morphine and Pregnancy--Prolonged

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

Topics: Amniotic Fluid; Electrocardiography; Embryonic and Fetal Development; Estriol; Female; Fetal Heart; Fetus; Gestational Age; Humans; Labor, Obstetric; Leukocyte Count; Meconium; Oxytocin; Placental Lactogen; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy Tests; Pregnancy, Prolonged; Radiography; Ultrasonography; Uterus

Our objective was to study the strength of the association between meconium-stained amniotic fluid and severe morbidity among neonates of nulliparas with prolonged pregnancies.. This was a secondary analysis of the NOCETER randomized trial that took place between 2009 and 2012 in which 11 French maternity units included 1373 nulliparas at 41. This study included 1274 patients: 803 (63%) in the group with normal amniotic fluid, 196 (15.4%) in the thin amniotic fluid group, and 275 (21.6%) in the thick amniotic fluid group. The neonates of patients with thick amniotic fluid had higher rates of neonatal morbidity than those of patients with normal amniotic fluid (7.3% vs. 2.2%; p < 0.001; adjusted relative risk [aRR] 3.3, 95% confidence interval [CI] 1.7-6.3), but those of patients with thin amniotic fluid did not (3.1% vs. 2.2%; p = 0.50; aRR 1.0, 95% CI, 0.4-2.7).. Among nulliparas at 41

Topics: Amniotic Fluid; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

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

Topics: Adolescent; Adult; Amniotic Fluid; Cesarean Section; Clinical Trials as Topic; Endoscopy; Female; Fetal Death; Humans; Infant Mortality; Infant, Newborn; Labor, Induced; Meconium; Pregnancy; Pregnancy, Prolonged

Several common maternal or neonatal risk factors have been linked to meconium amniotic fluid (MAF) development; however, the results are contradictory, depending on the study. This study aimed to assess the prevalence and risk factors of MAF in singleton pregnancies.. This study is a retrospective cohort that assessed singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups: 1) those diagnosed with meconium amniotic fluid (MAF) and 2) those diagnosed with clear amniotic fluid. Mothers with bloody amniotic fluid were excluded. Demographic factors, obstetrical factors, and maternal comorbidities were extracted from the electronic data of each mother. The Chi-square test was used to compare differences between the groups for categorical variables. Logistic regression models were used to assess meconium amniotic fluid risk factors.. Of 8888 singleton deliveries during the study period, 1085 (12.2%) were MAF. MAF was more common in adolescents, mothers with postterm pregnancy, and primiparous mothers, and it was less common in mothers with GDM and overt diabetes. The odds of having MAF in adolescents were three times higher than those in mothers 20-34 years old (aOR: 3.07, 95% CI: 1.87-4.98). Likewise, there were significantly increased odds of MAF in mothers with late-term pregnancy (aOR: 5.12, 95% CI: 2.76-8.94), and mothers with post-term pregnancy (aOR: 7.09, 95% CI: 3.92-9.80). Primiparous women were also more likely than multiparous mothers to have MAF (aOR: 3.41, 95% CI: 2.11-4.99).. Adolescents, primiparous mothers, and mothers with post-term pregnancies had a higher risk of MAF. Maternal comorbidities resulting in early termination of pregnancy can reduce the incidence of MAF.

Topics: Adolescent; Adult; Amniotic Fluid; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Retrospective Studies; Risk Factors; Tertiary Care Centers; Young Adult

