morphine and Fetal-Hypoxia

Despite the many efforts to study the (patho)physiology of meconium release before delivery, it still remains an indistinct subject. Some studies have reported a relationship between hypoxia and MSAF, whilst others have not. The most common association found however, is between MSAF and the term of gestation.. MEDLINE, EMBASE and the Cochrane library were electronically searched. Papers about the (patho)physiology of meconium-stained amniotic fluid in English were included. Papers about management strategies were excluded (see elsewhere this issue).. Different theories have been proposed including acute or chronic hypoxia, physiologic foetal ripening and peripartum infection.. We suggest that meconium-stained amniotic fluid should be regarded as a symptom rather than a syndrome becoming more prevalent with increasing term and which might be associated with higher levels of infection or asphyxia.

Topics: Amniotic Fluid; Female; Fetal Development; Fetal Hypoxia; Humans; Meconium; Models, Biological; Pregnancy

Intrapartum asphyxia is increased in several situations such as intrauterine growth retardation, preterm labor, postdate pregnancy or maternal diabetes. In all these cases, fetal heart rate monitoring should be preferred to intermittent auscultation. Fetal scalp blood pH or lactates can be used to identify fetuses at risk of intrapartum asphyxia. However, fetal scalp blood sampling should not delay delivery in case of severe abnormal fetal heart rate as fetal asphyxia could occur rapidly in theses high-risk pregnancies. Data is insufficient to recommend fetal pulse oximetry or ECG analysis. Research should be undertaken to evaluate their performance in these situations.

Topics: Diseases in Twins; Female; Fetal Blood; Fetal Growth Retardation; Fetal Hypoxia; Fetal Monitoring; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Labor, Obstetric; Lactates; Meconium; Obstetric Labor, Premature; Pregnancy; Pregnancy in Diabetics; Pregnancy, High-Risk; Pregnancy, Prolonged; Scalp

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

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

Approximately 8-15% of all infants are born with evidence of meconium-stained amniotic fluid (MSAF). MSAF is a potentially serious sign of fetal compromise and may indicate fetal hypoxia Objectives and aim of the work: The present study was designed to evaluate the relationship between meconium stained amniotic fluid and fetal nucleated red blood cell counts. As well, we aim to evaluate the relationship between the presence of meconium in amniotic fluid and Apgar scores in neonates.. A prospectively case-controlled study was performed on 40 women with clear amniotic fluid as control and 40 women with meconium-stained amniotic fluid as the study group. At delivery, 2 ml of umbilical cord blood was collected and analyzed for nucleated red blood cell (NRBC).. The mean NRBC counts in meconium-stained amniotic fluid was significantly higher than the control group (18.35 ± 7.7 and 9.6 ± 4.96), respectively (p < .001). There were statistically significant differences concerning 1- and 5-min Apgar scores with lower values in the MSAF group (p < .001 and .001, respectively).. Our results support previous studies which indicate the presence of meconium can be associated with chronic fetal hypoxia as demonstrated by elevated fetal NRBC levels.

Topics: Adolescent; Adult; Amniotic Fluid; Apgar Score; Blood Cell Count; Case-Control Studies; Erythroblasts; Female; Fetal Blood; Fetal Hypoxia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meconium; Pregnancy; Young Adult

To determine the association of cord arterial blood pH with neonatal outcome in cases of intrapartum fetal hypoxia.. Descriptive analytical study.. Gynaecology Unit-II, Civil Hospital, Karachi, from September 2011 to November 2012.. All singleton cephalic fetuses at term gestation were included in the study. Those with any anomaly, malpresentation, medical disorders, maternal age < 18 years, multiple gestation and ruptured membranes were excluded. Patients with abnormal cardiotocography and/or meconium stained liquor were enrolled as index case and immediate next delivery with no such signs as a control. Demographic characteristics, pH level < or > 7.25, neonatal outcome measures (healthy, NICU admission or neonatal death), color of liquor and mode of delivery recorded on predesigned proforma. Statistical analysis performed by SPSS 16 by using independent-t test or chi-square test and ANOVA test as needed.. A total of 204 newborns were evaluated. The mean pH level was found to be significantly different (p=0.007) in two groups. The pH value 7.25 had significant association (p < 0.001) with the neonatal outcome. However, the association of neonatal outcome with severity of acidemia was not found to be significant. Grading of Meconium Stained Liquor (MSL) also did not relate positively with pH levels as 85.7% of grade I, 68.9% of grade II and 59.4% of grade III MSLhad pH > 7.25. Majority (63.6%) cases needed caesarean section as compared to 31.4% controls.. There is a significant association of cord arterial blood pH at birth with neonatal outcome at pH < or > 7.25; but below the level of pH 7.25 it is still inconclusive.

