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Schreiber H, Cohen G, Zahavi M, Wiener I, Biron-Shental T, Chowers M, Kovo M. Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever. Arch Gynecol Obstet 2024:10.1007/s00404-024-07673-1. [PMID: 39093332 DOI: 10.1007/s00404-024-07673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Meconium-stained amniotic fluid (MSAF) often signifies colonization of the amniotic sac by microorganisms. This study investigated additional adverse obstetric outcomes associated with MSAF in deliveries complicated by maternal intrapartum fever (IF). METHODS This retrospective study included all singleton pregnancies from 2014 to 2020, with intrapartum maternal fever ≥ 38 °C during a trial of labor. In accordance with departmental protocol, all patients received intravenous antibiotic therapy consisting of ampicillin and gentamicin in the absence of allergies to these medications. Subsequent antibiotic therapy was adjusted based on the culture results. Antibiotic treatment was discontinued postpartum after 48 h without fever. Swab cultures were obtained immediately postpartum from both the maternal and fetal sides of the placenta. Maternal and fetal outcomes, along with positive placental cultures, were compared between participants with MSAF&IF and those with clear amniotic fluid &IF (control group). RESULTS In comparison to the control group (n = 1089), the MSAF&IF group (n = 264) exhibited significantly higher rates of cesarean delivery (CD) (p = 0.001), CD due to non-reassuring fetal heart rate (p = 0.001), and cord pH ≤ 7.1 (p = 0.004). Positive swab cultures from the placental maternal and fetal sides were more prevalent among the MSAF&IF group (23.1% vs. 17.6%, p = 0.041 and 29.2% vs. 22.9%, p = 0.032, respectively). Placental cultures yielding gastrointestinal pathogens and extended spectrum beta-lactamase were notably more common in the MSAF&IF group compared to controls (p = 0.023). However, there was no significant difference between groups regarding the rate of group B streptococcus positive placental cultures. CONCLUSIONS Women experiencing IF and MSAF during labor face an elevated risk of CD compared to those with IF alone. The presence of MSAF heightens the risk of positive placental cultures, particularly with gastrointestinal and extended spectrum beta-lactamase pathogens.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Maya Zahavi
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Izaac Wiener
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Michal Chowers
- Infectious Diseases Unit, Meir Medical Center, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel
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Schreiber H, Cohen G, Shalev-Ram H, Farladansky-Gershnabel S, Weitzner O, Biron-Shental T, Kovo M, Arnon S, Markovitch O. Bloody Amniotic Fluid and Neonatal Outcomes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1208. [PMID: 37508705 PMCID: PMC10378302 DOI: 10.3390/children10071208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Information on the effect of bloody amniotic fluid during labor at term is scarce. This study assessed risk factors and adverse outcomes in labors with bloody amniotic fluid. During the six years of this study, all nulliparas in our institution, with a trial of labor, were included. Multiple pregnancies and preterm deliveries were excluded. Outcomes were compared between the bloody amniotic fluid group and the clear amniotic fluid group. Overall, 11,252 women were included. Among them, 364 (3.2%) had bloody amniotic fluid and 10,888 (96.7%) had clear amniotic fluid. Women in the bloody amniotic fluid group were characterized by shorter duration of the second stage and higher rate of cesarean section due to non-reassuring fetal heart rate. In addition, there were higher rates of low cord pH (<7.1) and NICU admissions in the bloody amniotic fluid group. In multivariate logistic regression analysis, cesarean delivery, cord blood pH < 7.1, and NICU admission were independently associated with increased odds ratio for bloody amniotic fluid. Bloody amniotic fluid at term is associated with adverse outcomes and must be considered during labor.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Hila Shalev-Ram
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Sivan Farladansky-Gershnabel
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Omer Weitzner
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
| | - Shmuel Arnon
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
- Department of Neonatology, Meir Medical Center, Kfar Saba 4428163, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba 4428163, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6329302, Israel