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

Immigrants have higher risks for some adverse obstetric outcomes. Furthermore, refugees are reported to be the most vulnerable group. This study compared obstetric outcomes between immigrant women originating from conflict-zone countries and ethnic Norwegians who gave birth in a low-risk setting.. This was a population-based study linking the Medical Birth Registry of Norway to Statistics Norway. The study included the first registered birth during the study period of women from Somalia (n = 278), Iraq (n = 166), Afghanistan (n = 71), and Kosovo (n = 67) and ethnic Norwegians (n = 6826) at Baerum Hospital from 2006-2010. Background characteristics and obstetric outcomes of each immigrant group were compared with ethnic Norwegians with respect to proportions and risks calculated by logistic regression models.. In total, 7408 women and their births were analyzed. Women from Somalia were most at risk for adverse obstetric outcomes. Compared with ethnic Norwegians, they had increased odds ratios (OR) for emergency cesarean section (OR 1.81, CI 1.17-2.80), postterm birth (OR 1.93, CI 1.29-2.90), meconium-stained liquor (OR 2.39, CI 1.76-3.25), and having a small-for-gestational-age infant (OR 3.97, CI 2.73-5.77). They had a reduced OR for having epidural analgesia (OR 0.40, CI 0.28-0.56) and a large-for-gestational-age infant (OR 0.32, CI 0.16-0.64). Women from Iraq and Afghanistan had increased risk of having a small-for-gestational-age infant with OR of 2.21 (CI 1.36-3.60) and 2.77 (CI 1.42-5.39), respectively. Iraqi women also had reduced odds ratio of having a large-for-gestational-age infant (OR 0.35, CI 0.15-0.83). Women from Kosovo did not differ from ethnic Norwegians in any of the outcomes we tested.. Even in our low-risk maternity ward, women originating from Somalia were at the greatest risk for adverse obstetric outcomes in the compared groups. We could not find the same risk among the other immigrant women, also originating from conflict-zone countries. Several factors may influence these findings, and this study suggests that immigrant women from Somalia need more targeted care during pregnancy and childbirth.

Topics: Adolescent; Adult; Afghanistan; Analgesia, Epidural; Analgesia, Obstetrical; Cesarean Section; Cohort Studies; Emergencies; Emigrants and Immigrants; Female; Fetal Macrosomia; Hospitals; Humans; Infant, Newborn; Infant, Small for Gestational Age; Iraq; Kosovo; Logistic Models; Meconium; Norway; Odds Ratio; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Prospective Studies; Risk; Somalia; Warfare; Young Adult

To determine delivery outcome in women undergoing induction of labor for postdate pregnancy in relation to fetal gender.. A total of 365 nulliparous and 127 multiparous women carrying singleton postdate pregnancies with unfavorable cervix were enrolled. Clinical characteristics and delivery outcome were analyzed in relation to fetal gender.. Women carrying male fetuses showed higher rate of caesarean section than those carrying females, in both nulliparous and multiparous women. Moreover, women carrying male fetuses presented more frequently with (i) interval between induction of labor and delivery >24 hours (P < .0002); (ii) augmentation of labor after cervical ripening (P < .0391); (iii) meconium-stained liquor (P< .0126); and (iv) higher neonatal weight (P < .0011) than those carrying females.. Male fetuses are more likely to be associated with higher rates of cesarean section. In maternal fetal medicine, gender differences may add prognostic information on the delivery outcome in women induced for postdate pregnancy.

Topics: Adult; Birth Weight; Cervical Ripening; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Labor, Induced; Labor, Obstetric; Male; Meconium; Odds Ratio; Parity; Pregnancy; Pregnancy, Prolonged; Retrospective Studies; Risk Factors; Sex Factors; Time Factors

To evaluate the value of non-stress test (NST), biophysical profile score (BPS), amniotic fluid index (AFI) and foetal movement charted (FMC) by mother in the prediction of meconium passage in post-date pregnancies.. In a cross-sectional study performed from 2003 to 2005, in the Ali-Ebne-Abitaleb Hospital, all post-date singleton pregnant women were included and evaluated a few hours before delivery for AFI, NST, BPS and FMC. Based on the results of the mentioned tests the occurrence of foetal distress was foreseen and the judgments were compared with the results of evaluation of the amniotic fluid after amniotomy during labour. Our judgment of occurrence of foetal distress was based on meconium staining of amniotic fluid (MSAF) as the gold standard.. In this study 250 women were included. The sensitivity and specificity of these tests respectively were: 62% and 42% for NST, 66% and 56% for BPS, 38% and 83% for AFI and 44% and 64% for FMC. The highest positive predictive value was recorded respectively for AFI (52%) and negative predictive value was recorded for NST (94%). There was a significant association between MSAF and BPS. In univariate analyses, there was a significant association between MSAF and BPS (P = 0.010 for linear by linear association, exact method). Also there was a significant association between MSAF and AFI < 5 cm. (OR = 2.99, 95% CI, 1.57-5.74).. Although BPS and AFI had the highest level of prediction, they are of limited usefulness in prediction of foetal distress. The reactive NST is more conclusive.