Topics: Acid-Base Imbalance; Apgar Score; Cardiotocography; Female; Fetal Blood; Fetal Hypoxia; Fetus; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Male; Meconium; Meconium Aspiration Syndrome; Pregnancy; Pregnancy Outcome; Prospective Studies

The cause of meconium stained amniotic fluid in term healthy pregnancies is not clearly understood yet. The aim of this study was to investigate the placental ultrastructural changes and placental apoptosis in pregnancies complicated with meconium stained amniotic fluid.. The study group was composed of mothers (n: 13) and their term, appropriate for gestational age newborns with meconium stained amniotic fluid but without meconium aspiration syndrome. The control group consisted of mothers (n: 24) and their term appropriate for gestational age babies. We studied placental ultrastructural changes by transmission electron microscopy and placental apoptosis by transmission electron microscopy and the TUNEL method.. The incidence of placental apoptosis by the TUNEL method was significantly higher in the study group compared to the control group. Transmission electron microscopy investigation revealed more remarkable ultrastructural changes in the study group compared to the control group.. The increased apoptosis and ultrastructural findings in placentas with meconium stained amniotic fluid may be related to the placental adaptation to the hypoxic fetuses.

Topics: Adult; Amniotic Fluid; Apoptosis; Case-Control Studies; Female; Fetal Hypoxia; Gestational Age; Humans; In Situ Nick-End Labeling; Male; Meconium; Microscopy, Electron, Transmission; Placenta; Pregnancy; Turkey; Young Adult

Topics: Amniotic Fluid; Cholestasis; Female; Fetal Development; Fetal Hypoxia; Fetus; Gastrointestinal Tract; Gestational Age; Humans; Meconium; Pregnancy; Pregnancy Complications; Uterine Diseases

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

We sought to determine whether meconium-stained amniotic fluid is based on chronic hypoxia or not? In case of chronic hypoxia, higher red blood cell (Rbc) count and/or total hemoglobin levels (Hgb) and/or higher fetal hemoglobin (HbF) and/or lower adult hemoglobin (HbA) levels were expected when compared with controls.. Case-control study.. Obstetric unit of a tertiary ministry of health hospital.. Fifty singleton pregnancies with meconium-stained amniotic fluid and 50 singleton pregnancies with clear amniotic fluid at all stages of labor.. Umbilical cord blood samples were collected for determination of total blood parameters and hemoglobin electrophoresis.. Red blood cell count, total hemoglobin, fetal and adult hemoglobin contents (HbF and HbA).. Red blood cell count, total hemoglobin, fetal hemoglobin (HbF) and adult hemoglobin (HbA) contents were not different between meconium stained and clear amniotic fluid groups.. These results suggest that meconium passage may not be associated with chronic fetal hypoxia as demonstrated by similar red blood cell count, total hemoglobin values and fetal hemoglobin (HbF) and adult hemoglobin (HbA) contents.

Topics: Adult; Amniotic Fluid; Case-Control Studies; Erythrocyte Count; Female; Fetal Blood; Fetal Hemoglobin; Fetal Hypoxia; Humans; Infant, Newborn; Male; Meconium; Pregnancy

