Meconium passed in labor: How reassuring is clear amniotic fluid?
Meconium passed in labor: How reassuring is clear amniotic fluid?
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DOI：
10.1016/s0029-7844(03)00407-1
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发表时间：
2003-07-01
影响因子：
7.2
通讯作者：
Impey, L
中科院分区：
文献类型：
--
作者：
Greenwood, C;Lalchandani, S;Impey, L
目的：清澈的羊水通常被认为是分娩过程中令人安心的迹象。我们的目的是检查只能在产时排出的胎便的发生率，并确定其与新生儿的关系，以及胎便不存在是否是一个有用的迹象。方法：这是一项前瞻性队列研究，对象为 8394 名在早期羊膜切开术中羊水稀的足月妇女。结果：胎便。 5.2% 的产程中通过了检测，但其中 51.5% 的产程直到胎头分娩才被检测到。它与中重度酸中毒（比值比 [OR] 4.40；95% 置信区间 [CI] 3.21, 6.03）、5 分钟低 Apgar 评分（OR 6.49；95% CI 2.73, 15.44）和新生儿癫痫发作（OR 4.33；95% CI 3.17, 5.93）相关。然而，产时胎便排出的这些结果的敏感性非常差，特别是分娩前的检测。结论：尽管与不良新生儿结局相关，但大多数受影响的婴儿在整个分娩过程中羊水量都很高。羊水的存在是胎儿健康的不可靠标志。
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 dear 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 dear amniotic fluid throughout labor. The presence of dear amniotic fluid is an unreliable sign of fetal well-being.