Topics: Amniotic Fluid; Cross-Sectional Studies; Fetal Movement; Humans; Meconium; Pregnancy, Prolonged

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

This study was conducted to determine the incidence of meconium staining of the amniotic fluid (MSAF) and its associated factors in a Nigerian teaching hospital. Perinatal data on 80 consecutive live, singleton infants of booked mothers born through meconium-stained liquor from March - June 2003 were analysed and compared with babies born through clear liquor. The incidence of MSAF was 20.4% for 393 deliveries. The rate increased with gestational age: no case was found below 37 weeks (p = 0.001). Primiparity, prolonged rupture of fetal membranes and obstructed labour were more often associated with MSAF (p = 0.005, p = 0.0013 and p = 0.0000002, respectively) as were tachycardia or bradycardia and low Apgar scores (p = 0.0000001 and p = 0.046, respectively). It is concluded that meconium-staining is common. It is related to gestational maturity and stressful peripartum conditions and associated with adverse symptomatology in the fetus and newborn.

Topics: Amniotic Fluid; Apgar Score; Female; Gestational Age; Heart Rate, Fetal; Hospitals, Teaching; Hospitals, University; Humans; Infant, Newborn; Male; Meconium; Nigeria; Obstetric Labor Complications; Parity; Pregnancy; Pregnancy, Prolonged

The purpose of this study was to determine whether, when, and how rates of short-term neonatal complications increase beyond 37 weeks of gestation.. A retrospective cohort study was conducted of all low-risk, term, cephalic, and singleton births that were delivered at the University of California, San Francisco, between 1976 and 2001. Primary outcomes included neonatal umbilical artery pH, umbilical artery base excess, the presence of meconium, macrosomia, 5-minute Apgar scores, and admission to the intensive care nursery. Multivariate analyses were performed that controlled for maternal ethnicity, weight, age, socioeconomic status, and obstetric history.. Among the 32,679 women who were delivered at > or =37 completed weeks of gestation, the rates of umbilical artery pH <7.0, umbilical artery base excess less than -12 increased beyond 40 weeks of gestation, and the presence of meconium increased beyond 39 weeks of gestation (chi-squared test; P < .001). These outcomes continued to increase in each subsequent week, and these findings persisted when they were controlled for potential confounders in multivariate models.. We found that the rates of immediate neonatal morbidity increase with increasing gestational age. Accurate determination of these rates is important in the determination of gestational age at which the risk of continuing the pregnancy outweighs the risk of induction of labor.

Topics: Adult; Apgar Score; California; Cohort Studies; Female; Fetal Blood; Fetal Macrosomia; Gestational Age; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Intensive Care Units, Neonatal; Meconium; Medical Records; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Prolonged; Retrospective Studies; Socioeconomic Factors

This prospective observational study aims at determining the distribution of fetal cerebro-placental Doppler indices and amniotic fluid volume in a homogenous group of uncomplicated postdated pregnancies at 41 weeks. The correlation with incidence of passage of thick meconium-stained liquor in labor was analyzed to decide which parameter would be useful in the surveillance of postdated pregnancies.. The amniotic fluid volume, middle cerebral artery pulsatility index, umbilical artery pulsatility index, and cerebroplacental ratio were measured and distribution determined in 118 well-dated singleton pregnancies admitted for routine induction of labor at 41 weeks. The 10th centile and the 90th centile in each Doppler parameter and amniotic fluid volume were chosen to divide each parameter into three centile groups. The prevalence of thick meconium-stained liquor in labor in different Doppler and amniotic fluid volume centile groups was compared using Chi-square test for trend with P < 0.05 taken as statistically significant.. The prevalence of thick meconium-stained liquor in labor was significantly inversely correlated with the middle cerebral artery pulsatility index (P = 0.008), with significant difference across different middle cerebral artery pulsatility index centile groups (P = 0.02). There was no significant difference in the prevalence of thick meconium-stained liquor in labor or oligohydramnios across different umbilical artery pulsatility index centile groups. Neither was there significant difference in the prevalence of thick meconium-stained liquor in labor and oligohydramnios across different cerebroplacental ratio and amniotic fluid volume centile groups. Logistic regression using the 10th centile of middle cerebral artery pulsatility index confirmed that it was a significant independent predicting factor for risk of thick meconium-stained liquor in labor with adjusted odds ratio (95th CI) of 6.14 (1.6-24.1).. Middle cerebral artery pulsatility index is better than amniotic fluid volume or umbilical artery pulsatility index in predicting the risk of thick meconium-stained liquor in labor in uncomplicated postdated pregnancy at 41 weeks.