During pregnancy the placenta and the fetal membranes are the main sources of activin A. An increased level of activin A has been found in the serum of women with preeclampsia, diabetes mellitus and intrauterine growth restriction. Meconium is the predictor for adverse perinatal outcome, such as meconium aspiration syndrome or brain damage. The aim of our study was to evaluate the levels of fetal activin A in labors complicated by meconium-stained amniotic fluid.. Cord blood samples were collected from 65 full-term neonates from single pregnancies. In each case, the hematological parameters of cord blood and activin A (ELISA--Oxford Bio-Innovation Activin A Assay Kit) were assessed.. There were no significant differences in the concentration of activin A in cord blood between the group with and the group without meconium-stained amniotic fluid. The mean count of nucleated erythrocytes and white blood cells as well as the percentage of reticulocytes was significantly higher in the meconium group. There were no significant differences between concentration of fetal activin A in a vaginal delivery (0.58 +/- 0.38 ng/ml) and cesarean section after labor (0.44 +/- 0.32 ng/ml) or elective cesarean section (0.62 +/- 0.47 ng/ml) groups. There were also no correlations between the levels of activin A and the parameters of fetal acid base status or cord blood hematological values.. Fetal activin A has a limited significance for diagnosing fetal hypoxia in labors complicated by meconium-stained amniotic fluid. There were no correlations between the parameters of fetal acid base status and fetal activin A. The levels of fetal activin A do not depend on the mode of the delivery. Meconium-stained amniotic fluid resulted in significant changes of the hematological variables in cord blood.

Topics: Activins; Adolescent; Adult; Amniotic Fluid; Biomarkers; Enzyme-Linked Immunosorbent Assay; Female; Fetal Hypoxia; Humans; Meconium; Obstetric Labor Complications; Pregnancy

Meconium staining of the skin is a common event associated with fetal hypoxia, stillbirths, weak-born piglets, and neonatal mortality. Aspiration of meconium leads to meconium aspiration syndrome (MAS). This study was undertaken to assess the relationship between the degree of meconium staining of the skin at birth, meconium aspiration, and pulmonary changes in porcine neonates. A total of 353 farrowing sows and 3,693 born piglets were monitored during parturition and for 15 days after delivery. Umbilical cords were classified as normal or ruptured. Meconium staining in the skin was graded as nonstained, mildly, moderately, and severely stained. Mortality from birth to 15 days of age was 8.4%. The lungs from 60 meconium-stained piglets and 60 lungs from nonstained piglets were collected and microscopically examined for meconium aspiration and inflammation. Rupture of the umbilical cord was significantly higher (P < 0.01) in meconium-stained piglets. Microscopically, 32% and 40% of the lungs had evidence of meconium for the stained and nonstained groups, respectively. The microscopic grade of meconium aspiration and inflammatory cells was not different between nonstained and meconium-stained piglets. Aspiration of meconium induced a granulomatous response in the lungs. It was concluded that the grade of meconium staining is a good indicator of fetal hypoxia, but not a good predictor for meconium aspiration and MAS in piglets.

Topics: Animals; Animals, Newborn; Fetal Death; Fetal Hypoxia; Humans; Infant, Newborn; Lung; Meconium; Meconium Aspiration Syndrome; Skin; Swine; Swine Diseases; Umbilical Cord

Oxytocin is used to induce and control parturition, nevertheless, the increase of uterine contractions decreases blood flow and gaseous exchange through the womb predisposing to intra-partum mortality. The objective of the present study was to evaluate the effect of oxytocin on myometrial activity, fetal intrauterine hypoxia and postnatal asphyxia in sows during farrowing. Hybrid (n = 120) sows approaching the time of farrowing were randomly assigned in two groups of 60 animals each. Group I (G(1): control) was treated IM with saline solution and Group II (G(2)) was injected IM with oxytocin (1IU/6kg LW) as a single dose at birth of the first piglet. Both average number of myometrial contractions and intensity in G(2) were greater (P < 0.01) as compared with G(1). The mean of intra-partum stillbirths (IPS's) and those where fetal cardiac frequency (FCF) or heart beats, could not be detected after birth, were greater (P < 0.01) in G(2) as compared with G(1). The average decelerations of FCF known as dips II, which indicate severe hypoxia, was greater in G(2) (P < 0.01) as compared with that of G(1). There was a greater (P < 0.01) number of intra-partum stillbirths, stained with severe meconium in G(2) when compared with G(1). Oxytocin treatment increased (P < 0.01) the number of pigs born alive with ruptured umbilical cords and those with different grades of meconium staining on their skin. It was concluded that administration of oxytocin at the onset of parturition increased the myometrial activity, decreased fetal cardiac frequency, predisposed the rupture of umbilical cords and the degree of meconium staining, and increased intra-partum mortality.

