests to determine whether a patient is at high risk for an adverse perinatal outcome.

Topics: Adult; Amniotic Fluid; Apgar Score; Cesarean Section; Female; Fetal Blood; Fetal Distress; Humans; Hydrogen-Ion Concentration; Meconium; Oligohydramnios; Pregnancy; Pregnancy Outcome; Risk Factors; ROC Curve; Sensitivity and Specificity; Ultrasonography, Prenatal

Our purpose was to determine whether a borderline amniotic fluid index observed during antepartum testing confers a significant risk of adverse perinatal outcome.. We conducted a retrospective review of all patients entering antepartum testing at Los Angeles County-University of Southern California Women's and Children's Hospital during a 4-month period beginning January 1, 1996. Women with singleton pregnancies who underwent antepartum testing within 1 week of delivery and who were delivered at our institution were identified for our study. An amniotic fluid index >5 and <10 cm was defined as "borderline" and an amniotic fluid index of 10 to 24 cm was considered normal. Markers of adverse perinatal outcome included intrapartum fetal distress, 5-minute Apgar score <7, meconium-stained amniotic fluid, and intrauterine growth restriction.. There was a 2-fold increase in the incidence of adverse perinatal outcome among the women with borderline amniotic fluid index in comparison with control subjects with normal amniotic fluid volume. This difference reflected a 4-fold increase in the incidence of fetal growth restriction among women with a borderline amniotic fluid index.. A borderline amniotic fluid index observed in antepartum testing is associated with an increased risk of intrauterine growth restriction and overall adverse perinatal outcome. These observations suggest that borderline amniotic fluid index merits twice-weekly antepartum testing.

Topics: Amniotic Fluid; Female; Fetal Distress; Fetal Growth Retardation; Gestational Age; Heart Rate, Fetal; Humans; Meconium; Oligohydramnios; Pregnancy; Pregnancy Outcome; Retrospective Studies; Risk Factors; Ultrasonography, Prenatal

Topics: Adult; Fatal Outcome; Female; Fetal Distress; Humans; Meconium; Necrosis; Pregnancy; Rupture, Spontaneous; Umbilical Cord; Umbilical Veins

Amniotic fluid volumes were measured in 1,659 pregnant women to determine the predictive value of these measurements on perinatal outcome. All cases were evaluated by other tests of fetal well-being. 128 cases were oligohydramniotic, and 1,531 cases were normal. In all cases, several parameters were assayed, e.g. fetal distress, way of delivery, meconium in amniotic fluid, Apgar score, transfer to pediatric clinics and early-late neonatal complications. The results of the perinatal evaluation of oligohydramnios were as follows: assessing fetal distress: specificity 94.2%, sensitivity 18.4%, positive predictive value 35.9%, negative predictive value 86.7% and accuracy 82.8%, and assessing low Apgar score the values were 93.0, 21.3, 95.9 and 89.5%, respectively. As a result, measurement of the amniotic fluid volume is an important parameter predicting perinatal outcome, and its predictive value increases if it is combined with other fetal well-being tests with different end points.

Topics: Adolescent; Adult; Amniotic Fluid; Apgar Score; Cohort Studies; Delivery, Obstetric; Female; Fetal Distress; Follow-Up Studies; Humans; Labor, Induced; Meconium; Middle Aged; Oligohydramnios; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Third

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

To test a simple method of intrapartum amnioinfusion to replace amniotic fluid during labor in cases of prolonged labor and severe variable fetal heart rate decelerations or thick meconium.. We conducted a prospective study of intrapartum amnioinfusion in sixteen consecutive patients. A simple transcervically placed Foley bladder catheter was used for intrauterine infusion of saline solution, while monitoring was performed by external cardiotocography.. In twelve patients, catheter placement was easily performed; the remaining four required stabilization by a mandrel for insertion. Amnioinfusion was effective in ten out of thirteen patients for relief of fetal heart rate anomalies. No complications were observed; all had good neonatal outcome.. In our small, uncontrolled study, this amnioinfusion method proved to be a simple, inexpensive, effective and safe technique for the relief of severe heart rate anomalies in prolonged labor.

Topics: Amnion; Catheterization; Cervix Uteri; Female; Fetal Distress; Heart Rate, Fetal; Humans; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prospective Studies; Sodium Chloride; Solutions

