Ramin S M, Gilstrap L C, Leveno K J, Dax J S, Little B B
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032.
Am J Perinatol. 1993 Mar;10(2):143-5. doi: 10.1055/s-2007-994647.
Although the significance of meconium in the amniotic fluid diagnosed during labor remains problematic, there is little information regarding the significance of meconium discovered prior to labor. The present study consisted of 40 term pregnancies with meconium found at amniocentesis for lung maturity (n = 7) or elective cesarean section (n = 33) and 40 uncomplicated, control pregnancies with clear amniotic fluid at elective cesarean section. The mean umbilical artery (UA) blood pH was 7.26 in the meconium group and 7.28 in the control group. Overall, the frequency of fetal acidemia (UA pH < 7.20) was 15% (6 of 40) of the infants in the meconium group versus 8% (3 of 40) in the control group (p = 0.24). All nine of these infants had a respiratory acidosis defined as a UA blood pH less than 7.20 with normal bicarbonate and elevated carbon dioxide pressure. Importantly, none of the neonates had metabolic acidemia and all had uncomplicated hospital courses. All of the pregnancies reported were promptly delivered because of meconium and we therefore cannot recommend nonintervention when meconium is diagnosed in the antepartum period. Meconium discovered prior to labor is not necessarily a marker of immediate or chronic fetal compromise.
尽管产程中诊断出的羊水胎粪的意义仍存在问题，但关于分娩前发现胎粪的意义的信息却很少。本研究包括40例足月妊娠，这些妊娠在因肺成熟进行羊膜腔穿刺术时（n = 7）或择期剖宫产时（n = 33）发现有胎粪，以及40例择期剖宫产时羊水清晰的无并发症对照妊娠。胎粪组脐动脉（UA）血pH值平均为7.26，对照组为7.28。总体而言，胎粪组胎儿酸血症（UA pH < 7.20）的发生率为15%（40例中的6例），而对照组为8%（40例中的3例）（p = 0.24）。这9例婴儿均患有呼吸性酸中毒，定义为UA血pH值小于7.20，碳酸氢盐正常且二氧化碳分压升高。重要的是，没有新生儿患有代谢性酸血症，且所有新生儿住院过程均无并发症。所有报告的妊娠均因胎粪而迅速分娩，因此当在产前诊断出胎粪时，我们不建议不采取干预措施。分娩前发现的胎粪不一定是立即或慢性胎儿窘迫的标志。