Topics: Animals; Animals, Newborn; Female; Fetal Hypoxia; Fetal Monitoring; Heart Rate, Fetal; Meconium; Myometrium; Oxytocin; Parturition; Pregnancy; Pregnancy Outcome; Random Allocation; Swine; Uterine Contraction

Topics: Amnion; Animals; Female; Fetal Hypoxia; Humans; Meconium; Obstetric Labor Complications; Pregnancy; Sheep

This study assessed perinatal outcome in pregnancies with accidentally diagnosed fetal grasping of the umbilical cord (FGUC) on ultrasonography (US) in late gestation as a possible cause of fetal hypoxia due to mechanical occlusion of umbilical circulation. In this retrospective clinical study, routine antenatal US examination revealed FGUC from 32 to 41 weeks of gestation in seven normal single pregnancies. Upon FGUC findings, fetal condition was followed up every second day by repeat US findings of FGUC, and then by Doppler parameters of fetoplacental circulation measurement of resistance index in umbilical artery (URI) and middle cerebral artery (CRI), and cardiotocography (CTG), and perinatal outcome (peripartal cardiotocography, 5-min Apgar score, umbilical arterial blood pH, occurrence of meconium amniotic fluid, need of additional treatment at neonatal intensive care unit (NICU), and mode of pregnancy termination (cesarean section, forceps or vacuum extraction-VE for hypoxia). After delivery, neonatal neurosonography and neonatal complications related to pregnancy or birth were evaluated. All URI values were increased, resulting from persistent FGUC and elevated umbilical arterial RI. CRI showed great oscillations in the values for gestational age and decreased CRI. In two cases, cerebral/umbilical ratio was less than 1, indicating initial vasocentralization as a fetal compensatory mechanism for hypoxia. In these cases, a pathological peripartal CTG and pH 7.23, indicative of preacidosis, were verified. All children were discharged from NICU as healthy, free from neurological lesions, with the exception of the latter, who had dystonia syndrome and mild motor deficit as a sign of peripartal hypoxia. Although it probably belongs to normal reflexes, intermittent FGUC should be US controlled. Persistent FGUC should be considered pathological for its possible hypoxic effect and umbilical circulation obstruction. These pregnant women should be hospitalized and closely monitored, as in part confirmed by the present study.

Topics: Adult; Arterial Occlusive Diseases; Delivery, Obstetric; Female; Fetal Hypoxia; Fetal Movement; Gestational Age; Hand; Hand Strength; Humans; Hydrogen-Ion Concentration; Intensive Care, Neonatal; Meconium; Placental Circulation; Pregnancy; Ultrasonography, Prenatal; Umbilical Arteries; Umbilical Cord; Vascular Resistance

In an experimental study, chemically sympathectomised near term fetal sheep and a control group were subjected to repeated episodes of acute hypoxia. Despite severe hypotension and metabolic acidosis, no animal in the control group had meconium-stained amniotic fluid, whereas every animal in the sympathectomised group had heavily meconium-stained amniotic fluid at the end of the experiments. These data and the available literature do not support a direct association between acute hypoxia and meconium-stained amniotic fluid but suggest that a reduction in sympathetic neural tone must be a component of meconium passage. Clinical and experimental data on the occurrence of meconium-stained amniotic fluid are reviewed.

Topics: Amniotic Fluid; Animals; Blood Pressure; Fetal Hypoxia; Heart Rate, Fetal; Hydrogen-Ion Concentration; Meconium; Sheep; Sympathectomy, Chemical

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

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

We sought to determine whether umbilical cord plasma erythropoietin levels were different in deliveries complicated by meconium passage and to determine whether this response is influenced by gestational age.. Fetal erythropoietin levels were measured in 203 appropriately grown neonates at 37 to 43 weeks of gestation; among those, 70 had passed meconium.. Meconium passage in the entire population was associated with elevated fetal erythropoietin levels (68 vs 31 mIU/mL; P <.001). Cord blood gases, pH, base deficit, and PO (2), as well as the 1- and 5-minute Apgar scores, were not different between the meconium and no-meconium groups. Gestational age and birth weights were significantly higher in the meconium group. Stepwise multiple regression analysis with meconium and gestational age used as the independent variables showed both meconium and gestational age to be independently associated with fetal erythropoietin levels (r = 0.356, F = 14.5; meconium, P <.001; gestational age, P <.01).. These results suggest that meconium passage can be associated with chronic fetal hypoxia as demonstrated by elevated fetal erythropoietin levels, independent of gestational age.