To show that intrapartum prophylactic amnioinfusion in case of oligohydramnios or particulate meconium-stained amniotic fluid could be beneficial.. From March 1st, 1993 until December 31st, 1996, 6845 women were delivered at the University Hospital of Poitiers. Patients presenting with oligohydramnios (G1) (118 patients with an amniotic fluid index below 5 cm) or a particulate meconium-stained amniotic fluid (G2)(77 patients) were included. Each group was compared with a historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particulate meconium-stained amniotic fluid (CG2)), age, parity, gestational age, and duration of labor. Statistical analysis was performed using the Student's t test and the Fisher's exact test when appropriate with a level of significance of p < 0.05.. The mean infused volume was 883 ml in G1 and 751 ml in G2. A significant difference was found in terms of cesarean section between G1 and CG1 (14% versus 25%, p < 0.05) and of assisted deliveries for fetal distress between G2 and CG2 (5% versus 18%, p < 0.02). No other significant difference was found between the study groups and their control for all other studied criteria. When considering more specifically the presence of meconium below the vocal cords we also find a difference between G2 and CG2 (5% versus 14%) which was not significant. No neonatal or maternal adverse effects happened in this short study.. Amnioinfusion is easy to perform during labor in case of oligohydramnios or particulate meconium-stained amniotic fluid. In case of oligohydramnios, a decreased rate of cesarean sections has been observed in the infused group. Considering patients with particulate meconium-stained amniotic fluid, less interventions for fetal distress and neonates with meconium below the vocal cords has been found in the infused group. Further prospective evaluation is needed to confirm these results in case of particulate meconium-stained amniotic fluid and to compare the advantage of prophylactic versus therapeutic amnioinfusion performed in case of oligohydramnios and abnormal fetal heart rate.

Topics: Adult; Age Factors; Amnion; Amniotic Fluid; Case-Control Studies; Cesarean Section; Female; Fetal Distress; Fluid Therapy; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Injections; Labor, Obstetric; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Oligohydramnios; Parity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Prospective Studies; Retrospective Studies; Time Factors

Our purpose was: (1) to determine whether assessment of amniotic fluid index in high risk patients with a reactive nonstress test (NST) allowed improved recognition of the fetus at risk for perinatal morbidity than a reactive NST alone; and (2) to determine the optimal low amniotic fluid index (AFI) which should prompt clinical concern. The last NST performed within a week of delivery and amniotic fluid index were retro-spectively compared with various indices of perinatal morbidity. In fetuses with a reactive NST, decreasing AFI was directly correlated with a risk of 5-minute Apgar score of less than 7 and delivery for fetal distress. When various subgroupings of AFI were compared, 7 cm or greater appeared to have a better inverse correlation with the indices of morbidity than lower cut-off values. The addition of AFI assessment to the standard NST allows better prediction of perinatal morbidity than the NSTs alone. Seven centimeters appears to be a reasonable cut-off for clinical concern.

Topics: Amniotic Fluid; Apgar Score; Cesarean Section; False Positive Reactions; Female; Fetal Distress; Fetal Monitoring; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Meconium; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Risk Factors

To find out the incidence, outcome as well as antenatal, intrapartum and neonatal attributes of meconium stained amniotic fluid (MSAF).. Prospective study.. Neonatal Unit of Hospital.. 1426 live births occurring in 1500 consecutive deliveries, over one year period.. In all babies born through MSAF, thorough oropharyngeal suction as soon as the head was delivered followed by immediate intratracheal intubation and suctioning in infants depressed at birth.. 204 (14.3%) deliveries had MSAF of which thick meconium was present in 141. Hepatitis in mother, fetal distress during labor and intrauterine growth retardation were significant factors associated with MSAF. One fifth of babies born through MSAF suffered severe birth anoxia compared to 5.6% in non-MSAF group. The consistency of meconium had direct bearing on the neonatal outcome. Severe birth asphyxia (SBA) occurred in 27.0 and 6.3% of babies with thick and thin meconium staining, respectively. Meconium aspiration syndrome was observed in 9 babies of thick meconium group and 8 of these were depressed at birth. All deaths occurred in thick meconium group and were associated with SBA.. Selective approach can be adopted for babies with MSAF reserving intratracheal suctioning at birth for depressed neonate or evidence of fetal distress in utero. Rest of the neonates only need careful observation after thorough oronasopharyngeal suctioning.

Topics: Amniotic Fluid; Female; Fetal Distress; Humans; Incidence; Infant Mortality; Infant, Newborn; Male; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Complications; Prognosis; Prospective Studies; Risk Factors; Survival Rate

We reviewed records from 251 consecutive cesarean deliveries performed over a six-month period to evaluate the effect of amnioinfusion during labor on the incidence of postpartum endometritis in patients who delivered by cesarean section. One hundred fifty-four patients were excluded because they were not in labor, were at less than 35 weeks' gestation or received antibiotics during labor. Twenty-three of the remaining 97 patients received amnioinfusion during labor and represented the study group. Seventy-four patients did not receive amnioinfusion during labor and were used as controls. The incidence of postpartum endometritis in the amnioinfusion group was 13%, while the incidence in the group not receiving amnioinfusion was 38% (relative risk, 0.34; 95% confidence interval, 0.13-0.88; P = .026). Amnioinfusion during labor appears to significantly decrease the incidence of postpartum endometritis in patients subsequently undergoing cesarean delivery.