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Lezama-García K, Martínez-Burnes J, Baqueiro-Espinosa U, Olmos-Hernández A, Hernández-Ávalos I, Domínguez-Oliva A, Mota-Rojas D. Assessment of Vitality, Blood Profile, and Degree of Meconium Staining on the Skin in Newborn Dogs According to Its Birth Weight. Vet Sci 2023; 10:453. [PMID: 37505858 PMCID: PMC10386731 DOI: 10.3390/vetsci10070453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
Neonatal mortality in dogs reaches up to 40%. Due to the high rates, promptly detecting the causes and preventing newborns from dying are extremely important. Vitality evaluation, blood parameters, and the degree of meconium staining on the skin are valuable resources in canine perinatology. In this study, 435 puppies from 85 bitches close to parturition were recruited and divided into four quartiles according to the puppy's birth weight: Q1 (127-200 g) n = 110 puppies, Q2 (201-269 g) n = 108 puppies, Q3 (270-388 g) n = 108 puppies, and Q4 (389-464 g) n = 109 puppies. This experimental article aimed to report the effect of birth weight on the blood profile variables, the vitality of newborn puppies, and the meconium staining degree, integrating these three aspects. It was concluded that the weight of newborns was correlated with the degree of meconium staining, presenting more cases of severe meconium staining in the puppies of the highest birth weight group. The weight of the newborns was correlated with a higher number of stillbirths and alterations in the blood variables, showing the most severe cases of metabolic acidosis, hypoxia, and hypoglycemia in the puppies of the Q4 quartile. On the contrary, no statistically significant correlations were found between the weight of newborns and vitality. Nevertheless, the analysis of the results showed that the most vigorous puppies were found at Q1; however, at minute 60 after birth (AB), all the puppies in the four quartiles standardized their vitality scores.
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Affiliation(s)
- Karina Lezama-García
- PhD Program in Biological and Health Sciences, Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico City 04960, Mexico
| | - Julio Martínez-Burnes
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Mexico
| | | | - Adriana Olmos-Hernández
- Division of Biotechnology-Bioterio and Experimental Surgery, Instituto Nacional de Rehabilitación-Luis Guillermo Ibarra Ibarra (INR-LGII), Tlalpan, Mexico City 14389, Mexico
| | - Ismael Hernández-Ávalos
- Clinical Pharmacology and Veterinary Anesthesia, Facultad de Estudios Superiores Cuautitlán, Universidad Nacional Autónoma de México (UNAM), Cuautitlán Izcalli 54714, Mexico
| | - Adriana Domínguez-Oliva
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico
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Impact of Thin Meconium on Delivery and Early Neonatal Outcomes. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020215. [PMID: 36832344 PMCID: PMC9955471 DOI: 10.3390/children10020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/16/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
Several reports regarding the effects of thin meconium on maternal and neonatal outcomes are contradictory. This study evaluated the risk factors and obstetrical outcomes during deliveries complicated with thin meconium. This retrospective cohort study included all women with a singleton pregnancy, who underwent trial of labor >24 weeks of gestation, in a single tertiary center, over a six-year period. Obstetrical, delivery, and neonatal outcomes were compared between deliveries with thin meconium (thin meconium group) to deliveries with clear amniotic fluid (control group). Included in the study were 31,536 deliveries. Among them 1946 (6.2%) were in the thin meconium group and 29,590 (93.8%) were controls. Meconium aspiration syndrome was diagnosed in eight neonates in the thin meconium group and in none of the controls (0.41%, p < 0.001). In multivariate logistic regression analysis, the following adverse outcomes were found to be independently associated with increased odds ratio (OR) for thin meconium: intrapartum fever (OR 1.37, 95% CI 1.1-1.7), instrumental delivery (OR 1.26, 95% CI 1.09-1.46), cesarean delivery for non-reassuring fetal heart rate (OR 2.0, 95% CI 1.68-2.46), and respiratory distress requiring mechanical ventilation (OR 2.06, 95% CI 1.19-3.56). Thin meconium was associated with adverse obstetrical, delivery, and neonatal outcomes that should receive extra neonatal care and alert the pediatrician.