Topics: Adult; Amniotic Fluid; Blood Flow Velocity; Cerebral Arteries; Female; Fetus; Humans; Labor, Obstetric; Logistic Models; Meconium; Oligohydramnios; Placental Circulation; Predictive Value of Tests; Pregnancy; Pregnancy, Prolonged; Prospective Studies; Pulsatile Flow; Sensitivity and Specificity; Ultrasonography, Doppler, Color; Umbilical Arteries

To determine the occurrence of maternal and fetal complications in low-risk pregnancies beyond 39 weeks and to re-evaluate the acceptable cut-off (42 weeks) for induction of labor.. A total of 36 160 low-risk pregnancies with reliable dating of gestational age (last menstrual period and early ultrasound examination) were evaluated retrospectively for fetal and maternal complications, including non-progressive labor, cervical tear, retained placenta, postpartum hemorrhage, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid, non-reassuring fetal heart rate monitoring and ante-, intra- and postpartum death. Pregnancy outcomes at different gestational ages were compared using univariate and multivariate analysis and receiver operator curves.. The rates of non-progressive labor stage I and II, retained placenta, vacuum delivery, Cesarean section, macrosomia, meconium-stained amniotic fluid and non-reassuring fetal heart rate monitoring were found to be significantly higher with increasing gestational age in the univariate analysis. These parameters were evaluated using multivariate analysis and the following were found to be significantly higher: non-progressive labor stage I and II, macrosomia, meconium-stained amniotic fluid and Cesarean section. Statistical analysis (receiver operator curves) showed that the most significant rise in the risk for non-progressive labor occurred after 42 completed weeks of gestation, and after 41 completed weeks for macrosomia, meconium-stained amniotic fluid and Cesarean section.. The rates of non-progressive labor stage I and II, meconium-stained amniotic fluid, macrosomia and Cesarean section were significantly higher with increasing gestational age. In order to decrease the rate of macrosomia, meconium-stained amniotic fluid and Cesarean section, we suggest that induction of labor should be considered before 42 weeks.

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Macrosomia; Gestational Age; Humans; Labor, Induced; Meconium; Multivariate Analysis; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged; Retrospective Studies; Risk Assessment

Over a 7 month period 131 cases with intrapartum draining of meconium-stained liquor (MSL) were reviewed and the neonatal outcome compared to that of all deliveries during the same time. Mean Apgars were significantly lower and the proportion of neonates with poor Apgar scores was higher if thick meconium was present, but not for thin meconium. Prolonged labour was more common and associated with a particularly worse outcome in the MSL group. Caesarean sections were performed twice as frequently, failure to progress being the indication in more than half the cases. Close monitoring of labour in the presence of MSL (particularly thick MSL) is important to detect failure to progress and fetal distress early.

Topics: Adult; Amniotic Fluid; Apgar Score; Case-Control Studies; Cesarean Section; Female; Humans; Infant, Newborn; Meconium; Meconium Aspiration Syndrome; Medical Records; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Retrospective Studies; Rural Health; Zimbabwe

Our purpose was to study the association between dynamic changes in serial amniotic fluid index measurements and adverse fetal outcome in postterm pregnancies.. Serial amniotic fluid index values were obtained semiweekly in 139 reliably dated, uncomplicated, singleton pregnancies at > 41 weeks' gestation. Adverse fetal outcome was defined by the presence of moderate or thick meconium, fetal heart rate decelerations, cesarean delivery for fetal distress, neonatal intensive care unit admission, and perinatal mortality.. Prominent changes in the amniotic fluid index (i.e., > 50% increase or decrease) had no association with adverse fetal outcome irrespective of rate of change, provided the final value remained > 5.0 cm. A significant association with fetal heart rate decelerations and the presence of meconium was detected only in patients whose final amniotic fluid index was < or = 5.0 cm (p = 0.007 and p = 0.003, respectively).. Irrespective of the rate of change in amniotic fluid index, postterm pregnancies are significantly associated with potential complications such as fetal heart rate decelerations and meconium staining when the final amniotic fluid index is < or = 5.0 cm.