Topics: Adult; Amnion; Amniotic Fluid; Cesarean Section; Endometritis; Female; Fetal Distress; Humans; Incidence; Infusion Pumps; Isotonic Solutions; Meconium; Obstetric Labor Complications; Pregnancy; Puerperal Disorders; Retrospective Studies; Sodium Chloride

Although the significance of meconium-stained amniotic fluid as a sign of fetal distress remains controversial, its presence remains a concern to both obstetricians and neonatologists since signs of asphyxia and meconium staining are associated with an increase in perinatal morbidity and mortality. The aim of this study was to evaluate the role of meconium staining of the liquor in the low-risk obstetric population in terms of fetal distress and perinatal morbidity and mortality. In a prospective cohort study at a referral hospital and at one of two municipal clinics, women with a singleton pregnancy of 37 to 42 weeks gestation and with no pre-defined risk factor were recruited into the study. Study patients comprised those with meconium staining of the liquor and controls comprised similar women but with clear liquor. Meconium staining of the liquor was associated with poor outcome in all the outcome measures assessed. Fetal heart rate (FHR) abnormality was more closely associated with adverse outcome than meconium staining, and thin meconium alone was not associated with any adverse outcome except respiratory distress. Women with thin meconium in the presence of normal FHR can therefore be safely managed at the clinic level. Thick meconium itself was a risk factor for poor outcome, more so if associated with FHR abnormality, and should be an indicator for early referral.

Topics: Amniotic Fluid; Case-Control Studies; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy; Prognosis; Prospective Studies; Reproductive History; Zimbabwe

In a study of 331 term pregnancies a four-quadrant technique was used to obtain amniotic fluid index measurements, and the results were compared with the current widely used single-pocket measurement. In contrast to the "2-cm rule," the amniotic fluid index measurements consistently demonstrated higher sensitivity in predicting poor fetal outcome with no decrease in specificity. It was noted that pregnancies with an index of < or = 8 cm showed higher incidences of meconium staining, cesarean delivery for fetal distress, abnormal fetal heart rate monitoring and Apgar scores of < or = 7 or less at one minute.

Topics: Amniotic Fluid; Apgar Score; Cesarean Section; Female; Fetal Distress; Heart Rate, Fetal; Humans; Meconium; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Prenatal Diagnosis; Prospective Studies

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

Topics: Adult; Cesarean Section; Cystic Fibrosis; Female; Fetal Distress; Humans; Infant, Newborn; Infant, Premature; Intestinal Obstruction; Intestine, Small; Meconium; Pregnancy; Prenatal Diagnosis; Ultrasonography

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

The accuracy and reliability of amnioscopy in detecting the presence of meconium in amniotic fluid and in predicting fetal distress were evaluated in 289 postdate pregnancies. Meconium-stained amniotic fluid tended to be associated with complications of pregnancy such as ABO incompatibility (p less than 0.05), the need for operative delivery (p less than 0.02), and fetal distress at birth (p less than 0.05). Amnioscopy failed to detect the presence of meconium antenatally in most cases (57%), and positive amnioscopy for meconium was unrelated to the incidence of fetal distress. When meconium was present, induction of labour was ineffective in reducing the incidence of fetal distress. Amnioscopy is not recommended for the monitoring of postdate pregnancies.

Topics: Amniotic Fluid; Evaluation Studies as Topic; Female; Fetal Distress; Fetoscopy; Humans; Meconium; Pregnancy; Pregnancy, Prolonged

The authors have tried to determine the significance of meconial fluid by studying 3 groups: a first group (MF) representing the meconial fluid observed at he beginning, the second group where the meconial fluid was observed secondarily (SMF) and a third group which is the reference group (RG). The presence of meconial fluid is an ominous sign and an element of prognosis of fetal distress. Meconial fluid at the beginning may be present physiologically, but there are authentic pathological cases with a markedly decreased residual Apgar at 5 minutes. In addition, the perinatal mortality is 4 times higher. In the group with secondary meconial fluid, it is more of an obstetrical emergency. Distress occurs on a healthy fetus along with labor. The signs are occurring with abnormalities of the fetal heart rhythm which do not aggravate the prognosis. These data are confirmed with the study of the pH at the cord. The risk of meconial fluid is inhalation and its complications. The authors conclude by insisting of the need for nasopharyngeal aspirations soon as the fetal head is delivered.

Topics: Adult; Apgar Score; Female; Fetal Distress; Fetal Heart; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Parity; Pregnancy; Pregnancy Complications; Prognosis; Risk Factors

Three babies said to have had 'meconium stained liquor' were subsequently found never to have passed meconium. The green discoloured liquor was the result of bilious vomiting in utero secondary to intestinal obstruction.

Topics: Bile; Diagnosis, Differential; Female; Fetal Distress; Humans; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Pregnancy; Vomiting

Topics: Amniotic Fluid; Asphyxia Neonatorum; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Pregnancy

Topics: Acid-Base Equilibrium; Amniotic Fluid; Female; Fetal Blood; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Meconium; Oxygen; Partial Pressure; Pregnancy

The documented association between heavy meconium in early labor and increased perinatal morbidity and mortality has alerted physicians to the presence of a potential high-risk fetal condition and to the possible need for immediate fetal blood pH determination. The purpose of this study was to determine whether antepartum fetal assessment can predict whether a postterm fetus with heavy meconium in early labor is at low or high risk for an adverse perinatal outcome. Eight hundred thirty-nine postterm patients were followed with antepartum testing, consisting of twice-weekly fetal heart rate (FHR) testing and ultrasonic amniotic fluid volume estimation. Overall, patients with heavy meconium in early labor had a significantly greater frequency of fetal distress. However, when women with heavy meconium in early labor were separated according to their antepartum testing results, those with normal results were found to have no greater risk for fetal distress or perinatal morbidity than women with normal testing and subsequently clear amniotic fluid. These findings suggest that postterm patients with heavy meconium in early labor and normal antepartum testing can be managed in labor in the same manner as low-risk patients without meconium.

