Obstetrics and gynecology · 2003
Meconium passed in labor: how reassuring is clear amniotic fluid?
Сравнительное исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Greenwood Catherine, Lalchandani Savita, MacQuillan Kathryn, Sheil Orla, Murphy John, Impey Lawrence
Аннотация
OBJECTIVE: Clear amniotic fluid is frequently considered a reassuring sign during labor. Our aim was to examine the incidence of meconium that can only have been passed intrapartum and to determine its neonatal associations and whether its absence is a useful sign.
METHODS: This was a prospective cohort study of 8394 "low risk" laboring women at term with clear amniotic fluid at early amniotomy.
RESULTS: Meconium was passed in 5.2% of labors but was not detected until delivery of the fetal head in 51.5% of these. It was associated with moderate-severe acidosis (odds ratio [OR] 4.40; 95% confidence interval [CI] 3.21, 6.03), low Apgar score at 5 minutes (OR 6.49; 95% CI 2.73, 15.44), and neonatal seizures (OR 4.33; 95% CI 3.17, 5.93). However, the sensitivity for these outcomes of the intrapartum passage of meconium and, particularly, its detection before delivery was very poor.
CONCLUSION: Although correlated with adverse neonatal outcomes, most affected infants had clear amniotic fluid throughout labor. The presence of clear amniotic fluid is an unreliable sign of fetal well-being.
METHODS: This was a prospective cohort study of 8394 "low risk" laboring women at term with clear amniotic fluid at early amniotomy.
RESULTS: Meconium was passed in 5.2% of labors but was not detected until delivery of the fetal head in 51.5% of these. It was associated with moderate-severe acidosis (odds ratio [OR] 4.40; 95% confidence interval [CI] 3.21, 6.03), low Apgar score at 5 minutes (OR 6.49; 95% CI 2.73, 15.44), and neonatal seizures (OR 4.33; 95% CI 3.17, 5.93). However, the sensitivity for these outcomes of the intrapartum passage of meconium and, particularly, its detection before delivery was very poor.
CONCLUSION: Although correlated with adverse neonatal outcomes, most affected infants had clear amniotic fluid throughout labor. The presence of clear amniotic fluid is an unreliable sign of fetal well-being.
Предметные рубрики MeSH
AdultAmniotic FluidCohort StudiesConfidence IntervalsDelivery, ObstetricFemaleFetal DistressFetal MonitoringGestational AgeHumansInfant, NewbornMeconiumMeconium Aspiration SyndromeOdds RatioPredictive Value of TestsPregnancyPregnancy OutcomePrevalenceProspective StudiesReference ValuesRisk Assessment