Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Neonatal Intensive Care, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Perinatol. 2019 Oct;39(10):1349-1355. doi: 10.1038/s41372-019-0436-4. Epub 2019 Jul 18.
The objective of this study is to compare pregnancy outcomes in deliveries complicated by primary meconium-stained amniotic fluid (MSAF, present at membrane rupture) and secondary MSAF (transitioned from clear to MSAF during labor).
The medical records and neonatal charts of all deliveries ≥ 37 weeks between October 2008 and July 2018 were reviewed. The primary outcome was composite adverse neonatal outcome that included early neonatal complications.
Of 30,215 deliveries during the study period, 4302 (14.2 %) were included: 3845 (89.4%) in the primary MSAF group and 457 (10.6%) in the secondary MSAF group. The rate of the primary outcome was higher in the secondary MSAF group (p = 0.006). This association remained significant after controlling for background confounders. The secondary MSAF group had higher rate of cesarean deliveries (CDs) and assisted vaginal deliveries. There was a higher rate of composite adverse neonatal outcome when secondary MSAF was diagnosed < 3 vs. >3 h before delivery (p = 0.004).
Secondary MSAF was associated with higher rates of adverse neonatal outcome, CDs, and assisted vaginal deliveries, compared with primary MSAF.
本研究旨在比较原发性羊水粪染（MSAF，胎膜破裂时存在）和继发性羊水粪染（在产程中由清亮转为 MSAF）分娩的妊娠结局。
回顾 2008 年 10 月至 2018 年 7 月期间所有≥37 周分娩的病历和新生儿图表。主要结局为包括早期新生儿并发症在内的复合不良新生儿结局。
在研究期间的 30215 次分娩中，有 4302 次（14.2%）被纳入：3845 次（89.4%）在原发性 MSAF 组，457 次（10.6%）在继发性 MSAF 组。继发性 MSAF 组的主要结局发生率更高（p=0.006）。在控制了背景混杂因素后，这种关联仍然显著。继发性 MSAF 组剖宫产率（CD）和辅助阴道分娩率较高。当继发性 MSAF 在分娩前<3 小时和>3 小时诊断时，复合不良新生儿结局的发生率更高（p=0.004）。
与原发性 MSAF 相比，继发性 MSAF 与更高的不良新生儿结局、CD 和辅助阴道分娩率相关。