Topics: Amniotic Fluid; Delivery, Obstetric; Female; Fetal Distress; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Meconium; Pregnancy; Pregnancy, Prolonged; Prenatal Diagnosis; Risk; Ultrasonography; Uterine Contraction

Topics: Adolescent; Adult; Amniotic Fluid; Female; Fetal Distress; Heart Rate; Humans; Infant Mortality; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Prospective Studies

A total of 4886 nonstress tests were reviewed to establish the relationship between antepartum variable decelerations and perinatal outcome. The association between various fetal heart rate components and variable decelerations was also studied. The incidence of variable decelerations, defined as three or more decelerations greater than or equal to 15 bpm lasting at least 15 seconds in a 20-minute period, was 1.3%. The results suggest that in the presence of variable decelerations: there is a higher incidence of fetal distress in labor, low Apgar scores, neonatal intensive care unit admissions, and nuchal cord involvement; the presence of accelerations and normal variability is associated with good neonatal outcome, whereas their absence is associated with adverse outcome; the presence of accelerations or good variability is not independently correlated with neonatal outcome.

Topics: Apgar Score; Female; Fetal Distress; Fetal Movement; Heart Rate, Fetal; Humans; Meconium; Pregnancy; Retrospective Studies

The usefulness of a short electronic fetal heart rate recording at admission of patients in labor (admission test) was investigated in low-risk patients in two prospective studies. The admission test was done in a concealed manner, and the result of the test was evaluated after delivery so as not to influence the clinical management. In part I of the investigation, the test was performed in 130 patients monitored during labor with pH determinations in scalp blood and in cord blood at birth. Patients with reactive admission tests had a low rate of intrauterine asphyxia in labor (0.9%), whereas half of the patients with ominous traces had intrauterine fetal asphyxia with a low scalp blood pH and neonatal depression. Similar results were obtained in part II, when the admission test was used as a screening procedure involving 1041 patients. The test was reactive in 94.3%, and in this group fetal distress (cesarean section, or forceps on that indication, or an Apgar score less than 7 at five minutes) occurred in 1.3%. Ten patients (1.0%) had ominous tests; four of these had fetal distress, and one of these fetuses died in utero three hours after admission, during which time stethoscopic auscultation failed to detect the fetal compromise. It is concluded that the admission test can detect fetal distress already present at admission and unnecessary delay in intervention can be avoided in such a case. The test seems also to have some predictive value for the fetal well-being for the next few hours of labor. The test is simple and convenient for screening purposes.

Topics: Delivery, Obstetric; Diagnostic Tests, Routine; Female; Fetal Distress; Fetal Monitoring; Heart Rate, Fetal; Humans; Infant, Newborn; Meconium; Pregnancy; Prognosis; Prospective Studies

Topics: Female; Fetal Blood; Fetal Diseases; Fetal Distress; Fetal Heart; Fetal Monitoring; Fetal Movement; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Placenta; Pregnancy; Pregnancy Complications; Regional Blood Flow; Respiration

The gross and microscopic effects of exposing placenta and umbilical cord to meconium were studied in vitro. Gross staining begins with one hour and is a surface phenomenon proportional to length of exposure and meconium concentration. Pigment penetration into the membranes with subsequent uptake by macrophages is dependent primarily on exposure length. Eight of 11 placentas exposed to various meconium solutions were found to have meconium pigment-laden macrophages in the amnion after one hour. These were seen in the chorion somewhat later. Although only three of 11 placentas showed chorionic pigmented macrophages at one hour, 12 of 12 exhibited this finding after three hours. Amniotic epithelial degeneration also showed a time correlation. These findings, especially the microscopic changes described, permit more accurate determination of the defecation-to-birth interval.

Topics: Defecation; Epithelium; Female; Fetal Distress; Humans; In Vitro Techniques; Infant, Newborn; Meconium; Placenta; Pregnancy; Staining and Labeling; Time Factors; Umbilical Cord

The fetal heart rate acceleration response to an acoustic stimulation was compared to the traditional nonstress test in regard to pregnancy outcome, as reflected by the incidence of intrapartum fetal distress, meconium staining of the amniotic fluid, 1- and 5-minute Apgar scores, and perinatal mortality. Fetuses with spontaneous or sound-generated reactivity had comparably good outcomes with respect to all outcome measures investigated. Fetuses who lacked spontaneous or sound-stimulated reactivity had an increased risk for intrapartum fetal distress. The acoustic stimulation test is a safe and rapid test of fetoplacental sufficiency that appears to perform comparably to the nonstress test. The acoustic stimulation test significantly shortens total antepartum testing time and expense.