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Muacevic A, Adler JR, Darsareh F, Pariafsay F, Shirzadfardjahromi M, Shekari M. The Incidence and Outcomes of Late-Term Pregnancy. Cureus 2023; 15:e33550. [PMID: 36779141 PMCID: PMC9907390 DOI: 10.7759/cureus.33550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Little is known about the outcomes of late-term pregnancy. In this study, we aim to assess the incidence and adverse prenatal outcomes associated with late-term pregnancy. METHODS We retrospectively assessed all singleton pregnant mothers who gave birth at Khalij-e-Fars Hospital in Bandar Abbas, Iran, between January 2020 and 2022. All preterm and post-term deliveries were excluded. Mothers were divided into two groups: late-term mothers (41 0/7-41 6/7 weeks of gestation) and term mothers (37 0/7-40 6/7 weeks of gestation). Demographic factors, obstetric factors, maternal comorbidities, and prenatal outcomes were extracted from the electronic data of each mother. The incidence of late-term births was calculated. The chi-squared test was used to compare differences between the groups. Logistic regression models were used to assess the association of prenatal outcome with late-term pregnancy. RESULTS There were 8,888 singleton deliveries during the study period, and 1,269 preterm and post-term pregnancies were ruled out. Of the 7,619 deliveries, 309 (4.1%) were late-term, while 7,310 (95.9%) were term. There were no sociodemographic differences between term and late-term mothers. The late-term group had a higher prevalence of primiparous mothers, and the term group had a higher prevalence of diabetes. Late-term mothers had a higher risk of macrosomia (adjusted odds ratio (aOR): 2.24 (95% confidence interval (CI): 1.34-3.01)), meconium amniotic fluid (aOR: 2.32 (95% CI: 1.59-3.14)), and fetal distress (aOR: 2.38 (95% CI: 1.54-2.79)). When compared to term pregnancy, the risk of low birth weight (LBW) was lower in late-term pregnancy (aOR: 0.69 (95% CI: 0.36-0.81)). CONCLUSIONS Late-term pregnancy was found to be more likely to be associated with macrosomia, meconium amniotic fluid, and fetal distress, but serious maternal and neonatal adverse events were comparable to term pregnancy.
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Shekari M, Jahromi MS, Ranjbar A, Mehrnoush V, Darsareh F, Roozbeh N. The incidence and risk factors of meconium amniotic fluid in singleton pregnancies: an experience of a tertiary hospital in Iran. BMC Pregnancy Childbirth 2022; 22:930. [PMID: 36510200 PMCID: PMC9743099 DOI: 10.1186/s12884-022-05285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Mitra Shekari
- grid.412237.10000 0004 0385 452XMother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Malihe Shirzadfard Jahromi
- grid.412237.10000 0004 0385 452XMother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Amene Ranjbar
- grid.412237.10000 0004 0385 452XFertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Vahid Mehrnoush
- grid.412237.10000 0004 0385 452XMother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Fatemeh Darsareh
- grid.412237.10000 0004 0385 452XMother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Nasibeh Roozbeh
- grid.412237.10000 0004 0385 452XMother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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G/Silassie R, Gebretsadik W, Degefa N, Getahun D, Kassie N. Determinants of Meconium-Stained Amniotic Fluid at Hadiya Zone Hospitals, Southern Ethiopia; Unmatched Case-Control Study. Int J Womens Health 2022; 14:1351-1360. [PMID: 36147889 PMCID: PMC9488596 DOI: 10.2147/ijwh.s376963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/08/2022] [Indexed: 11/24/2022] Open
Abstract
