JURNAL READING

Bagian/SMF Ilmu Kebidanan dan Penyakit Kandungan

FK Unsyiah/RSUDZA Banda Aceh

Preterm Meconium-stained Amniotic Fluid is

an Amious Sign for The Chorioamnionitis and
for In Utero Cord Compression
D a n a B r a b b i n g - G o l d s t e i n , D a n N i r, D e b o r a h C o h e n , A r i e l M a n y a n d
Sharon Maslovitz
D e p a r t e m e n t o f O b s t e t r i c s a n d G y n e c o l o g y, T h e L i s M a t e r n i t y H o s p i t a ,
S a c k l e r S c h o o l o f M e d i c i n e , Te l A v i v U n i v e r s i t y, Te l A v i v, I s r a e l

d r. D e fa re n d y S u l a i m a n
 INTRODUCTION

Meconium-strained amniotic fluid (MSAF) increase with

gestasional age and with relation to fetal gut maturation. In term and
post pregnancies, it is also considered to be related to fetal distress or
hypoxia
Whether or not meconium is also a risk factor for perinatal
complications in preterm pregnancies as it is in term and post term
pregnancies is still under debate.
A number of studies found increased risk for clinical chorioamnionitis,
perinatal complications, and cerebral palsy among preterm infants
with MSAF in comparison with those with clear amniotic fluid (AF)
while others did not.
 PUSPOSE

“to determine the clinical significance of MSAF in preterm

delivery or preterm premature rupture of membranes
(PPROM)”

“the differences in the outcome of neonates of those

pregnancies”
 METHODS

Retrospective Study
At Lis Maternity Hospital (tertiary obstetric unit)
Since 2000-2012

STATISTICAL ANALYSIS
Laboratory for statistical consultation in the mathematics Faculty of the Tel Aviv
University
SPSS Version 15 computer program

Levene’s test was used to compare between the study’s groups for analysis of
continuous variables an to determine equality of variances
 METHODS
INCLUSION CRITERIA
- Women who had problem
delivery of PPROM between
24-34 weeks gestation
- MSAF
- - Gestational Age determined
by first trimester
- Singleton/twin gestation
EXCLUSION CRITERIA
- Maternal Age <18 or >42 years
- IUFD
- Fetal Malformations
- Termination of pregnancy for
any indication
- Missing data regarding
umbilical cord pH
- Apgar Score
- Cause of hospitalization NICU
 METHODS

CONTROL
Pregnant women with clear AF
matched for gestational age at
CLINICAL CHORIOAMNINITIS
delivery or PPROM
Maternal Fever >38oC
Maternal/Fetal Tachycardia
Abdominal Tenderness in the
presence of PROM
 PERINATAL OUTCOME
Incidence of cord aroud neck, birth
weight, APGAR Score, Umbicical
cord pH, length of NICU stay,
Neonatal Complication such RSD,
BPD, IVH

PRIMER OUTCOME
SECONDARY OUTCOME Cord aroud the neck,
Obstetrical Complication, APGAR Score <7 at 5 min,
Mode of delivery, and cord pH <7,1
Latency period,
Length of NICU stay
Rate of composite neonatal outcome
RESULT
No significant differences in the adverse neonatal outcomes
 Variable Study Group Control Group P value
(MSAF Group) (Clear AF)
Clinical Chorioamnionitis 15% 4,3% 0.041

Obtetrical Complications
- Preeklampsia 3,1% 3,7% 0.78
- IUGR <10th percentile 1,8% 1,8% 1
- Antenatal Bleeding 3,1% 2,5% 0.64

Variable Study Group Control Group P value

Infant Chacacteristic (MSAF Group) (Clear AF)
Male 50,0% 44,6% 0.585

Birthweight 1600.69±548.52 1600.58±551.89 0.9

Incidence of cord around the 27,4% 18,4% 0.04
neck/body
APGAR Score <7 at 5 min 0.09
Cord pH 0.15
 DISUCSSION

MSAF is uncommon in preterm pregnancies and its clinical significance

is controversial.
Result of this study suggest that diagnosing MSAF in women with
preterm labor may serve as warning sign for intrauterine infection.
Clinical chorioamnionitis was more common among pregnancies with
MSAF than among pregnancies with clear fluid.
Markovitch et al, found preterm births complicated by MSAF were
higher risk for clinical chorioamnionitis and histological
chorioamnionitis when compared with preterm birth without MSAF.
 DISCUSSION

MSAF in preterm pregnancies is suggested by some to correlate with a

number of adverse neonatal outcome.
Spinillo et all, found increased incidence of cerebral palsy among
preterm infants with MSAF in comparison with those with clear AF
Mazor et al, found meconium in preterm pregnancies to be a
statistically significant independent risk factor for perinatal
complications.
Tybulewicz et al, observed more severe intraventricular hemorrhages
in infants with preterm MSAF in comparison with controls and more
infants died or developed chronic lung disease in MSAF group.
 DISCUSSION

In this study, we did not find a significant differences in cord pH or in

the number of cases of APGAR Score <7 at 5 min between MSAF and
clear AF groups.
The absence of differences in umbilical pH between both groups, this
study’s finding that there was an increased incidence of cord around
the neck in meconium versus clear AF group may have important
implications.
The lack of statistical significance may be explained by a small number
of cases and the fact that complications in this age group may be
influenced more by prematurity rather than by characteristic of
amnion fluid.
 CONCLUSION

This study suggests that MSAF in pregnancies before 34 weeks

gestation is a hazard sign for antenatal infection and cord around the
neck/body which may result in early meconium passage due to chronic
in utero stress.
MSAF in preterm pregnancy should promptly raise the suspicion of
chorioamnionitis and fetal heart rate monitoring should be more
intense and interpreted more cautiously by its presence
THANK YOU
2018