morphine and Puerperal-Disorders

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

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

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

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

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

Topics: Female; Humans; Infant, Newborn; Meconium; Pregnancy; Pregnancy Complications; Puerperal Disorders; Substance-Related Disorders

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

Topics: Cesarean Section; Female; Granuloma; Humans; Infant, Newborn; Meconium; Peritonitis; Pregnancy; Puerperal Disorders; Vernix Caseosa