MECONIUM STAINED AMNIOTIC-FLUID IN PRETERM DELIVERY IS AN INDEPENDENTRISK FACTOR FOR PERINATAL COMPLICATIONS

Objective. To determine the prevalence and clinical significance of me conium stained amniotic fluid (MSAF) in women with preterm delivery. S tudy design: The study population consisted of consecutive patients wh o arrived with intact membranes and delivered preterm, singleton neona tes at the Soroka Medical Center between I January 1985 and 31 Decembe r 1995. Only vertex presentation was included. Antepartum death was ex cluded from the study. Patients were classified according to the color of amniotic fluid into two groups: MSAF and clear amniotic fluid. Mat ernal puerperal complications were defined in our study as the presenc e of at least one of the next variables: clinical chorioamnionitis; ma jor puerperal infection including endometritis, cesarean section or po stpartum hemorrhage. Perinatal complications were defined in our study as: (1) intrapartum death (IPD) or postpartum death (PPD); (2) one or more of the following: I-min Apgar score <3, 5-min Apgar score <7 or small for gestational age. Rates of perinatal complications were asses sed at: (1) 24-27 weeks; (2) 28-31 weeks; (3) 32-36 weeks. Logistic re gression was used to investigate the relationship of MSAF to perinatal complications and maternal morbidity in a multivariate model. Results : During the study period, a total of 96 566 deliveries occurred in ou r institution and 4872 (5.0%) deliveries were preterm. Among the women delivering preterm meeting eligibility criteria, 276 (5.7%) women had intrapartum MSAF. A higher rate of IPD and PPD was observed only betw een 32 and 36 weeks' gestation in patients with MSAF in comparison wit h patients with clear amniotic fluid [6.1% (14/230) vs. 2.1% (85/4045) , respectively, P=0.0001]. A statistically significant higher rate of perinatal complications was found between 28 and 31 weeks' gestation, and even a higher rate was noted between 32 and 36 weeks' gestation in the MSAF group in comparison with patients with clear amniotic fluid [51% (18/35) vs. 27.2% (93/341), respectively, P=0.003; 20% (46/230) v s. 9.8% (396/4045), respectively, P=0.0004]. Conclusions: (1) MSAF is an independent risk factor for perinatal complications in preterm deli veries (OR=1.73, CI: 1.057-2.43, P=0.001; OR=2.35, CI:1.34-4.12, P=0.0 02, respectively). (2) MSAF was not found to be an independent risk fa ctor for maternal morbidity. (C) 1998 Elsevier Science Ireland Ltd. Al l rights reserved.