Department of Obstetrics and Gynecology, Rabin Medical Center, Helen Schneider Hospital for Women, 4941492, Petah Tiqva, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2020 May;301(5):1181-1187. doi: 10.1007/s00404-020-05541-2. Epub 2020 Apr 17.
To determine whether meconium-stained amniotic fluid (MSAF) encountered in pregnancies complicated by preterm premature rupture of membranes (PPROM) is associated with adverse maternal and perinatal outcome.
A retrospective cohort study of all singleton pregnancies with PPROM and MSAF who delivered in a tertiary hospital at 24 + 0-36 + 6 weeks of gestation between 2007 and 2017. Women with PPROM-MSAF (study group) were compared to women with PPROM and clear amniotic fluid (control group). Controls were matched to cases according to age, gravidity, parity and gestational age at delivery in a 3:1 ratio. Primary outcome was defined as neonatal intensive care unit admission. Secondary outcomes were neonatal adverse outcomes, chorioamnionitis and placental abruption diagnosed clinically or by placental cultures and histology.
Seventy-five women comprised the study group and were matched to 225 women representing the control group. A significantly higher rate of neonatal intensive care unit admissions was noted in the study group compared to controls (61.3% vs. 45.7%, p = 0.03). Multivariate analysis demonstrated that MSAF is an independent risk factor for neonatal intensive care unit admission (adjusted OR = 2.82, 95% CI 1.39-5.75, p = 0.004). MSAF was found to be associated to higher rates of cesarean and operative vaginal deliveries (30.7% vs. 24.4% and 5.3% vs. 2.7%, p = 0.057, respectively) as well as to chorioamnionitis and placental abruption (33.3% vs. 19.3%, p = 0.034 and 16.0% vs. 7.7%, p = 0.021, respectively).
MSAF is associated with higher frequencies of adverse perinatal outcome when compared to clear amniotic fluid in pregnancies complicated by PPROM.
确定在患有早产胎膜早破（PPROM）的孕妇中遇到的胎粪污染羊水（MSAF）是否与不良母婴围产结局相关。
对 2007 年至 2017 年期间在一家三级医院分娩的 24+0-36+6 周龄的所有患有 PPROM 和 MSAF 的单胎妊娠进行回顾性队列研究。将 MSAF-PPROM 孕妇（研究组）与具有清澈羊水的 PPROM 孕妇（对照组）进行比较。按照年龄、孕次、产次和分娩时的孕龄以 3:1 的比例对病例进行匹配。主要结局定义为新生儿重症监护病房入院。次要结局为新生儿不良结局、临床或胎盘培养和组织学诊断的绒毛膜羊膜炎和胎盘早剥。
共有 75 名孕妇纳入研究组，并与 225 名代表对照组的孕妇相匹配。研究组新生儿重症监护病房入院率明显高于对照组（61.3%比 45.7%，p=0.03）。多变量分析表明，MSAF 是新生儿重症监护病房入院的独立危险因素（调整 OR=2.82，95%CI 1.39-5.75，p=0.004）。MSAF 与较高的剖宫产和阴道分娩率相关（30.7%比 24.4%和 5.3%比 2.7%，p=0.057），也与绒毛膜羊膜炎和胎盘早剥相关（33.3%比 19.3%，p=0.034 和 16.0%比 7.7%，p=0.021）。
与清澈羊水相比，MSAF 与 PPROM 孕妇不良围产结局的发生频率更高相关。
