Prognostic Value of Change in Amniotic Fluid Color during Labor

Abstract

Objective: Evidence of meconium-stained amniotic fluid (AF) during labor suggests implementation of close monitoring of fetal well-being. We have investigated whether the presence of meconium in the AF on admission for labor is as important a predictor of neonatal outcome as a change in AF color during labor. Methods: AF characteristics on admission for labor at term (37–42 weeks) and their changes during labor were recorded in all singleton pregnancies during an 8-year period (1992–1999). Excluded were stillbirths on admission, congenital anomalies, and elective cesarean sections. The presence of meconium and its consistency (light or thick) were documented on admission by inspection with transcervical amnioscopy in women with intact membranes or in the vaginal pool in those with ruptured membranes. Changes in AF color or consistency during labor were recorded and correlated with the obstetric and neonatal outcome. Statistical analysis utilized χ² for trend, with p < 0.05 considered significant. Results: 19,090 women were admitted in labor at term during the study period and fulfilled the study inclusion criteria and had amniotic fluid evaluation available. The appearance of meconium or worsening in thickness of meconium during labor was associated with higher rates of Apgar scores <7 at 5 min (clear AF on admission and at delivery 0.6%; light or thick meconium on admission and no change at delivery 0.8%; clear AF on admission and light or thick meconium at delivery 3.2%, and light meconium on admission and thick meconium at delivery 2.5%; p < 0.001) and umbilical artery pH <7.10 (the respective rates in the four groups were 1.7, 1.8, 3.6, and 3.8%; p < 0.001). Conclusion: The appearance or thickening of meconium during labor has a greater predictive ability for depressed neonates than the presence of meconium on admission.

Vascular endothelial growth factor levels in newborns with meconium stained amniotic fluid

“…On the other hand, it is known that APGAR scores < 7 at 5 th minute and umbilical artery pH < 7.10 during labor are known prognostic factors of MSAF and the appearance or thickening of meconium during labor have a greater predictive value for depressed neonates. 10,11 However, no correlation between VEGF levels, pH and base excess was shown. Additionally, none of the infants required postnatal resuscitation nor had antenatal evidence of fetal distress, except for MSAF (as a fetal distress finding) and no statistically significant difference in VEGF levels between MSAF infants with thick or light meconium was found.…”

Neonatal outcome in meconium stained amniotic fluid: a hospital based study

“…Presence of meconium in amniotic fluid is a potentially serious sign of fetal compromise and associated with an increased perinatal morbidity and mortality. 1,2 It is associated with low APGAR scores, increased need for resuscitation, increased NICU admission, prolonged stay and high perinatal mortality. 3 Meconium stained amniotic fluid is considered a harbinger of fetal compromise because of its direct correlation with fetal distress and increased likelihood of aspiration of meconium with resultant deleterious effects on the neonatal lung.…”

An Investigation of the Mortality Rate and Risk Factors in Newborn Infants With Meconium Aspiration Syndrome

“…Meconium aspiration syndrome (MAS) occurs in 1.3% of live births and symptoms range from mild respiratory distress syndrome with auto recovery to progressive respiratory failure, complications and death, and in the most severe cases, respiratory distress, hypoxia, hypercapnia and respiratory acidosis increase, requiring intensive care and mechanical ventilation (1)(2)(3), and 10 to 40% of cases result in infant's death (4,5).…”