Topics: Acoustic Stimulation; Amniotic Fluid; Apgar Score; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Meconium; Placental Function Tests; Placental Insufficiency; Pregnancy; Risk; Ultrasonography

The relationship of placental size to perinatal outcome was investigated in a population of low-risk infants. A trimmed and drained placenta was weighed for each of 417 low-risk infants, and for 108 infants whose intrapartum course was complicated only by compression of the umbilical cord. Tracings from intrapartum electronic fetal heart rate monitoring were analyzed by an investigator who was unaware of the fetal weight/placental weight ratio. The incidence of perinatal problems was increased in those infants whose fetal weight/placental weight ratio was greater than 11: intrapartum fetal distress, 20% (p = 0.0046); meconium-stained amniotic fluid, 28.9% (p = 0.0017); Apgar score less than 7, 11.1% (p = 0.04); and hyperbilirubinemia, 24.4% (p = 0.0008). On the basis of these data, the conclusion drawn was that there is a population of presumably low-risk infants who are at increased risk because they have outgrown their placentas.

Topics: Amniotic Fluid; Apgar Score; Birth Weight; Black People; Female; Fetal Distress; Fetal Monitoring; Fetus; Growth; Heart Rate; Humans; Infant, Newborn; Jaundice, Neonatal; Meconium; Organ Size; Placenta; Pregnancy; Prospective Studies; Risk

Ultrasound assessment of amniotic fluid volume was used to monitor 335 patients with prolonged pregnancy. Reduced amniotic fluid was diagnosed when no single vertical pool of amniotic fluid measured greater than 30 mm. Sixty-five patients with reduced amniotic fluid had labour induced while 270 patients with normal amniotic fluid were managed expectantly unless the cervix was favourable. Patients with reduced amniotic fluid had a statistically significant increase in meconium-stained amniotic fluid and growth-retarded babies and were more likely to require delivery by caesarean section for fetal distress. There were no perinatal deaths in the series and the perinatal outcome was satisfactory in both groups. Ultrasound measurement of amniotic fluid represents an effective discriminatory test in post-term pregnancy.

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Blood; Fetal Distress; Fetal Heart; Fetal Monitoring; Fetoscopy; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy, Prolonged; Ultrasonography; Uterine Contraction

Topics: Adult; Amniotic Fluid; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Pregnancy; Ultrasonography

The long-term outcome of infants subjected to perinatal asphyxia can be improved if they are recognized as high risk before birth and managed so as to reduce the period of hypoxemia to a minimum. Prompt and effective resuscitation of asphyxiated infants at the time of birth can contribute much to improving the long-term outcome of these infants.

Topics: Airway Obstruction; Apgar Score; Asphyxia Neonatorum; Congenital Abnormalities; Female; Fetal Distress; Fetal Hypoxia; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Meconium; Pregnancy; Pregnancy Complications; Respiratory Distress Syndrome, Newborn; Resuscitation

In this prospective study we evaluate the role of serum bile acids in the investigation and management of cholestasis of pregnancy in a detailed study of 18 patients. Bile acids were the most sensitive diagnostic test. The increased incidence of fetal distress (33.3% in this series) and meconium-stained fluid (58.3%) did not correlate with very high values of bile acids in maternal serum, umbilical cord serum, or amniotic fluid. Treatment of pruritus with cholestyramine and/or phenobarbital is ineffective in this condition, induction of labor is suggested once fetal lung maturity is established.

Topics: Adolescent; Adult; Amniotic Fluid; Bile Acids and Salts; Cholestasis; Cholestyramine Resin; Drug Therapy, Combination; Evaluation Studies as Topic; Female; Fetal Blood; Fetal Distress; Fetal Organ Maturity; Gestational Age; Humans; Infant, Newborn; Labor, Induced; Lung; Meconium; Phenobarbital; Pregnancy; Pregnancy Complications; Prospective Studies

Although the passage early in labor of thick amniotic fluid heavily stained with meconium is recognized as an indication of potential fetal asphyxia, the significance of late passage of meconium-stained fluid in labor is less certain. One hundren twenty-eight patients with late passage of meconium in labor and 134 control patients were examined, using chi 2 and discriminant analysis, to determine if any relationships existed between fetal heart rate (FHR) patterns, late passage of meconium in labor, and neonatal morbidity. In the group with late meconium passage, adequate baseline FHR variability and nonperiodic accelerations were predictive of high Apgar scores, and repeated (over 20) variable decelerations were predictive of low Apgar scores. In the control group, none of the FHR patterns examined were predictive of Apgar score. Thus, the combination of late passage of meconium in labor with other intrapartum signs may indicate a fetus at risk for asphyxia when neither sign alone is predictive. The presence of late meconium passage demands close observation of the patient in labor, including assessment by electronic FHR monitoring.