Background Meconium-stained amniotic fluid (MSAF) refers to an amniotic fluid that is green in color or mixed with meconium. MSAF leads to a serious maternal complication that increases the likelihood of operative delivery and poses a hazard to the fetus or the neonate. This in turn enhances the chances of maternal and neonatal mortality and morbidity. So, the identification of determinants helps to breach this vicious cycle. The current study aimed to assess the determinants of MSAF. Methods An institution-based, unmatched case-control study with a sample size of 363 participants (121 cases and 242 controls) was conducted on mothers who gave birth at Hadiya zone public hospitals between March and April 2020. A proportionate distribution was made to each facility depending on the volume of patients, and cases and control mothers were chosen sequentially. The data was gathered through in-person interviews and secondary data extraction. In multivariable logistic regression, variables with (p < 0.25) in bivariate analysis were included. After multivariable logistic regression was finished, statistical significance was declared at (p < 0.05). Results A total of 121 cases and 242 controls were included in this study Multivariable logistic regression analysis showed that gestational age ≥ 41 week (AOR = 3.44, 95% CI: 1.02–11.63), premature rupture of membrane (AOR = 3.71, 95% CI: 1.98–6.93) obstructed labor (AOR = 2.90, 95% CI: 1.15–7.33) preeclampsia (AOR = 4.16, 95% CI: 1.29–13.35) and non-reassuring fetal heart rate (AOR = 6.75, 95% CI: 3.45–13.19) were significantly associated with MSAF. Conclusion Advanced gestational age, an early membrane rupture, an obstructed labor, preeclampsia, and non-reassuring fetal heart rate all increase the incidence of meconium-stained amniotic fluid in laboring mothers. Making every effort to prevent, identify, and treat those obstetric determinants as early as feasible should be taken into consideration throughout follow-up of pregnancy, labor, and delivery could assist to lower the incidence of MSAF.
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Affiliation(s)
- Rediet G/Silassie
- Department of Midwifery, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Woiynshet Gebretsadik
- Schools of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Nega Degefa
- Schools of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Dinkalem Getahun
- Schools of Nursing, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Nigus Kassie
- Department of Midwifery, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
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Matmor Loeub S, Weintraub AY, Rotem R, Geva Y, Yaniv Salem S. Correlation between total deceleration area and fetal cord blood pH in neonates complicated with meconium-stained amniotic fluid at term. Int J Gynaecol Obstet 2022; 159:974-978. [PMID: 35598120 DOI: 10.1002/ijgo.14274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/10/2022] [Accepted: 05/10/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the correlation between total area under the Curve (AUC) of decelerations and accelerations and neonatal acidemia in pregnancies complicated with meconium-stained amniotic fluid (MSAF). METHODS A retrospective cohort study was conducted among women who delivered with a diagnosis of MSAF. Electronic fetal monitoring (EFM) patterns 120 min before delivery were interpreted by a researcher blinded to fetal outcomes. The primary outcome was fetal acidemia, defined as umbilical artery pH below 7.10. The correlation was tested using the Spearman correlation coefficient. RESULTS A total of 102 women were included; 24 delivered infants with cord blood pH < 7.20, and only five delivered infants with cord blood pH < 7.10. A significant correlation was demonstrated between total AUC of decelerations and accelerations and cord blood pH (P = 0.02). A sub-analysis according to gestational age at delivery (up to and beyond 40 weeks) was conducted. A significant correlation was demonstrated (P = 0.02) only in the term group(n = 37). CONCLUSION A correlation was demonstrated between total AUC of decelerations and accelerations and cord blood pH in neonates with MSAF. This correlation was significant for neonates delivered before 40 weeks of gestation, but not for those delivered after 40 weeks of gestation.
