Consequences of meconium stained amniotic fluid: What does the evidence tell us?

Hutton, Eileen K.; Thorpe, Julia

doi:10.1016/j.earlhumdev.2014.04.005

Cited by 75 publications

(68 citation statements)

References 48 publications

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“…This is a very rare complication, but it can be fatal and when it appears in preterm infants it is associated with higher neonatal morbidity [34]. In the present series, these neonates were treated in intensive care units with close monitoring and all of them had good outcomes.…”

Section: Discussionmentioning

confidence: 79%

Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid

et al. 2017

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BackgroundIntrahepatic cholestasis of pregnancy (ICP) is the commonest gestational liver disease. The risk of adverse fetal outcome has been associated with the severity of maternal hypercholanemia after diagnosis.ObjectiveTo investigate whether there is a relationship between the severity and timing of onset of hypercholanemia and the risk of meconium-stained amniotic fluid (MSAF) and adverse neonatal events.Study designThe study included 382 pregnancies complicated by ICP managed at a referral hospital in Buenos Aires (Argentina) between June 2009 and December 2013. The patients were classified into three groups according to the severity of hypercholanemia at diagnosis; mild (10–19.9 μmol/L), moderate (20–39.9 μmol/L) and severe (≥40 μmol/L). Their clinical characteristics and pregnancy outcomes were investigated in a prospective observational study.ResultsHigher risk of MSAF was observed when ICP appeared early in gestation or when hypercholanemia was more severe. Taking both parameters into account an MSAF risk factor (MRF) was defined. Based on a model of positive/negative predictive values, a cut-off point of MRF = 3 was selected, which prioritized sensitivity versus specificity. In ICP patients with MRF>3, the probability of MSAF was enhanced 4-fold. An increase in the frequency of MSAF was also associated with higher serum levels at diagnosis of alanine transaminase, alkaline phosphatase and direct bilirubin.ConclusionsThe risk of MSAF is associated not only with the magnitude of hypercholanemia at diagnosis but also with the early gestational onset of raised maternal serum bile acids.

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Section: Discussionmentioning

confidence: 79%

Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid

et al. 2017

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“…1, 13, 14 Meconium-stained amniotic fluid (MSAF) is present in one of every seven pregnancies (range: 5%–20%; 400,000–600,000 deliveries in the U.S. per year), 1, 15–20 but only approximately 5% (20,000–30,000) of neonates born to mothers with MSAF develop MAS. 1, 15, 21–23 It is not known why only some, or which, neonates exposed to MSAF will develop MAS. 1, 18, 24, 25 Attempts to prevent MAS have included oropharyngeal, 26, 27 nasopharyngeal, 26 and tracheal 28–30 suctioning and amnioinfusion in women who have MSAF, 31, 32 but none of these interventions has proven effective.…”

Section: Introductionmentioning

confidence: 99%

Meconium aspiration syndrome: a role for fetal systemic inflammation

Lee

Romero

Lee

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Meconium aspiration syndrome (MAS) is a leading cause of morbidity and mortality in term infants. Meconium-stained amniotic fluid (MSAF) occurs in approximately one of every seven pregnancies, but only 5% of neonates exposed to MSAF develop MAS. Why some infants exposed to meconium develop MAS while others do not is a fundamental question. Patients with MSAF have a higher frequency of intra-amniotic infection/inflammation than those with clear fluid. We propose that fetal systemic inflammation is a risk factor for the development of MAS in patients with MSAF. Objective To investigate whether intra-amniotic inflammation and funisitis, the histopathologic landmark of a fetal inflammatory response, predispose to MAS. Study Design A prospective cohort study was conducted from 1995 through 2009. Amniotic fluid (AF) samples (n=1,281) were collected at the time of cesarean delivery from women who delivered singleton newborns at term (gestational age ≥38 weeks). Intra-amniotic inflammation was diagnosed if the AF concentration of matrix metalloproteinase-8 (MMP-8) was >23 ng/ml. Funisitis was diagnosed by histologic examination if inflammation was present in the umbilical cord. Results The prevalence of MSAF was 9.2% (118/1,281), and 10.2% (12/118) of neonates exposed to MSAF developed MAS. There were no significant differences in the median gestational age or umbilical cord arterial pH at birth between neonates who developed MAS and those who did not (each p > 0.1). Mothers whose newborns developed MAS had a higher median AF MMP-8 (456.8 ng/ml vs.157.2 ng/ml; p < 0.05). Newborns exposed to intra-amniotic inflammation had a higher rate of MAS than those who were not exposed to intra-amniotic inflammation [13.0% (10/77) vs. 0% (0/32), p = 0.03], as did those exposed to funisitis [31.3% (5/16) vs. 7.3% (6/82), relative risk, 4.3; 95% confidence interval, 1.5–12.3]. Among the 89 newborns for whom both AF and placental histology were available, MAS was more common in patients with both intra-amniotic inflammation and funisitis than in those without intra-amniotic inflammation and funisitis [28.6% (4/14) vs. 0% (0/28), p = 0.009], while the rate of MAS did not show a significant difference between patients with intra-amniotic inflammation alone (without funisitis) and those without intra-amniotic inflammation and funisitis [10.9% (5/46) vs. 0% (0/28)]. Conclusion The combination of intra-amniotic inflammation with fetal systemic inflammation is an important antecedent of MAS. This concept has implications for the understanding of the mechanisms of disease responsible for MAS and for the development of prognostic models and therapeutic interventions for this disorder.

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“…1 Moreover, neonates exposed to meconium are more likely to have other complications such as sepsis, seizures, neurologic impairment, and prolonged neonatal intensive care unit (NICU) stay. 5 Although chemical pneumonitis, inflammation, infection, and surfactant inhibition by meconium have a role in MAS, airway obstruction and filling of alveoli by meconium are the most important mechanisms contributing to the pathophysiology. 6 As such, clearing of the airway by routine intrapartum oropharyngeal suction and immediate postnatal endotracheal suction became standard interventions to prevent MAS.…”

mentioning

confidence: 99%

Endotracheal Suction for Nonvigorous Neonates Born through Meconium Stained Amniotic Fluid: A Randomized Controlled Trial

Chettri

Adhisivam

Bhat

2015

The Journal of Pediatrics

105

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Consequences of meconium stained amniotic fluid: What does the evidence tell us?

Cited by 75 publications

References 48 publications

Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid

Relationship between early onset severe intrahepatic cholestasis of pregnancy and higher risk of meconium-stained fluid

Meconium aspiration syndrome: a role for fetal systemic inflammation

Endotracheal Suction for Nonvigorous Neonates Born through Meconium Stained Amniotic Fluid: A Randomized Controlled Trial

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