Topics: Apgar Score; Female; Fetal Distress; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Labor, Obstetric; Meconium; Pregnancy; Prospective Studies

Topics: Alkaline Phosphatase; Amniocentesis; Clinical Enzyme Tests; Female; Fetal Distress; Humans; Meconium; Pregnancy; Prospective Studies

Topics: Amniocentesis; Amniotic Fluid; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Trimester, Second; Prenatal Diagnosis; Risk

The obstetrical outcome of 357 pregnancies complicated by "spurious" labour was documented and compared with that in a control group. Patients with spurious labour were more likely to have had a spontaneous or induced abortion in the preceding pregnancy. In almost 85% of patients, the painful uterine contractions had ceased within 1 hour of hospital admission and there was no increased fetal morbidity in this group. There was a significantly increased incidence of meconium-stained liquor in patients who continued to have painful uterine contractions, but in whom labour did not ensue. Placental abnormalities were significantly more common in patients with spurious labour.

Topics: Amniotic Fluid; Apgar Score; Delivery, Obstetric; Female; Fetal Distress; Follow-Up Studies; Humans; Infant, Newborn; Labor, Obstetric; Length of Stay; Meconium; Obstetric Labor Complications; Pregnancy

Topics: Female; Fetal Distress; Gestational Age; Humans; Meconium; Pregnancy

A 32-year-old woman underwent cesarean section because of fetal distress. Meconium spilled into the incision during delivery. The patient subsequently had a fever, right-sided pleuritic chest pain, a right lower lobe infiltrate, and a pleural effusion. Exploratory laparotomy disclosed intra-abdominal fibrosis with inflammatory mass formation. A biopsy specimen showed a granulomatous reaction around the bile-staining material similar to meconium. The patient was treated with prednisone, and her symptoms abated. During the next four years, episodes of fever, abdominal discomfort, and pleuritis recurred, which eventually responded to indomethacin therapy.

Topics: Adult; Cesarean Section; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Omentum; Peritonitis; Pleural Effusion; Pregnancy

Studies on the lecithin: sphingomyelin (L:S) ratio in amniotic fluid were made before and after the addition of meconium in 130 normal pregnancies. The meconium was collected from premature and term infants after delivery. That which was collected from premature neonates had no significant effect on the mean L:S ratio of amniotic fluid; in 28% (17 of 60), however, the L:S ratio was elevated by 0.1 to 0.2, though in none by more than 0.2. When meconium collected from term neonates was added to amniotic fluid, it significantly increased the mean L:S ratio of amniotic fluid when the baseline L:S ratio was between 1.0 and 1.9 (P less than .01); in 56% (39 of 70), the L:S ratios were elevated by 0.1 to 0.5, though none increased by more than 0.5. This study suggests that when amniotic fluid is contaminated with meconium, an L:S ratio of 2.2 in premature pregnancies and 2.5 or greater in term pregnancies retains its original predictive value.

Topics: Amniotic Fluid; Female; Fetal Distress; Humans; In Vitro Techniques; Infant, Newborn; Infant, Premature; Meconium; Phosphatidylcholines; Pregnancy; Sphingomyelins

The Authors examined perinatal outcome and presence of accelerations in cardiotocographic records in a group of patients showing meconium staining of amniotic fluid in labor, in comparison with the data of a control group. The first group showed an average Apgar between 1' and 5' and an average number of accelerations every 30' significantly lower than those of the control group. Moreover the study of accelerations confirmed that an average of more than 5 accelerations every 30' is a clear indicator of fetal well-being.

Topics: Amniotic Fluid; Apgar Score; Female; Fetal Death; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Meconium; Pregnancy; Uterine Contraction

Topics: Amniotic Fluid; Blood Group Incompatibility; Female; Fetal Distress; Humans; Meconium; Pregnancy; Rh-Hr Blood-Group System

Values of carcinoembryonic antigen (CEA) were measured by radioimmunoassay in 100 pregnant women divided into 4 groups. In group 1 (49 normal pregnancies) and 2 (17 pre-eclamptic pregnancies), the estimation of CEA was done in maternal vein blood, umbilical cord blood and in amniotic fluid. In group 3 (20 normal pregnancies) CEA was measured separately in blood of the two umbilical vessels as well as in maternal vein blood. In group 4 (14 pregnancies with small-for-date infants) CEA was estimated in umbilical cord blood. The values in amniotic fluid of normal and pre-eclamptic pregnancies were more than 20 times higher than in the other two compartments. A significant correlation was found between the amniotic fluid and umbilical cord blood values (r = 0.500; P < 0.05), as well as between the values in umbilical artery and vein (r = 0.792; P < 0.001). Thus, it is thought that CEA is transferred from the amniotic cavity to the umbilical cord while a part of CEA perhaps is produced by the placenta. Umbilical cord blood values of small-for-date fetuses do not differ significantly from the normal. On the contrary, significantly lower values were obtained in umbilical cord blood and in amniotic fluid of pre-eclamptic women as compared to the normal, but this finding is not useful clinically because of the large standard deviation.

Topics: Amniotic Fluid; Carcinoembryonic Antigen; Female; Fetal Blood; Fetal Distress; Humans; Infant, Newborn; Meconium; Pre-Eclampsia; Pregnancy; Radioimmunoassay; Umbilical Arteries; Umbilical Veins

Fetal heart rate (FHR) tracings of 284 fetuses with meconium-stained amniotic fluid (MSAF) and 1,672 fetuses without meconium staining were compared to investigate the significance of meconium associated with normal and abnormal FHR patterns. MSAF was found to be associated with significantly more low 1- and 5-minute Apgar scores and higher neonatal mortality rates than the control group without meconium. An increase in abnormal FHR patterns in the MSAF group over the control group as well as the postpartum sequelae of meconium itself was likely responsible for the unfavorable outcome. It is concluded that the presence of meconium should be viewed as a warning sign of fetal distress which warrants close intrapartum observation of the patient.