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Affiliation(s)
- Shirel Matmor Loeub
- Joyce and Irving Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Adi Y Weintraub
- Joyce and Irving Goldman School of Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.,Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Yael Geva
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Shimrit Yaniv Salem
- Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Ben Gurion University of the Negev, Beer Sheva, Israel
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Rodavsky G, Sheiner E, Walfisch A, Gutvirtz G, Hermon N, Landau D, Wainstock T. Meconium stained amniotic fluid exposure and long-term respiratory morbidity in the offspring. Pediatr Pulmonol 2021; 56:2328-2334. [PMID: 33730429 DOI: 10.1002/ppul.25357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/07/2021] [Accepted: 02/16/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Meconium stained amniotic fluid (MSAF) is a well-established risk factor for neonatal short-term respiratory complications. Little is known regarding the long-term morbidity. We investigated the possible association between MSAF and offspring respiratory morbidity. METHODS A population-based, cohort study of singleton deliveries occurring between 1991 and 2014 at a sole regional tertiary medical center was performed. Incidence of offspring respiratory related hospitalizations up to the age of 18 years were evaluated and compared to unexposed offspring. A Kaplan-Meier survival curve was used to compare cumulative respiratory morbidity incidence, and a Cox proportional hazards model was used to control for confounders. RESULTS During the study period 242,342 deliveries met the inclusion criteria. Of them, 14.7% (n = 35,609) were complicated with MSAF. Incidence of respiratory-related hospitalizations was significantly lower in children exposed to MSAF as compared to the unexposed group (4.5% vs. 4.9%, respectively; p < .01). Specifically, hospitalizations involving pneumonitis were significantly less common among the MSAF group (odds ratio, 0.35; 95% confidence interval [95% CI], 0.13-0.96; p = .03). The Kaplan-Meier survival curve demonstrated significantly lower total cumulative respiratory morbidity rates in the MSAF exposed group (log rank p < .01). In the Cox model, controlled for clinically relevant confounders, MSAF exhibited an independent and significant protective effect on long-term childhood respiratory morbidity (aHR, 0.91; 95% CI, 0.86-0.96; p < .01). CONCLUSIONS Fetal exposure to MSAF during labor appears to be associated with lower rates of long-term respiratory related hospitalizations in the offspring. Changes in offspring microbiome, as well as functional and anatomical modulations possibly resulting from MSAF exposure, might offer a plausible explanation of our findings.
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Affiliation(s)
- Gal Rodavsky
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gil Gutvirtz
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Narkis Hermon
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Phattraprayoon N, Tangamornsuksan W, Ungtrakul T. Outcomes of endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:31-38. [PMID: 32561566 PMCID: PMC7788200 DOI: 10.1136/archdischild-2020-318941] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates. DESIGN We conducted a systematic review of non-ETS and ETS in non-vigorous infants born through meconium-stained amniotic fluid (MSAF). We searched PubMed/Medline, Scopus, Clinical Trials.gov, Cumulative Index to Nursing and Allied Health, and Cochrane Library databases from inception to November 2019, using keywords and related terms. Only non-vigorous infants born through MSAF included in randomised controlled trials, were included. We calculated overall relative risks (RRs) and mean differences with 95% CIs using a random-effects model, to determine the impact of ETS in non-vigorous infants born through MSAF. MAIN OUTCOME MEASURES The primary outcome was the incidence of meconium aspiration syndrome (MAS). Secondary outcomes were respiratory outcome measures (pneumothorax, persistent pulmonary hypertension of the newborn, secondary pneumonia, need for respiratory support, duration of mechanical ventilation), initial resuscitation and others including shock, perinatal asphyxia, convulsions, neonatal mortality, blood culture-positive sepsis and duration of hospital stay. RESULTS A total of 2085 articles were identified in the initial database search. Four studies, including 581 non-vigorous meconium-stained infants, fulfilled the inclusion criteria, comprising 292 infants in the non-ETS group and 289 in the ETS group. No statistically significant difference was found for MAS (RR 0.98; 95% CI 0.71 to 1.35). CONCLUSIONS Initiating ETS soon after birth in non-vigorous meconium-stained infants may not alter their neonatal outcomes.
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Affiliation(s)
- Nanthida Phattraprayoon
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Wimonchat Tangamornsuksan
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Teerapat Ungtrakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
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Pinto KRTDF, Zani AV, Bernardy CCF, Rossaneis MA, Rodrigues R, Parada CMGDL. Factors associated with obstetric interventions in public maternity hospitals. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000400009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: to identify the prevalence and factors associated with obstetric interventions in parturients assisted in public maternity hospitals. Methods: a cross-sectional study with 344 puerperal women, from two public maternity hospitals, referring to childbirth by Sistema Único de Saúde (SUS) (Public Health Service System) in Londrina City, Paraná, Brazil, between January and June 2017. The medical records were the data source. The following obstetric interventions were considered: oxytocin use, artificial rupture of the membranes, instrumental childbirth and episiotomy. Multivariate Poisson regression was used to analyze associated factors, with p<5% being significant. Results: the prevalence of obstetric intervention was 55.5%, the maximum number of interventions in the same parturient woman was three. The most frequent interventions were the use of oxytocin (50.0%) and artificial rupture of membranes (29.7%). The variables associated on maternal disease (p=0.005) and intrapartum meconium (p=0.022) independently increased, the risk of obstetric intervention, while dilation was equal to or greater than 5 cm at admission, there was a protective factor against this outcome (p=0.030). Conclusion: the prevalence of obstetric interventions was high. In the case of maternal disease and intrapartum meconium, special attention should be given to the parturient woman, in order to avoid unnecessary interventions. Thus, the maternity hospitals need to review their protocols, seeking good practices in childbirth care.