Topics: Apgar Score; Birth Weight; Erythropoietin; Female; Fetal Blood; Fetal Hypoxia; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Logistic Models; Meconium; Odds Ratio; Oxygen; Pregnancy; Regression Analysis

We sought to use an in vitro approach to determine relationships between meconium and fetal lung liquid production and to relate meconium to possible problems in lung liquid removal at birth.. Near-term fetal guinea pigs were divided according to the level of spontaneously occurring meconium (no meconium, light meconium, or heavy meconium). Their lungs were maintained in vitro in Krebs-Henseleit saline solution for 3 hours. Lung liquid production or reabsorption was measured by a dye-dilution method, and loss of lactate to the lung liquid and outer Krebs-Henseleit solution was monitored. Reabsorptions were investigated by activating powerful responses with dinitrophenol during the middle hour.. During the first hour, lungs from meconium-free fetuses produced liquid at 1.25 +/- 0.12 mL/kg(-1) body weight. h(-1); rates from light or heavy meconium groups were not significantly different (n = 18). Similarly, total lactate loss was not significantly different between the meconium-free and light-meconium groups but was twice as high in heavy-meconium preparations (73.68 +/- 10.60 micromol/L. g(-1) dry lung tissue. h(-1); P <.025, analysis of variance). The meconium-free and heavy-meconium groups continued to produce fluid, with no significant change throughout the 3 hours of incubation; lactate losses fell slightly. Therefore there were no problems with fluid production with meconium present, but the high-lactate losses with heavy meconium suggested long-term intrauterine hypoxia. Dinitrophenol produced powerful reabsorptions in lungs from meconium-free fetuses (-0.85 +/- 0.35 mL. kg(-1) body weight. h(-1); P <.005, analysis of variance; P <.0005, regression analysis) but failed to do so in heavy-meconium fetuses (n = 36). Lactate losses rose 2-fold in both groups (P <.005 to P < 0.0005, analysis of variance and regression analysis), despite already elevated losses with heavy meconium (n = 12). Therefore, in heavy-meconium fetuses, dinitrophenol affected metabolic pathways but did not activate fluid reabsorption, suggesting damage to reabsorptive mechanisms.. Unless major airways are blocked, meconium is not associated with reduced fetal lung liquid production, which can cause poor lung development, but there may well be poor fluid removal after birth because of compromised reabsorptive mechanisms, which are unlikely to be helped by possible hormonal intervention.

Topics: Absorption; Animals; Body Fluids; Dinitrophenols; Female; Fetal Hypoxia; Guinea Pigs; In Vitro Techniques; Kinetics; Lactic Acid; Lung; Meconium; Pregnancy; Regression Analysis

Most frequently, placental glycogen has been studied as an index of fetal nutrition. There are no published studies of placental glycogen as an index of fetal stress. In this study of 1573 samples from 71 placentae, glycogen levels in the placental disk, fetal membranes and umbilical cord of normal uncomplicated pregnancies were compared with those in complicated pregnancies. The complicated pregnancies included preterm delivery, hypertensive disorders, inadequate prenatal care, substance abuse, maternal fever or infection, obesity, diabetes mellitus, premature rupture of membranes, intrauterine growth retardation, sickle cell trait, and acute meconium staining of amniotic fluid at delivery. The data showed that the only significant differences were in the subgroup complicated by meconium-stained amniotic fluid in which the placental disks and umbilical cords had significantly lower (P=0.0006) glycogen levels. This finding suggests a relatively specific association. It is interesting to speculate that the passage of meconium with its vasoconstrictive effect increases utilization of local glycogen stores, decreases local glycogen reserves needed for the work of further vasoconstriction, and, in the event of subsequent acute stress, impairs vascular perfusion of tissues. In this way, meconium could predispose the infant to asphyxia.