Topics: Amniotic Fluid; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Meconium; Pregnancy

Topics: Amniotic Fluid; Chromatography, High Pressure Liquid; Female; Fetal Death; Fetal Distress; Humans; Hypoxanthines; Hypoxia; Infant, Newborn; Inosine; Meconium; Pregnancy; Purines; Xanthines

Sixty-seven patients with a history of no fetal movements for at least 12 hours and a live fetus were managed according to a fixed protocol. Twelve of these patients were found to have meconium-stained amniotic fluid and/or abnormal unstressed or oxytocin-stressed cardiotocograms; all of them were delivered within 24 hours of a live infant. The remaining 55 patients had no meconium and normal unstressed and stressed cardiotocograms, and their pregnancy, was allowed to continue. All felt fetal movements again and were delivered of live babies one to ten weeks later.

Topics: Amniotic Fluid; Delivery, Obstetric; Female; Fetal Distress; Fetal Heart; Fetus; Heart Rate; Humans; Infant, Newborn; Meconium; Movement; Pregnancy

In order to assess the benefits of routine amnioscopy in the screening of fetal distress, the CTG score, the pH of umbilical artery and the Apgar score were determined and compared in two groups of patients: one group had meconium stained amniotic fluid (MSAF), the other (control) had clear amniotic fluid. Although the prepathological and pathological CTG scores were more frequent in the MSAF group, the values of the umbilical artery pH had the same distribution in the two groups. The percentage of acidotic fetuses in the MSAF group is very low (2.9 p. 100) and practically the same as in the control group (2.5 p. 100). The Apgar score distribution at one and five minutes is also the same in the two groups. The distribution of CTG scores in acidotic fetuses is the same in the two groups, but the pre-acidotic fetuses born with meconial fluid have more often a pre-pathological or pathological CTG score. Fetuses with normal or suspect CTG-score and nevertheless acidotic or pre-acidotic pH values at birth are equally present whether the liquid is stained or not. Amnioscopy is therefore of no help even in this situation. In conclusion, the discovery of a MSAF is the manifestation of fetal hypoxia in only 2.9 p. 100 of cases: the detection of this condition is better achieved by CTG recordings than by routine amnioscopy.

Topics: Amniotic Fluid; Apgar Score; Cesarean Section; Female; Fetal Distress; Fetoscopy; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pregnancy

Topics: Female; Fetal Distress; Fetus; Gastrointestinal Hormones; Gastrointestinal Motility; Humans; Meconium; Motilin; Pregnancy

Topics: Amniotic Fluid; Asphyxia Neonatorum; Female; Fetal Distress; Fetal Monitoring; Fetus; Heart Rate; Humans; Infant, Newborn; Meconium; Pregnancy

Labour, labour outcome and fetal outcome were compared in 200 patients with meconium-stained amniotic fluid and in 200 matched controls with clear liquor amnii. All patients were subjected to a standardized form of management. The caesarean section rate was higher in the meconium group because of a higher incidence of cephalopelvic disproportion and fetal distress. In distinguishing between thick and thin meconium, no differences in labour or fetal outcome were found. The finding of meconium in the latent phase of labour seemed to be more ominous than during the active phase of labour.

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Distress; Humans; Meconium; Obstetric Labor Complications; Pregnancy; Risk

The importance of meconium passage as a sign of the third-trimester fetus in distress is well known. The significance of similar observations in the midtrimester fetus is much less certain. The increasing use of amniocentesis during the middle trimester for the diagnosis of genetic disease makes ascertainment of such data important. Ten instances of meconium-stained amniotic fluid in the last 514 amniocenteses performed at our institution for antenatal genetic diagnosis are reported. Seven pregnancies have ended at term with normal deliveries. Three pregnancies have terminated with fetal death. Meconium staining may be a sign of impending fetal death when passed during the second trimester. When accompanied by alpha-fetoprotein elevation two of three pregnancies terminated with fetal death.

Topics: Adult; alpha-Fetoproteins; Amniocentesis; Amniotic Fluid; Female; Fetal Death; Fetal Distress; Genetic Diseases, Inborn; Humans; Infant, Newborn; Maternal Age; Meconium; Pregnancy; Pregnancy Trimester, Second

Topics: Amniotic Fluid; Apgar Score; Birth Weight; Female; Fetal Distress; Gestational Age; Humans; Infant, Newborn; Labor, Obstetric; Meconium; Pregnancy

Topics: Female; Fetal Death; Fetal Distress; Humans; Infant, Newborn; Labor, Induced; Meconium; Pregnancy

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

Topics: Amniotic Fluid; Female; Fetal Distress; Humans; Infant, Newborn; Meconium; Pregnancy

Seventy five pregnancies where the presence of antepartum meconium was detected by transabdominal amniocentesis, were compared with 224 cases showing clear amniotic fluid (A.F.). The statistical differences were analized in terms of data of anamnesis, diseases complicating pregnancy, gestational age, fetal maturity diagnosis from the A.F. study, oxytocin test, labor characteristics, perinatal mortality and neurologic morbidity during the first nine months of life. The results suggest that the presence of antepartum meconium implies an increase in fetal risk, demanding an adequate analysis of the obstetric solutions, which is discussed.