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Oikonomou M, Chandraharan E. Fetal heart rate monitoring in labor: from pattern recognition to fetal physiology. Minerva Obstet Gynecol 2020; 73:19-33. [PMID: 33238664 DOI: 10.23736/s2724-606x.20.04666-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The journey of human labor involves hypoxic and mechanical stresses as a result of progressively increasing frequency, duration and strength of uterine contractions and resultant compression of the umbilical cord. In addition, occlusion of the spiral arteries during myometrial contractions also leads to repetitive interruptions in the utero-placental circulation, predisposing a fetus to progressively worsening hypoxic stress as labor progresses. The vast majority of fetuses are equipped with compensatory mechanisms to withstand these hypoxic and mechanical stresses. They emerge unharmed at birth. However, some fetuses may sustain an antenatal injury or experience a chronic utero-placental insufficiency prior to the onset of labor. These may impair the fetus to compensate for the ongoing hypoxic stress secondary to ongoing uterine contractions. Non-hypoxic pathways of neurological damage such as chorioamnionitis, fetal anemia or an acute fetal hypovolemia may potentiate fetal neurological injury, especially in the presence of a super-imposed, additional hypoxic stress. The use of utero-tonic agents to induce or augment labor may increase the risk of hypoxic-ischemic injury. Clinicians need to move away from "pattern recognition" guidelines ("normal," "suspicious," "pathological"), and apply the knowledge of fetal physiology to differentiate fetal compensation from decompensation. Individualization of care is essential to optimize outcomes.
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Affiliation(s)
- Maria Oikonomou
- Department of Obstetrics and Gynecology, Watford General Hospital, Watford, UK -
| | - Edwin Chandraharan
- Department of Intrapartum Care Obstetrics and Gynecology, Basildon and Thurrock University Hospital, Basildon, UK
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Krieger Y, Horev A, Wainstock T, Sheiner E, Walfisch A. Meconium-stained amniotic fluid as a protective factor against childhood dermatitis and skin rash-related hospitalization in the offspring - a population-based cohort analysis. J Eur Acad Dermatol Venereol 2019; 34:319-324. [PMID: 31419350 DOI: 10.1111/jdv.15881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/09/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gut microbiome influences cutaneous diseases including atopic dermatitis. Possible impact of intrauterine exposure to meconium on the occurrence of dermatitis and skin rash was proposed. OBJECTIVE We investigated the possible influence of intrauterine exposure to meconium-stained amniotic fluid (MSAF) on the occurrence of dermatitis and skin rash-related hospitalizations throughout childhood. METHODS Singleton deliveries occurring between 1991 and 2014 at a single medical centre were divided into two study groups based on presence or lack of MSAF during delivery. Population-based cohort analysis, Kaplan-Meier survival analysis and Cox proportional hazards model were used to study the association between MSAF and cutaneous morbidity-related hospitalizations. RESULTS A lower rate of the total dermatitis or skin eruption-related hospitalization was documented in the MSAF-exposed group; 0.78 per 1000-person years (0.9%, n = 312), as compared to 0.98 per 1000-person years in the unexposed group (1.0%, n = 1992) with a hazard ratio of 0.86 (95% CI 0.76-0.96, P = 0.011). The survival curve showed lower cumulative hospitalization rate in the MSAF-exposed group as compared to the unexposed group (log rank P = 0.01). The Cox analysis, controlled for confounders, demonstrated MSAF exposure to be an independent protective factor for dermatitis and skin rash-related hospitalizations during childhood (adjusted HR 0.878 (95% CI 0.779-0.990, P = 0.034). CONCLUSION Fetal exposure to MSAF appears to be an independent protective factor for dermatitis and skin rash-related hospitalizations in the offspring throughout childhood and adolescence.