Topics: Amniotic Fluid; Female; Gestational Age; Heart Rate, Fetal; Humans; Infant, Newborn; Longitudinal Studies; Meconium; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged

This study was undertaken to determine the influences of increased maternal prepregnancy weight and increased gestational weight gain on pregnancy outcome.. This was a longitudinal retrospective study of 7407 term pregnancies delivered from 1987 through 1989. After excluding cases with multiple fetuses, stillbirths, fetal anomalies, no prenatal care, selected medical and surgical complications, and those with incomplete medical records, 3191 cases remained for analyses by determination of odds ratios for obstetric outcomes, by chi 2 tests for significant differences and by adjustment for risk factors with stepwise logistic regression.. Both increased maternal prepregnancy weight (body mass index) and increased maternal gestational weight gain were associated with increased risks of fetal macrosomia (p less than 0.0001), labor abnormalities (p less than 0.0001), postdatism (p = 0.002), meconium staining (p less than 0.001), and unscheduled cesarean sections (p less than 0.0001). They were also associated with decreased frequencies of low birth weight (p less than 0.001). The magnitude of the last was less than that of the other outcomes.. Increased maternal weight gain in pregnancy results in higher frequencies of fetal macrosomia, which in turn lead to increased rates of cesarean section and other major maternal and fetal complications. Because these costs of increased maternal weight gain appear to outweigh benefits, weight gain recommendations for pregnancy warrant careful review.

Topics: Apgar Score; Birth Weight; Body Weight; Cesarean Section; Female; Fetal Heart; Fetal Macrosomia; Heart Rate; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Meconium; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Pregnancy, Prolonged; Resuscitation

Charts of 443 postdate pregnancies were reviewed to determine the effect of late maternal age on pregnancy outcome. There were significantly more low 1-minute Apgar scores, intrapartum decelerations, and cesarean sections in the group of women greater than 35 years old. Use of oxytocin percentages and the results were similar with regard to both groups. Five-minute Apgar scores also were similar. Women greater than 35 years of age are less able to be delivered of postdate infants with optimal outcomes, but it is still safe to allow them to exceed 42 weeks' gestation.

Topics: Adult; Apgar Score; Cesarean Section; Female; Heart Rate, Fetal; Humans; Infant Mortality; Infant, Newborn; Labor Onset; Labor, Induced; Maternal Age; Meconium; Oxytocin; Pregnancy; Pregnancy Outcome; Pregnancy, High-Risk; Pregnancy, Prolonged

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

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

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

Topics: Delivery, Obstetric; Embryonic and Fetal Development; Female; Fetal Monitoring; Fetal Movement; Heart Rate, Fetal; Humans; Infant, Newborn; Inhalation; Meconium; Patient Education as Topic; Pregnancy; Pregnancy, Prolonged; Ultrasonography

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; Amniocentesis; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Postmature; Meconium; Middle Aged; Pregnancy; Pregnancy, Prolonged

Eighty patients with prolonged pregnancy were managed conservatively using outpatient non-stress testing as the only form of fetal monitoring; there was no excess perinatal mortality or morbidity. The 'at risk' fetus appeared to be predominantly within the 'postmature' group who pass meconium. Non-stress testing using this rigid regimen was an excellent screening test to identify the 'at risk' fetus and in this study had a zero false-negative rate. Probably only one in 20 post-term infants require induction for fetal indications.

