MECONIUM - A MARKER FOR PERIPARTUM INFECTION

Objective: To test the hypothesis that the presence of meconium-staine d amniotic fluid (AF) is associated with maternal and neonatal infecti on, both before and after delivery. Methods: Nine hundred thirty-six l aboring women were analyzed for the presence of meconium in amniotic f luid and occurrence of peripartum infection. Meconium was assessed cli nically as thin, moderate, or thick. Intra-amniotic infection and endo metritis were diagnosed by standard definitions. All patients were tes ted for vaginal group B streptococcus, bacterial vaginosis, and other aerobic organisms. Results: Meconium-stained AF was present in 28% of the study participants (9% thin, 12% moderate, 7% thick). The presence of meconium was associated with increased intraamniotic fluid (17% ve rsus 9%, relative risk [RR] 1.98, 95% confidence interval [CI] 1.3, 3. 1), endometritis (10% versus 5%, RR 2.38, 95% CI 1.3, 4.4), and total infection (25% versus 13%, RR 2.19, 95% CI 1.5, 3.2). Thick meconium h ad higher infection rates than clear AF (44% Versus 13%, RR 5.18, 95% CI 2.9, 9.3). Meconium was associated independently with peripartum in fection by multiple logistic regression (RR 1.28, 95% CI 1.1, 1.6). Co nclusion: Meconium-stained AF is associated with increased peripartum infection, independent of other risk factors for infection. Thick meco nium, in particular, is associated with a marked increase-in peripartu m infectious morbidity. (C) 1998 by The American College of Obstetrici ans and Gynecologists.