Attali Emmanuel, Lavie Michael, Lavie Inbar, Gomez Rachel, Yogev Yariv, Gamzu Ronni, Many Ariel
Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6681-6686. doi: 10.1080/14767058.2021.1919077. Epub 2021 Apr 28.
To evaluate the impact of prolonged exposure to meconium-stained amniotic fluid (MSAF), in women with term pre-labor spontaneous rupture of membranes (PROM), on pregnancy outcome.
A retrospective cohort study of women who gave birth in a single university-affiliated tertiary medical center (2011-2019). Eligibility was limited to singleton pregnancies at term who presented with PROM. Women with MSAF were immediately induced and were compared to low-risk pregnant women with clear amniotic fluid (CAF) at admission who underwent induction of labor 24 h after rupture of membranes. All women were stratified into 4-time frame groups from rupture of membranes to delivery: T0: 0-7 h, T1: 8-13 h, T2: 14-18 h, and T3: > 18 h for the MSAF group. The time frames for the CAF were: T0 - 24-31 h, T1: 32-38 h, T2: 40-44 h, and T3: > 44 h. The maternal adverse composite outcome included any of the following: intrapartum fever (IPF), prolonged second stage (PSS), need for manual removal of suspected retained placenta, postpartum hemorrhage, and readmission within 45 days after delivery. The adverse composite neonatal outcome included one or more of the following: meconium aspiration syndrome, neonatal asphyxia, need for respiratory support, and intracranial hemorrhage.
Overall, 1631 women met the inclusion criteria (536 in the MSAF and 1095 in the CAF group). Both groups showed a gradual decrease in the rate of vaginal delivery over time, the vaginal delivery rate in the MSAF group was 75.7% at T0 in comparison to 61.6% at T3 ( < .001). In the CAF group, the vaginal delivery rate was 84.5% at T0 in comparison to 68.8% at T3 ( < .001). This decrease was in concomitance with an increase in the rates of prolonged second-stage and intrapartum fever. There were no significant differences in the rates of postpartum hemorrhage, suspected retained placenta, or readmission within 45 days between women with either MSAF or CAF. There was a significant gradual increase in the adverse composite neonatal outcome in the MSAF group (1.9% at T0, 5.2% at T1, 6.0% at T2, and 8.2% at T3. = .038). No similar increase was found in the CAF group (2.5% at T0, 4.1% at T1, 2.6% at T2, and 4.1% at T3. = .449).
Prolonged rupture of membranes in the presence of meconium does not affect maternal outcomes, however, prolonged exposure to meconium lead to an increased adverse neonatal outcome.
评估足月胎膜早破（PROM）孕妇长时间暴露于胎粪污染羊水（MSAF）对妊娠结局的影响。
对在一所大学附属三级医疗中心分娩的女性进行回顾性队列研究（2011 - 2019年）。纳入标准仅限于足月单胎妊娠且出现胎膜早破的孕妇。MSAF孕妇立即引产，并与入院时羊水清亮（CAF）的低风险孕妇进行比较，后者在胎膜破裂24小时后引产。所有女性从胎膜破裂到分娩分为4个时间框架组：MSAF组，T0：0 - 7小时，T1：8 - 13小时，T2：14 - 18小时，T3：>18小时。CAF组的时间框架为：T0 - 24 - 31小时，T1：32 - 38小时，T2：40 - 44小时，T3：>44小时。孕产妇不良复合结局包括以下任何一种：产时发热（IPF）、第二产程延长（PSS）、疑似胎盘残留需手动取出、产后出血以及分娩后45天内再次入院。不良复合新生儿结局包括以下一项或多项：胎粪吸入综合征、新生儿窒息、需要呼吸支持以及颅内出血。
总体而言，1631名女性符合纳入标准（MSAF组536例，CAF组1095例）。两组阴道分娩率均随时间逐渐下降，MSAF组T0时阴道分娩率为75.7%，T3时为61.6%（<0.001）。CAF组T0时阴道分娩率为84.5%，T3时为68.8%（<0.001）。这种下降与第二产程延长和产时发热率的增加同时出现。MSAF或CAF女性产后出血、疑似胎盘残留或45天内再次入院率无显著差异。MSAF组不良复合新生儿结局有显著的逐渐增加（T0时为1.9%，T1时为5.2%，T2时为6.0%，T3时为8.2%，P = 0.038）。CAF组未发现类似增加（T0时为2.5%，T1时为4.1%，T2时为2.6%，T3时为4.1%，P = 0.449）。
存在胎粪时胎膜长时间破裂不影响孕产妇结局，但长时间暴露于胎粪会导致不良新生儿结局增加。
