Maternal and Fetal Characteristics Associated With Meconium-Stained Amniotic Fluid

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OBJECTIVE:To estimate the rates of meconium-stained amniotic fluid (AF) and adverse outcome in relation to gestational age and racial group, and to investigate the predictors of meconium-stained AF.METHODS:We studied 499,096 singleton births weighing at least 500 g, at 24 or more weeks of gestation, from 1988 to 2000. The predictors of meconium-stained AF from 37 weeks of gestation onward were determined using multiple logistic regression.RESULTS:The crude meconium-stained AF rates in preterm, term, and postterm births were 5.1% (95% confidence interval [CI] 4.9–5.4), 16.5% (95% CI 16.4–16.6), and 27.1% (95% CI 26.5–27.6), respectively; the rates in blacks, South Asians, and whites were 22.6% (95% CI 22.2–23.1), 16.8% (95% CI 16.5–17.1), and 15.7% (95% CI 15.6–15.8), respectively. Independent predictors of meconium-stained AF included being black (odds ratio [OR] 8.4, 95% CI 2.4–28.8), vaginal breech delivery (OR 4.7, 95% CI 4.2–5.3), being South Asian (OR 3.3, 95% CI 1.3–8.3), and being in an advancing week of gestation (OR 1.39, 95% CI 1.38–1.40). More blacks (17.9%, 95% CI 17.3–18.4) and South Asians (11.8%, 95% CI 11.5–12.1) with good outcome and no risk factors for fetal hypoxia had meconium-stained AF than did whites (11.2%, 95% CI 11.1–11.4). Using white neonates born at 40 weeks as reference, the absolute risk of adverse outcome at 41 and 42 weeks were 2% and 5% in whites, 3% and 7%, in South Asians, and 7% and 11% in blacks.CONCLUSION:Meconium-stained AF rates are different among races and across gestational age, and overall risk of adverse outcomes in meconium stained AF is low.LEVEL OF EVIDENCE:II

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