STUDY OF SOME RISK FACTORS FOR MECONIUN-STAINED AMNIOTIC FLUIO
Keywords:
pregnancy complications, aminiotic fluid, meconiumAbstract
Introduction
The incidence of meconium in amniotic fluid is 8% to 25% of pregnancies. There is a consensus that its presence in amniotic fluid can compromise the pregnancy and puerperal cycle, increasing maternal and fetal morbidity and mortality. The etiology of such an event is not fully known. Some authors believe it to be a physiological phenomenon, while for others the phenomenon occurs due to fetal hypoxia, and a third group accepts both theories.
Objective
The objective of this study was to identify factors related to the presence of meconium in amniotic fluid.
Method
Thus, a retrospective study was carried out with low-risk patients treated at the Hospital e Maternidade Celso Pierro, from January to December 1998. 3158 medical records were analyzed and a final sample of 465 pregnant women was obtained, who were classified into two groups. according to the presence of meconium. Meconium was present in the amniotic fluid in 83 women and absent in another 382. Univariate and multivariate Logistic Regression and Stepwise methods were used for statistical analysis. A p<0.05 was considered as the level of significance.
Results
As a result, it was observed that women's age, parity, number of prenatal consultations, birth weight and placental weight were not associated with the occurrence of meconium. However, gestational age and changes in fetal heartbeat significantly altered this occurrence. With advancing gestational age, the chance of the presence of meconium in the amniotic fluid increased 1.3 times each week. It was found that the chance of meconium in amniotic fluid was 5.4 times higher when fetal heartbeats were abnormal.
Conclusion
The results of this study suggest that maternal age, parity, number of prenatal visits, birth weight and placental weight are not risk factors for passing meconium. On the other hand, increasing gestational age and changes in fetal heartbeat were shown to be statistically significant factors for the passage of meconium.
Downloads
References
Mvumbi L, Manei EA, Ulmer RD, Shah AK. Decreased placenta! and umbilical cord glycogen leveis associated with meconium-stained amniotic fluid. Placenta 1998; 19(4):295-9.
Piper JM, Newton ER, Berkus MD, Peairs WA. Meconium: a marker for peripartum infection. Obstet Gynecol 1998; 91(5 Pt 1):741-45.
Houlihan CM, Knuppel RA. Meconium-stained amniotic fluid: current controversies. J Reprod Med 1994; 39(11 ):888-98.
Rezende J, Orlandi OV. O feto. ln: Rezende J. Obstetrícia. 4. ed. Rio de Janeiro: Guanabara Koogan; 1982. p.56-74
Katz VL, Bowes WA Jr. Meconium aspiration syndrome: reflections on a murky subject. Am J Obstet Gynecol 1992;166 (1 Pt 1):171-183.
Benny PS, Malani S, Hoby MA, Hutton JD. Meconium Aspiration: role of obstetric factors and suction. Aust NZ Obstet Gynaecol; 1987; 27:36-9.
Cleary G M, Wiswel TF. Meconium-stained amniotic fluid and the meconium aspiration syndrome na update. Pediatr Clin N Am 1998; 45(3):511-29.
Spencer JAD. lntrapartum fetal monitoring. ln: Edmonds K. Dewhurst's Text book of Ostetrics and Gynaecology for Postgraduates. 6th. London: Blackwell Science; 1999. p.259-76
Penny C, Patrick D. lnhibition of neutrophil oxidative burst and phagocytosis by meconium. Am J Obstet Gynecol 1995; 173:1301-5.
Altshuler G, Hyde S. Meconium-induced vasocontraction: a potential cause of cerebral an other fetal hispoperfusion and of poor pregnancy outcome. F Child Neurol 1989; 4(2):137-42.
Miyadahira S, Zugaib M. Cardiotocografia. ln: Cha SC, Zugaib M. Medicina fetal. São Paulo: Atheneu; 1993. p.77-80.
Miyadahira S. Avaliação da vitalidade fetal. ln: Neme B. Patologia da gestação. São Paulo: Sarvier; 1998. p.406-27 .
Porto AGM, Marra AR, Souza JALJr, Achilles RB, Rodrigues JLT, Mizobuchi CC. Evolução obstétrica em mulheres portadoras do Vírus da Deficiência Humana do Tipo 1. RBGO 1996; 18:305-4 .
Bertuol M, Oliveira C, Pereira-Lima C, Pereira-Luz N. Incidência e significado da presença de mecônio de pacientes atendidas em um hospital assistencial do INAMPS. RBGO 1989; 08: 153-56.
Karinieme V, Harrela M. Significance of meconium staining of the amniotic fluid. J Perinat Med 1990; 18(5):345-9.
Mayes T, Reid J. Meconium staining: is it related to maternal smoking? J Ky Med Assoe 1994; 92(10):401-5.
Grecory C S. Correlation of meconiun-stained amniotic fluid, early intrapartum fetal ph, and Apgar scores as predictors of perinatal outcome. Obstet Gynecol 1980; 56(5):604-9 .
Capurro H, Konichezky S, Fonseca D, Caldeyro-Barcia R. A simplified method for diagnosis of gestational age in the newborn infant. J Pediatr 1978; 93:120-2.
Elisabeth K Watanabe. Evolução cronológica do concepto: duração da prenhez. ln: Neme B. Obstetrícia básica. São Paulo: Sarvier; 2000.p. 66-9.
Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr 1967; 71 (2): 159-63.
Bochner CJ, Medearis A, Ross MG, Oakes GK, Jones P, Hobel JC, et ai. The role of antepartum testing in the management of pos-term pregnancies with heavy meconium in early labor. Obstet Gynecol 1987; 69(6):903-7.
Bittar RE, Zugaib M. Crescimento intra-útero retardado. ln: Neme, B. Patologia da gestação. São Paulo: Sarvier; 1998. p.49-58.
Usher RH, Boyd ME, Mclean FH, Kramer MS . Assessment of fetal risk in postdate pregnancies. Am J Obstet Gynecol 1988; 158:259.
Eden RD, Seifert LS, Winegar A, Spellacy WN. Perinatal characteristics of uncomplicated postdate pregnancies. Obstet Gynecol 1987; 69(3):296-9.
Steer PJ, Eigbe F, Lissauer TJ, Beard RW. lnterrelationships among abnormal cardiotocograms in labor, meconium staining of the ammniotic fluid, arterial cord blood ph, and Apgar scores Obstet Gynecol 1989; 7 4(5):715-21.
Alexander GR, Hulsey TC, Robillard PY, De Caunes F, Papiernik E. Determinants of meconium-stained amniotic fluid in term pregnancies. J Perinatol 1994; 14(4):259-63.
Berkus MD, Langer O, Samueloff A, Xenakis EM, Field NT, Ridgway LE. Meconium-stained amniotic fluid: increased risk adverse neonatal outcome. Obstet Gynecol 1994; 84(1 ): 115-20.
Hofmeyr GJ. Amnioinfusion for meconium-stained liquor I labour (Cochrane Review). The Cochrane Library; 2002; lssue 3.