Meconium in the Amniotic Fluid and Fetal Acid-Base Status

Yeomans, Edward R.; Gilstrap, Larry C.; Leveno, Kenneth J.; Burris, Jody

doi:10.1097/00132582-198910000-00019

Cited by 30 publications

(29 citation statements)

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“…They found that in the absence of other signs of fetal distress (late decelerations in the fetal heart rate for example) the presence of meconium did not influence neonatal outcome as assessed by measuring scalp pH in labor and arterial blood gases at birth. Similarly, Yeomans et al 14 assessed 323 term infants with meconium present during labor. Although 21% of fetuses had a cord pH less than 7.20, only 2% had a pH of less than 7.10 and none were less than 7.0.…”

Section: Discussionmentioning

confidence: 99%

Significance of Meconium-Stained Amniotic Fluid in the Preterm Population

2001

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Section: Discussionmentioning

confidence: 99%

Significance of Meconium-Stained Amniotic Fluid in the Preterm Population

2001

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“…However, previous research did not adjust for bile acid and liver transaminase levels. 14,20 It is important to adjust for bile acid and transaminase levels, since early onset of disease is also reported to be associated with higher level of bile acid and liver enzymes. 12 In our study, after adjusting for confounders, early onset of disease was not associated with increased risk of composite neonatal outcome.…”

Section: Commentmentioning

confidence: 99%

Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy

Kawakita

Parikh

Ramsey

et al. 2015

American Journal of Obstetrics and Gynecology

125

103

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Objective-We sought to determine predictors of adverse neonatal outcomes in women with intrahepatic cholestasis of pregnancy (ICP).Study Design-This study was a multicenter retrospective cohort study of all women diagnosed with ICP across 5 hospital facilities from January 2009 through December 2014. Obstetric and neonatal complications were evaluated according to total bile acid (TBA) level. Multivariable logistic regression models were developed to evaluate predictors of composite neonatal outcome (neonatal intensive care unit admission, hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, transient tachypnea of the newborn, mechanical ventilation use, oxygen by nasal cannula, pneumonia, and stillbirth). Predictors including TBA level, hepatic transaminase level, gestational age at diagnosis, underlying liver disease, and use of ursodeoxycholic acid were evaluated.Results-Of 233 women with ICP, 152 women had TBA levels 10-39.9 μmol/L, 55 had TBA 40-99.9 μmol/L, and 26 had TBA ≥100 μmol/L. There was no difference in maternal age, ethnicity, or prepregnancy body mass index according to TBA level. Increasing TBA level was associated with higher hepatic transaminase and total bilirubin level (P < .05). TBA levels ≥100 μmol/L were associated with increased risk of stillbirth (P< .01). Increasing TBA level was also associated with earlier gestational age at diagnosis (P< .01) and ursodeoxycholic acid use (P = . 02). After adjusting for confounders, no predictors were associated with composite neonatal morbidity. TBA 40-99.9 μmol/L and TBA ≥100 μmol/L were associated with increased risk of meconium-stained amniotic fluid (adjusted odds ratio, 3.55; 95% confidence interval, 1. 45-8.68 and adjusted odds ratio, 4.55; 95% confidence interval, 1.47-14.08, respectively).Corresponding author: Tetsuya Kawakita, MD. tetsuya.x.kawakita@gunet.georgetown.edu. The authors report no conflict of interest.Presented at the 35th annual meeting of the Society for Maternal-Fetal Medicine, San Diego, CA, Feb. 2-7, 2015. Conclusion-In women with ICP, TBA level ≥100 μmol/L was associated with increased risk of stillbirth. TBA ≥40 μmol/L was associated with increased risk of meconium-stained amniotic fluid. HHS Public AccessKeywords bile acid; intrahepatic cholestasis of pregnancy; neonatal outcome; ursodeoxycholic acid Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease in pregnancy characterized by pruritus, elevated total serum bile acids, and elevated liver enzymes. ICP is associated with increased risk of preterm birth (19-60%), meconium passage <37 weeks (17.9%), intrapartum nonreassuring fetal heart tracing (22-41%), respiratory distress syndrome (RDS) (29%), and stillbirth (0.75-7%). 1-4 Based on high rates of stillbirth and neonatal morbidity, early delivery is often advocated to reduce the risk of term stillbirth. In the absence of evidence-based guidelines for optimal timing of delivery, induction of labor at 36-37 weeks of gestation or after documenting fetal lung maturity is freque...

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“…While some workers demonstrated that foetuses with meconium stained liquor are at significant risk of neonatal morbidity and mortality, 15,16 others have shown that it correlates poorly with infant condition. 17,18 Fenton and Steer 19 who attempted to separate meconium passage from other markers of foetal compromise indicated from their study that the passage of meconium does not have any hypoxic consequences on the foetus if the FHR is greater than 110 beats per minute. Besides this explanation, the relationship between meconium staining of liquor (as a single entity) and extent of neonatal depression in our study may be attributable to the lack of discrimination in the consistency of meconium used for diagnosis since the evidence linking thick meconium staining of liquor to severe birth asphyxia is not in dispute.…”

Section: Resultsmentioning

confidence: 99%

Predictors of Severe Neonatal Compromise Following Caesarean Section for Clinically Diagnosed Foetal Distress

Oladapo¹,

Sotimehin²,

Ayoola-Sotubo³

2010

West African Journal of Medicine

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BACKGROUND:The potential harm to a mother and baby from caesarean delivery for clinically diagnosed foetal distress may not always be justified by the degree of neonatal depression at birth. OBJECTIVE: To assess the accuracy of clinical diagnosis of foetal distress indicating caesarean section and identify antepartum and intrapartum characteristics that may predict severe neonatal compromise at birth. METHODS: A chart analysis of 246 singleton caesarean births primarily indicated by clinically diagnosed foetal distress over a ten-year period at a Nigerian University Hospital. Gestational and intrapartum characteristics were compared for severely compromised neonates (Apgar score 0-3) and those with Apgar score of four-seven at one minute of birth. Multivariate logistic regression analysis was applied to determine independent predictors of severe neonatal compromise. (OR ajusté, 0, RESULTS

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Meconium in the Amniotic Fluid and Fetal Acid-Base Status

Cited by 30 publications

References 0 publications

Significance of Meconium-Stained Amniotic Fluid in the Preterm Population

Significance of Meconium-Stained Amniotic Fluid in the Preterm Population

Predictors of adverse neonatal outcomes in intrahepatic cholestasis of pregnancy

Predictors of Severe Neonatal Compromise Following Caesarean Section for Clinically Diagnosed Foetal Distress

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