Intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid
Intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid
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DOI：
10.1016/j.ejogrb.2018.03.029y
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发表时间：
2018-05-01
影响因子：
2.6
通讯作者：
Couceiro Naveira, Emilio
中科院分区：
文献类型：
--
作者：
Rodriguez Fernandez, Vanesa;Ramon y Cajal, Carlos Nicolas Lopez;Couceiro Naveira, Emilio
目的：探讨胎粪染色羊水（MSAF）不同染色程度对分娩及围生期的影响。研究设计：对2015年（2015年）住院所有单胎分娩患者进行回顾性研究，比较不同程度的MSAF（黄、绿、浓）对羊水的清除效果，并分析各组产妇、产中、新生儿变量以及脐带血气分析。结果：在纳入的3590例分娩中，503例（14%）发生MSAF。MSAF的发病率随着分娩时胎龄的增加而上升，41周以上的妊娠期为20.7%，37周以下的妊娠期为4.3%。随着羊水染色的进展，我们发现产时发热（p < 0.001）、病理性胎心模式（p < 0.05）、手术阴道分娩和剖宫产（p < 0.001）以及需要晚期新生儿复苏（p < 0.001）的比例更高。msafandlowapgarscores5分钟（p < 0.001）与胎儿-新生儿死亡率（p < 0.001）也有相关性，但新生儿重症监护入院比例不高（p < 0.05）。我们观察到各组脐动脉pH值分布相似（p < 0.05）。结论：MSAF与病理性胎儿心率模式、产时发热、阴道和剖宫产手术分娩、新生儿复苏需求、低Apgar评分和较高的胎儿-新生儿死亡率相关。此外，我们发现，随着羊水染色和浓度的变化，风险增加，因此应提醒产科医生和儿科医生注意潜在的不良后果。(C) 2018 Elsevier B.V.版权所有
Objective: To determine the intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid (MSAF).Study design: lnaretrospectivecohortstudyofallsingletondeliveriesoveraperiodofoneyear(2015)inatertiary hospital, we compared different degrees of MSAF (yellow, green and thick) to clear amniotic fluids, and analysed in each group maternal, intrapartum and neonatal variables as well as umbilical cord blood gas analysis. Results: Of the 3590 deliveries included, 503 (14%) had MSAF. The incidence of MSAF rises with gestational age at delivery, reaching 20.7% in gestations above 41 weeks compared to 4.3% below 37 weeks. As the amniotic fluid staining progresses we found a higher proportion of intrapartum fevers (p < 0.001), pathological fetal heart rate patterns (p < 0.05), operative vaginal deliveries and cesarean sections (p < 0.001), as well as the need for advanced neonatal resuscitation (p < 0.001). There was also a correlation between MSAFandlowApgarscoresatfiveminutes(p < 0.001)andfetal-neonatalmortality(p < 0.001)but there was not a higher proportion of neonatal intensive care admissions (p > 0.05). We have observed a similar distribution of umbilical artery pH ranges in all groups (p > 0.05).Conclusions: MSAF was associated with an increase in the rate of pathological fetal heart rate patterns, intrapartum fevers, operative vaginal and cesarean section deliveries, need for neonatal resuscitation, low Apgar scores and higher fetal-neonatal mortality. Moreover, we found that the risks increase as the staining and consistency of the amniotic fluid evolves so it should alert the obstetrician and paediatrician to the potential adverse outcomes. (C) 2018 Elsevier B.V. All rights reserved.