Taiwanese journal of obstetrics & gynecology · 2025
Maternal and neonatal outcomes in primary vs. secondary meconium-stained amniotic fluid.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Hebi Haya, Haj Lilian, Hamoudi Rudi, Kayal Raneen Sawaid, Aiob Ala, Lowenstein Lior, Sgayer Inshirah
Аннотация
OBJECTIVE: We aimed to compare obstetrical and neonatal outcomes between women with primary meconium-stained amniotic fluid (MSAF), which presents at membrane rupture, and women with secondary MSAF, which appears after rupture of initially clear fluid.
MATERIAL AND METHODS: This retrospective cohort study included all singleton deliveries at ≥37 weeks gestation with MSAF, at a tertiary university-affiliated hospital between March 2020 and July 2024. Multiple pregnancies, preterm deliveries and elective cesarean deliveries (CD) were excluded. The primary outcome was a composite of adverse neonatal events, including low Apgar scores, umbilical artery pH < 7.15, admission to the neonatal intensive care unit, meconium aspiration syndrome, and neonatal death.
RESULTS: Of 2142 women with MSAF, 128 (6 %) had secondary MSAF. Secondary compared to primary MSAF was associated with higher rates of CD (26.6 % vs 14.9 %, p < 0.001), CD due to fetal distress (24.2 % vs. 12.9 %, p = 0.001), operative deliveries (7.8 % vs. 3.8 %, p < 0.001), admission to the neonatal intensive care unit (8.6 % vs. 3.4 %, p = 0.007), and respiratory support (7.0 % vs. 3.0 %, p = 0.034). The composite adverse neonatal outcome was more frequent following secondary MSAF (30.5 % vs 15.7 %, p < 0.001), particularly in deliveries beyond 40 weeks (40.0 % vs. 22.1 %, p = 0.035). In multivariate analysis, secondary MSAF was an independent risk factor for the composite adverse neonatal outcome (odds ratio 1.73, 95 % CI = 1.13-2.67, p = 0.012) after adjustment for potential confounders.
CONCLUSION: Compared to primary MSAF, secondary MSAF, especially after 40 weeks of gestation was associated with worse neonatal outcomes. This supports the role of secondary MSAF as a potential marker of adverse neonatal outcomes.
MATERIAL AND METHODS: This retrospective cohort study included all singleton deliveries at ≥37 weeks gestation with MSAF, at a tertiary university-affiliated hospital between March 2020 and July 2024. Multiple pregnancies, preterm deliveries and elective cesarean deliveries (CD) were excluded. The primary outcome was a composite of adverse neonatal events, including low Apgar scores, umbilical artery pH < 7.15, admission to the neonatal intensive care unit, meconium aspiration syndrome, and neonatal death.
RESULTS: Of 2142 women with MSAF, 128 (6 %) had secondary MSAF. Secondary compared to primary MSAF was associated with higher rates of CD (26.6 % vs 14.9 %, p < 0.001), CD due to fetal distress (24.2 % vs. 12.9 %, p = 0.001), operative deliveries (7.8 % vs. 3.8 %, p < 0.001), admission to the neonatal intensive care unit (8.6 % vs. 3.4 %, p = 0.007), and respiratory support (7.0 % vs. 3.0 %, p = 0.034). The composite adverse neonatal outcome was more frequent following secondary MSAF (30.5 % vs 15.7 %, p < 0.001), particularly in deliveries beyond 40 weeks (40.0 % vs. 22.1 %, p = 0.035). In multivariate analysis, secondary MSAF was an independent risk factor for the composite adverse neonatal outcome (odds ratio 1.73, 95 % CI = 1.13-2.67, p = 0.012) after adjustment for potential confounders.
CONCLUSION: Compared to primary MSAF, secondary MSAF, especially after 40 weeks of gestation was associated with worse neonatal outcomes. This supports the role of secondary MSAF as a potential marker of adverse neonatal outcomes.