Topics: Adolescent; Adult; Female; Fetal Diseases; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant, Newborn; Infant, Postmature; Meconium; Pregnancy; Pregnancy, Prolonged; 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

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

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

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

A total of 2702 transabdominal amniocenteses performed at the Los Angeles County--University of Southern California Medical Center were reviewed, with particular emphasis on 392 samples performed beyong 41 weeks' gestation. A significant rise in the percent of amniocenteses with meconium staining was found to occur at an beyond 39 weeks. Meconium-stained fluid at amniocentesis was found to be associated with an increased incidence of babies weighing greater than 4000 g, maternal diabetes mellitus, and cesarean deliveries, in comparison to samples with clear amniotic fluid. Infants with meconium-stained fluid had an increased incidence of low 1-minute Apgar scores, but all 5-minute Apgar scores were 7 or greater. Ten perinatal deaths occurred after an amniocentesis with clear fluid in prolonged pregnancy, with four of these occurring within 7 days of amniocentesis. Lecithin/sphingomyelin (L/S) ratios less than 2.0 were found in 6% of amniocenteses performed beyond 41 weeks. However, none of the newborns with low L/S ratios develop subsequent neonatal respiratory distress syndrome. Amniotic fluid creatine values or blood-contaminated fluid were not found to be correlated with fetal outcome. No fetal mortality was attributable to amniocentesis. In view of the significant amount of false-positive and false-negative results, and the rare inherent danger associated with amniocentesis, its use solely to demonstrate the presence or absence of meconium staining appears to be of questionable value in the management of prolonged pregnancy.

Topics: Amniocentesis; Amniotic Fluid; Creatinine; Female; Humans; Infant, Newborn; Meconium; Phosphatidylcholines; Pregnancy; Pregnancy, Prolonged; Sphingomyelins

One hundred four postdate pregnancies were managed according to a well-defined protocol calling for weekly oxytocin challenge tests and urinary estriols three times per week. Although the perinatal mortality rate in these patients was not increased there was a significant increase in the incidence of neonatal morbidity and complications. The clinical syndrome of dysmaturity was seen in 20 per cent of the neonates. When meconium was present in the amniotic fluid the incidence of neonatal and fetal complications was higher. The cesarean section rate was twice the normal rate, with nonprogression of labor being the commonest indication. It is recommended that: (1) pregnancies carried beyond 42 weeks do not require termination simply because they are post dates; (2) all postdate patients should be monitored during labor; (3) trained personnel to initiate neonatal resuscitation should be present at each postdate delivery.

Topics: Amniocentesis; Cesarean Section; Estriol; Female; Fetal Death; Fetal Heart; Fetal Monitoring; Heart Rate; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Oxytocin; Placenta Diseases; Pregnancy; Pregnancy, Prolonged; Risk

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

Till now there is no unequivocal diagnostic tool for the discovery of prolonged pregnancy. Therefore the present study was performed to evaluate whether HPL-values correlate with the presence of postmaturity syndrome in coherence with other known symptoms. 86 cases, partly with signs of postmaturity (n = 12), partly without such signs (n = 74), were compared with a non-postmature group. In prolonged pregnancy HPL-values were distinctly lower than at term. The more severe the condition, the lower were the HPL-values. There was a significant incidence of higher rates of meconium stained amniotic fluid beyond 42 weeks of gestation. After careful delivery the babies were generally in good condition. There was a slight shift to lower Apgar-values, but base excess and actual pH were found to be normal in umbilical artery. Birth-weights of the postmature infants did not show any differences to those born at term.

Topics: Amniotic Fluid; Birth Weight; Female; Humans; Meconium; Placental Lactogen; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

A five-year review of 127 elderly patients (35 years of age and over), in their first pregnancies, defines the risk to the fetus in terms of perinatal death and neonatal morbidity. With the equivalent of a perinatal mortality rate of 94/1,000, an 11 per cent incidence of small-for-dates infants, and a neonatal morbidity rate of 18 per cent, there would still appear to be a need for an increased awareness of the fetal risks in this group and an increased emphasia on their prevention. Areas of management in prenatal care and labor which might reduce these figures are defined.

Topics: Adult; Apgar Score; Birth Weight; Cesarean Section; Congenital Abnormalities; Delivery, Obstetric; Extraction, Obstetrical; Female; Fetal Death; Fetal Diseases; Follow-Up Studies; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Labor, Induced; Labor, Obstetric; Maternal Age; Meconium; Middle Aged; Parity; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Over the last 4 years at Los Angeles County-University of Southern California Medical Center, Women's Hospital, clinical interest in antepartum fetal monitoring has increased considerably. As a result of approximately 1,500 tests in some 600 patients at high risk for placental insufficiency, we have reached several conclusions regarding the methods for antepartum fetal monitoring, criteria for interpretation of the results obtained, and the role of antepartum monitoring information in clinical management. In this paper, the results of "stress" monitoring (monitoring in the presence of uterine contractions) are presented. The term "oxytocin challenge test" is used in reference to "stressed" monitoring even though sometimes the contractions were spontaneous, or without oxytocin stimulation.