Topics: Amniotic Fluid; Case-Control Studies; Extraembryonic Membranes; Female; Fetal Hypoxia; Fetus; Glycogen; Humans; Infant, Newborn; Male; Meconium; Placenta; Pregnancy; Pregnancy Complications; Umbilical Cord; Vasoconstriction

The sensitivity of meconium stain in amniotic fluid for prediction of fetal well-being in intrahepatic cholestasis of pregnancy(ICP) was evaluated. The study consisted of an ICP group(n = 30), and a control group (n = 30) and the umbilical arterial pH value(< 7.2) was used as a standard. The positive and negative predicttive valus of meconium-stained amniotic fluid in ICP group were 80.0%; the positive and negative predictive values in control group were 60.0% and 92.0% respectively. There was no significant difference (P > 0.05) between the two groups in positive and negative predictive values. However, the positive and negative predictive values of the two groups were high, which indicated that meconium-stained amniotic fluid related to fetal hypoxia. Moreover, the incidence of meconium-stained amniotic fluid in ICP was higher than that in control (40.0%: 16.70%, P < 0.05). Therefore, we suggest that the amniotic fluid of patients with ICP should be observed very closely. When meconium-stained amniotic fluid is discovered, delivery by cesarean section is imminent.

Topics: Adult; Amniotic Fluid; Cholestasis, Intrahepatic; Female; Fetal Blood; Fetal Hypoxia; Fetal Monitoring; Humans; Hydrogen-Ion Concentration; Meconium; Pregnancy; Pregnancy Complications; Prospective Studies

Our purpose was to demonstrate the predictive value of clinical risk scoring and fetal assessment for intrapartum fetal asphyxia.. Intrapartum fetal asphyxia was defined by an umbilical artery buffer base < 34 mmol/L. The predictive value of 20 antepartum and intrapartum risk factors was examined in 1909 consecutive pregnancies. The predictive value of clinical risk factors with periodic fetal assessment was examined in a second population of 100 consecutive pregnancies with biochemically determined intrapartum fetal asphyxia.. The incidence of intrapartum was 2.3%. Two problems were apparent in these studies. A significant proportion of intrapartum fetal asphyxia occurred in pregnancies with no risk factors. The positive predictive value of clinical risk factors was low, 3%, resulting in a large number of false positives requiring clarification.. Screening and fetal assessment methods must be improved to ensure the early recognition of intrapartum fetal asphyxia that may require intervention during labor to avoid morbidity and mortality.

Topics: Delivery, Obstetric; Female; Fetal Blood; Fetal Hypoxia; Humans; Hydrogen-Ion Concentration; Incidence; Labor, Obstetric; Meconium; Obstetric Labor Complications; Obstetric Labor, Premature; Predictive Value of Tests; Pregnancy; Retrospective Studies; Risk Factors

To investigate the relation between the biochemical markers of umbilical venous erythropoietin and umbilical arterial pH and morphologic placental abnormalities in fetal hypoxia.. Placentas from 300 high-risk newborn infants (gestational age 24-42 weeks) were examined macroscopically and microscopically following standardized criteria. The morphologic findings were correlated with the erythropoietin concentration in umbilical venous blood and with umbilical arterial pH at birth. Venous hematocrit and circulating nucleated red blood cells were measured in 112 of these infants during the first 6 hours of life.. The umbilical venous erythropoietin concentration correlated significantly (r = 0.74) with the number of circulating nucleated red blood cells. In 26 placentas without morphologic abnormalities, the median (and 25th and 75th percentiles) erythropoietin concentration was 35.2 mU/mL (19.2-48.7) and umbilical arterial pH was 7.30 (7.20-7.33). The erythropoietin concentration was elevated significantly when placental examination showed evidence of acute villous circulatory disturbance (61.3 mU/mL; 24.2-125.1), fetal vasculopathy (85.6 mU/mL; 23.7-119.7), or chorioamnionitis with fetal reaction (51.3 mU/mL; 27.7-118.7). The erythropoietin concentration varied significantly with the stage of placental meconium phagocytosis; it was 62.7 mU/mL (16.3-125.9) if meconium phagocytosis was classified as recent, 128.2 mU/mL (44.4-1483.2) if it was classified as a few hours old, and 66.2 mU/mL (46.3-140.1) if it was classified as a few days old. Umbilical arterial pH was not altered significantly with different morphologic placental abnormalities.. Fetal erythropoietin production is stimulated by hypoxia after a few hours' delay and leads to increased erythropoiesis. Placental examination combined with measurement of umbilical venous erythropoietin and umbilical arterial pH provides information about earlier fetal hypoxia.

