To determine the independent associations of meconium stained amniotic fluidMETHODS:
This is a retrospective review of 4085 (12.2%) women at 37-42 weeks with meconium staining compared to 29397 (87.8%) women who delivered at a single hospital system from 1/2013-12/2016. The primary outcome was a composite neonatal adverse outcome comprised of five-minute Apgar score < 4, umbilical arterial pH < 7.0, sepsis, seizures, encephalopathy, and respiratory failure. Secondary outcome was neonatal intensive care unit (NICU) admission. Logistic regression and hierarchical regression analysis were used.RESULTS:
Prenatal factors which positively independently correlated with meconium staining were African-Americans, nulliparity, BMI and public insurance but negatively associated with male fetal gender and multiple pregnancies. For intrapartum factors, vaginal delivery, epidural analgesia, chorioamnionitis and abnormal fetal heart rate patterns were associated with increased risks while abruption and opioid use were associated with decreased meconium staining. Meconium staining was significantly positively correlated with both neonatal composite adverse outcomes and NICU admission. Hierarchical analysis showed that meconium staining significantly increased albeit by a small percentage the variability accounted for both NICU admission (R2=0.015, R2Adjusted=0.017; p<0.001, β=0.037) and the primary outcome (R2=0.004, R2Adjusted=0.005; p<0.001, β=0.021) when controlled for accelerations, late, variable, and prolonged decelerations, tachycardia, bradycardia and minimal variability.CONCLUSION:
Amniotic fluid meconium staining during labor indicates a slightly increased neonatal risk beyond what is explained by abnormal fetal heart rate patterns.