Topics: Adult; Amniotic Fluid; Apgar Score; Female; Fetal Distress; Follow-Up Studies; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Menstruation; Nervous System Diseases; Obstetric Labor Complications; Parity; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Prognosis

This study reviews 27 patients with positive OCTs who were subsequently allowed a trial of directly monitored labor. Of these, 19 patients (70%) developed FHR signs of fetal distress and 8 (30%) tolerated labor without late decelerations. These patients were evaluated for signs of fetal reactivity (acceleration of the FHR associated with fetal movement of contractions) during the OCT. Those with a reactive pattern during the OCT (15 patients) uniformly had a good fetal outcome (unless there was birth trauma or premature delivery), but 8 of these 15 patients showed fetal distress during monitored labor. If the positive OCT was associated with a nonreactive baseline FHR recording, a trial of labor uniformly resulted in FHR signs of fetal distress. It is therefore concluded that a patient with a nonreactive positive OCT is unlikely to tolerate subsequent labor without fetal distress.

Topics: Apgar Score; Estriol; Female; Fetal Distress; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Labor, Obstetric; Meconium; Oxytocin; Pregnancy; Pregnancy Complications; Retrospective Studies

Topics: Chicago; Female; Fetal Distress; Fetal Heart; Gestational Age; Heart Rate; Humans; Infant, Newborn; Infant, Postmature; Infant, Premature; Labor, Obstetric; Meconium; Placenta; Pregnancy; Reflex

A controlled study for the management of antepartum meconium-stained amniotic fluid (MSAF) detected by amnioscopy performed in a total of 508 patients is presented. The incidence of antepartum MSAF was 2.2%, while intrapartum MSAF was found in 15% of cases. A significant incidence of depressed neonates was found in the latter group. Patients with antepartum MSAF had no perinatal losses, whether managed expectantly or by oxytocin induction. Immediate operative intervention (ie, cesarean section) is not warranted. Observations on FHR patterns, fetal pH, and Apgar scores of these patients are presented.

Topics: Apgar Score; Estriol; Female; Fetal Death; Fetal Distress; Fetal Heart; Fetoscopy; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pregnancy; Pregnancy Complications; Prenatal Care; Prenatal Diagnosis

Topics: Electronics, Medical; Female; Fetal Distress; Fetal Heart; Heart Auscultation; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; Humans; Male; Meconium; Monitoring, Physiologic; Obstetrics; Pregnancy

Amniocentesis has assumed a major and increasing role in the proper management of highrisk pregnancies but the procedure is not without complications. This study was undertaken to compare the suprapubic with the periumblical or "small-parts"approach. A total of 308 amniocenteses were included. The suprapubic method had fewer failures and fewer complications. The rate of premature rupture of the membranes was identifical with both approaches; in fact, following either type of amniocentesis, the percentage of premature ruptured membranes was no differnet from the anticipated spontaneous rate. In all cases of premature rupture of the membranes there were no cases of respiratory distress syndrome, maternal infection, or neonatal infection.

Topics: Amniocentesis; Apgar Score; Cesarean Section; Delivery, Obstetric; Female; Fetal Distress; Fetal Membranes, Premature Rupture; Humans; Meconium; Pregnancy; Pubic Bone; Umbilicus; Vagina

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Blood; Fetal Distress; Fetal Heart; Fetus; Heart Auscultation; Heart Rate; Humans; Hydrogen-Ion Concentration; Labor, Obstetric; Meconium; Monitoring, Physiologic; Placental Function Tests; Pregnancy; Prenatal Diagnosis; Uterine Contraction

Topics: Amniotic Fluid; Female; Fetal Distress; Fetal Heart; Fetoscopy; Humans; Infant, Newborn; Meconium; Placenta; Pregnancy; Risk

Topics: Amniocentesis; Amniotic Fluid; Female; Fetal Distress; Fetoscopy; Humans; Meconium; Pregnancy; Pregnancy Trimester, Third

Topics: Amniotic Fluid; Asphyxia Neonatorum; Blood Circulation; Classification; Female; Fetal Death; Fetal Distress; Fetal Heart; Fetal Hemoglobin; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Metabolism; Pathology; Placenta; Pregnancy

Topics: Asphyxia Neonatorum; Bradycardia; Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Fetal Distress; Fetal Heart; Humans; Infant, Newborn; Meconium; Placenta; Pregnancy

Topics: Female; Fetal Distress; Humans; Infant Mortality; Infant, Newborn; Labor Presentation; Meconium; Pregnancy

Topics: Amniotic Fluid; Female; Fetal Distress; Fetal Mortality; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Staining and Labeling