Topics: Age Factors; Biomarkers; Blood Gas Analysis; Congenital Abnormalities; Delivery, Obstetric; Erythrocyte Count; Erythropoiesis; Erythropoietin; Evaluation Studies as Topic; Female; Fetal Blood; Fetal Hypoxia; Gestational Age; Hematocrit; Humans; Hydrogen-Ion Concentration; Linear Models; Male; Meconium; Phagocytosis; Placenta; Pregnancy; Risk Factors; Time Factors; Umbilical Arteries; Umbilical Veins

Meconium peritonitis is a sterile, chemical peritonitis resulting from perforation of the bowel in perinatal life. In stillbirths meconium peritonitis is extremely rare. We report the autopsy findings in three fetuses ranging from 21-39 weeks gestation in which meconium peritonitis was identified. Maternal history in two cases was suggestive of possible fetal hypoxia. No family history of cystic fibrosis was discerned. One fetus was hydropic and abdominal calcifications were noted on postmortem radiograph. Gross evidence of meconium in the peritoneal cavity, visceral adhesions, and serosal nodules were noted in two fetuses. Nodules of calcified meconium seen by microscopy were the only clues to diagnosis in the third fetus. The discovery of meconium peritonitis at autopsy may be the only residual evidence of antecedent bowel perforation. We suggest that intrauterine hypoxia may play a role in the development of meconium peritonitis in some cases.

Topics: Adult; Female; Fetal Death; Fetal Hypoxia; Humans; Hydrops Fetalis; Male; Meconium; Peritonitis; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third

Hypoxia is a potent stimulus to the release of vasopressin in fetal sheep and, in turn, plasma concentrations of the hormone correlate inversely with fetal oxygenation. Because the fetal kidney contributes to vasopressin clearance, we propose that measurement of increased amounts of vasopressin in amniotic fluid would be indicative of fetal hypoxia. We therefore measured concentrations of vasopressin in amniotic fluid under resting conditions, during and after fetal hypoxia, and with intravenous and intra-amniotic administration of vasopressin in 15 chronically instrumented fetal lambs 111-141 d gestation. In the resting state mean (+/- SE) vasopressin concentrations in amniotic fluid (1.6 +/- 0.3 pg . ml-1) did not differ from those in maternal (1.4 +/- 0.4 pg . ml-1) or fetal (1.8 +/- 0.2 pg . ml-1) plasma. After exposure of the ewe to 10% O2 or partial occlusion of the umbilical cord, vasopressin concentrations in fetal plasma increased significantly (P less than 0.001) to 200 +/- 59 pg . ml-1 with a delayed increase in amniotic fluid concentrations (P less than 0.03) to 15.8 +/- 4.5 pg . ml-1. This rise in concentration of vasopressin in amniotic fluid was sustained for at least 24 h and levels at that time were highly correlated with peak plasma concentrations (r = 0.83, P less than 0.001). Intravenous infusion of vasopressin into the fetus was accompanied by an equally significant (P less than 0.02) and sustained increase of vasopressin in amniotic fluid. After intraamniotic injection of vasopressin, levels remained increased for at least 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amniotic Fluid; Animals; Female; Fetal Hypoxia; Fetus; Maternal-Fetal Exchange; Meconium; Pregnancy; Radioimmunoassay; Sheep; Time Factors; Vasopressins

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

Topics: Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Female; Fetal Hypoxia; Fetus; Gestational Age; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Postmature; Infant, Premature; Meconium; Pregnancy

Amniotic fluid samples were obtained at induction of labour in 64 women; in 15 of these there was meconium staining of the amniotic fluid; the remainder showed no signs of fetal distress. Using high pressure liquid chromatography, compared to the samples from normal patients there were highly significantly raised levels of hypoxanthine, xanthine and uridine in the meconium stained samples; oxypurines in the meconium itself could not explain the difference. Where serial samples were obtained during labour by intrauterine catheter, a terminal rise in oxypurine levels was apparent. Where the proportion of oxypurine present as hypoxanthine exceeded one per cent in amniotic fluid at the time of induction, there was a significantly greater occurrence of late fetal heart rate decelerations in the ensuing labour. These findings are consistent with other evidence that when tissues become hypoxic the metabolic products of nucleotide breakdown escape from the cells and appear in extracellular fluid. Oxygen lack in the fetus probably causes loss of these compounds from the hypoxic kidneys to the urine so that they appear in amniotic fluid.