Topics: Cesarean Section; Electrocardiography; Estriol; Female; Fetal Death; Fetal Heart; Heart Rate; Hemoglobinopathies; Humans; Labor, Obstetric; Meconium; Monitoring, Physiologic; Obstetric Labor, Premature; Oxytocin; Phonocardiography; Placenta Diseases; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy in Diabetics; Pregnancy, Prolonged; Prenatal Diagnosis; Ultrasonography; Uterus

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

Topics: Amniocentesis; Amniotic Fluid; Apgar Score; Emphysema; Female; Fetal Diseases; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Labor, Obstetric; Meconium; Pneumothorax; Pregnancy; Pregnancy, Prolonged; Prenatal Diagnosis; Punctures; Radiography; Skin

Topics: Adult; Amnion; Amniotic Fluid; Apgar Score; Female; Fetal Death; Fetal Diseases; Fetoscopy; Humans; Hypoxia; Infant Mortality; Infant, Newborn; Labor, Induced; Meconium; Pregnancy; Pregnancy, Prolonged

Topics: Amniotic Fluid; Child Development; Female; Fetoscopy; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy, Prolonged

Topics: Anthropometry; Asphyxia Neonatorum; Birth Weight; Child Development; Congenital Abnormalities; Emaciation; Female; Fetal Death; Fetal Diseases; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Meconium; Nails; Neurologic Manifestations; Organ Size; Pregnancy; Pregnancy, Prolonged; Sleep Wake Disorders; Social Behavior; Thumb; Umbilical Cord

Topics: Abruptio Placentae; Amnion; Amniotic Fluid; Apgar Score; Endoscopy; Erythroblastosis, Fetal; Female; Fetal Death; Fetal Diseases; Fetoscopy; Humans; Hypoxia; Meconium; Placenta Previa; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Age Factors; Amnion; Amniotic Fluid; Endoscopy; Female; Fetoscopy; Gestational Age; Humans; Labor, Induced; Meconium; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Aminopeptidases; Amniotic Fluid; Clinical Enzyme Tests; Female; Fetal Death; Gestational Age; Humans; Leucyl Aminopeptidase; Meconium; Photometry; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Anemia; Erythroblastosis, Fetal; Female; Fetal Diseases; Fetal Heart; Humans; Meconium; Pre-Eclampsia; Pregnancy; Pregnancy in Diabetics; Pregnancy, Prolonged

Topics: Adult; Amniotic Fluid; Australia; Estriol; Female; Fetal Death; Fetal Diseases; Fetal Heart; Gestational Age; Humans; Infant, Newborn; Labor Presentation; Labor, Induced; Meconium; Obstetric Labor Complications; Placenta; Pregnancy; Pregnancy, Prolonged; Punctures

Topics: Amniotic Fluid; Bilirubin; Electrocardiography; Embryonic and Fetal Development; Estrogens; Female; Fetal Diseases; Fetus; Humans; Maternal-Fetal Exchange; Meconium; Methionine; Placenta; Placental Hormones; Placental Lactogen; Pregnancy; Pregnancy, Prolonged; Pregnanediol; Progesterone; Selenium; Ultrasonics; Vagina

Topics: Amniotic Fluid; Cesarean Section; Female; Fetal Death; Fetal Diseases; Humans; Infant Mortality; Labor, Induced; Meconium; Methods; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Amniotic Fluid; Endoscopy; Erythroblastosis, Fetal; Female; Fetal Diseases; Humans; Infant Mortality; Maternal-Fetal Exchange; Meconium; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Prolonged

Topics: Amniotic Fluid; Female; Fetal Diseases; Humans; In Vitro Techniques; Meconium; Oscillometry; Pregnancy; Pregnancy, Prolonged; Ultrasonics

Topics: Adult; Amniotic Fluid; Female; Fetal Diseases; Fetal Heart; Humans; Lactates; Meconium; Pregnancy; Pregnancy, Prolonged