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Affiliation(s)
- Y Krieger
- Department of Plastic Surgery, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - A Horev
- Department of Dermatology and Venereology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - T Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - E Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - A Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Ma'ayeh M, Snyder A, Oliver EA, Gee SE, Rood KM. Meconium-stained amniotic fluid and the risk of postcesarean surgical site infection. J Matern Fetal Neonatal Med 2019; 34:1361-1367. [PMID: 31242790 DOI: 10.1080/14767058.2019.1637408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the association between meconium-stained amniotic fluid (MSAF) and postcesarean surgical site infections. METHODS This was a secondary analysis of the Maternal-Fetal Medicine Units Network (MFMU) Cesarean Registry. Women with a singleton pregnancy attempting labor or induction of labor, who ultimately had a cesarean delivery, were included in the study. Pregnancies complicated by MSAF (n = 4262) and those who did not have MSAF (n = 13,850) were compared. The primary outcome was the incidence of SSI. RESULTS A total of 18,112 patients were included in the study. 4262 (38%) had meconium-stained amniotic fluid. After accounting for potential confounders in a multivariable logistic regression, meconium-stained amniotic fluid was associated with an increased risk of postoperative surgical site infection (odds ratio 1.16, 95% CI 1.03-1.30). CONCLUSIONS Meconium-stained amniotic fluid may be associated with an increased risk of postoperative surgical site infection.
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Affiliation(s)
- Marwan Ma'ayeh
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Andrea Snyder
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Emily A Oliver
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Stephen E Gee
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Kara M Rood
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH, USA
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Paz Levy D, Walfisch A, Wainstock T, Sergienko R, Kluwgant D, Landau D, Sheiner E. Meconium-stained amniotic fluid exposure is associated with a lower incidence of offspring long-term infectious morbidity. Am J Reprod Immunol 2019; 81:e13108. [PMID: 30817041 DOI: 10.1111/aji.13108] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/27/2019] [Accepted: 02/11/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Meconium-stained amniotic fluid (MSAF) is a well-established risk factor for immediate adverse neonatal outcomes and was recently suggested to be associated with microbial invasion of the amniotic cavity. We aimed to determine whether MSAF exposure during labor carries a longer lasting impact on pediatric infectious morbidity. STUDY DESIGN A population-based cohort analysis was performed including all singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Exposure was defined as the presence of MSAF during labor. Hospitalizations of the offspring up to the age of 18 years involving infectious diseases were evaluated. A Kaplan-Meier survival curve was used to compare cumulative morbidity and a Cox regression model to control for confounders. RESULTS During the study period, 243 725 deliveries met the inclusion criteria. Of them, 35 897 (14.7%) involved MSAF. Rate of infectious-related hospitalizations of the offspring was significantly lower in children exposed to MSAF as compared with the unexposed group (10.8% vs 11.1%, P < 0.05). Specifically, hospitalizations involving respiratory infections were significantly less common among the MSAF group (5.1% vs 5.6%, P < 0.001). The survival curve demonstrated significantly lower cumulative total infectious morbidity rates in the MSAF-exposed group (log rank P < 0.001). In the Cox model, controlled for maternal age, diabetes, hypertension, mode of delivery, and gestational age, exposed children exhibited lower rates of long-term childhood infectious morbidity (adjusted HR 0.96, 95% CI 0.92-0.99, P < 0.001). CONCLUSION Fetal exposure to MSAF during labor and delivery appears to be associated with lower rates of long-term infectious-related hospitalizations in the offspring.
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Affiliation(s)
- Dorit Paz Levy
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Dvora Kluwgant
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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