Topics: Amniotic Fluid; Female; Fetal Hypoxia; Humans; Hypoxanthines; Infant, Newborn; Labor, Induced; Meconium; Pregnancy; Uridine; Xanthines

Continuous monitoring of fetal heart rate (FHR) and routine sampling of fetal scalp blood were utilized to evaluate the intrapartum performance of 82 fetuses of postdates pregnancies. A comparison was made between this group and 260 term pregnancies. The incidences of abnormal FHR patterns were not different between the postdates group and the control group. All of the postdates neonates with low 5 minute Apgar scores had passed meconium. The mean pH values of the postdates fetuses with meconium were significantly lower than those of the control group at each sampling interval (i.e., early labor, late labor, and umbilical artery). Those fetuses with thick meconium had significantly lower pH values in late labor than did those with thin meconium. Continuous electronic FHR monitoring is recommended for intrapartum surveillance of all postdates patients. Because of the increased incidence of fetal acidosis in the presence of thick meconium, sampling of fetal scalp blood is not unreasonable even with a normal FHR pattern.

Topics: Adolescent; Adult; Apgar Score; Delivery, Obstetric; Female; Fetal Heart; Fetal Hypoxia; Fetal Monitoring; Heart Rate; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Meconium; Pregnancy; Pregnancy, Prolonged

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

Topics: alpha-Fetoproteins; Amniotic Fluid; Down Syndrome; Female; Fetal Hypoxia; Gestational Age; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications

Topics: Female; Fetal Hypoxia; Humans; Infant, Newborn; Meconium; Pneumonia, Aspiration; Pregnancy; Pregnancy Complications; Staining and Labeling

Aspiration of meconium by the fetus at or near delivery may be associated with high infant morbidity and mortality. The meconium aspiration syndrome (MAS) is often preventable, yet cases of MAS continue to occur. This paper describes the pathophysiology of MAS. The development of MAS involves passage of meconium by a compromised fetus and the subsequent aspiration of that meconium. Respiratory tract obstruction, hypoxia, hypercapnia, and acidosis may all result. Treatment of MAS is primarily supportive, and high mortality rates have been reported with the more severe cases. There is good evidence that careful suctioning of the infant's upper respiratory tract can in most cases prevent MAS. The suctioning, performed while the infant's head is still on the mother's perineum and prior to the first inspirations, is both a safe and effective preventive procedure.

Topics: Airway Obstruction; Female; Fetal Hypoxia; Fetus; Gastrointestinal Motility; Humans; Infant, Newborn; Meconium; Pneumonia, Aspiration; Pregnancy; Respiratory Insufficiency; Respiratory System; Suction; Syndrome

Topics: Amniotic Fluid; Female; Fetal Diseases; Fetal Heart; Fetal Hypoxia; Heart Function Tests; Humans; Inhalation; Meconium; Monitoring, Physiologic; Pregnancy; Respiration; Tachycardia

Topics: Adult; Asphyxia Neonatorum; Female; Fetal Diseases; Fetal Hypoxia; Humans; Infant, Newborn; Inhalation; Meconium; Pregnancy; Prenatal Care; Subarachnoid Hemorrhage

Topics: Amniotic Fluid; Female; Fetal Heart; Fetal Hypoxia; Heart Auscultation; Heart Rate; Humans; Meconium; Pregnancy

Topics: Amniotic Fluid; Apgar Score; Female; Fetal Hypoxia; Humans; Infant, Newborn; Meconium; Obstetric Labor, Premature; Pregnancy

Topics: Amniotic Fluid; Asphyxia Neonatorum; Biomarkers; Fetal Hypoxia; Humans; Infant, Newborn; Meconium; Staining and Labeling