Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections

Perinatal risk factors for neonatal early-onset sepsis: a meta-analysis of observational studies

OBJECTIVE

Early-onset neonatal sepsis (EONS) remains an important cause of neonatal mortality and has many risk factors, therefore, this study aimed to investigate the perinatal risk factors for EONS.

METHODS

We searched CNKI, Wan Fang, VIP, CBM, PubMed, Embase, and Web of Science to compile studies regarding the incidence of neonatal early-onset sepsis, published up to 1 May 2022. To evaluate the quality of the included studies, we used the Newcastle-Ottawa Scale, and the RevMan5.3 software was used for meta-analysis.

RESULTS

A total of 17 studies were included, with 1987 cases in the case group and 4814 cases in the control group. Meta-analysis showed that perinatal asphyxia or intrauterine distress (OR = 3.00, 95% CI: 2.18-4.13), amniotic fluid meconium contamination (OR = 4.51, 95% CI: 2.31-8.81), group B streptococcal (GBS) colonization in pregnant women (OR = 2.13, 95% CI: 1.48-3.05), chorioamnionitis (OR = 4.58, 95% CI: 2.61-8.05), premature rupture of membranes (OR = 2.63, 95% CI: 2.09-3.30), lower gestational age (OR = 1.31, 95% CI: 1.18-1.44), maternal urinary or reproductive tract infection (OR = 3.61, 95% CI: 2.14-6.11), perinatal fever (OR = 3.59, 95% CI: 2.25-5.71), very low birth weight (OR = 3.79, 95% CI: 2.14-6.73), and vaginal examination ≥3 times (OR = 7.95, 95% CI: 4.04-15.64) were the perinatal risk factors for EONS.

CONCLUSION

Perinatal asphyxia or intrauterine distress, meconium contamination in amniotic fluid, GBS colonization in pregnant women, chorioamnionitis, premature rupture of membranes, lower gestational age, maternal urinary tract or reproductive tract infection, perinatal fever, very low birth weight, and vaginal examinations ≥3 times may increase the risk of EONS.

Pattern of Inflammatory Markers and Use of Antibiotics in Meconium Aspiration Syndrome: A Retrospective Cohort Study

Objectives To study the pattern of inflammatory markers in meconium aspiration syndrome (MAS) and their correlation with illness severity/antibiotic usage. Study design This is a retrospective analysis of neonates who were admitted with MAS and had inflammatory markers done during the first week of life. Results Seventy-six neonates with MAS were identified. White cell count (WCC), absolute neutrophil count (ANC), and immature to total neutrophil count (I/T) ratio peaked at 12 and CRP (43.75 mg/dl) at 48 hours of life (HOL). Neonates needing nasal cannula oxygen had lower CRP at 12 (p=0.035) and 24 HOL (p=0.046). There was no correlation between CRP at 48 HOL and score for neonatal acute physiology and perinatal extension II (SNAPPE-II; R2 0.0004). High CRP at 24 HOL was associated with longer duration of antibiotics (p<0.001) despite no correlation with the blood cultures. Conclusion MAS was associated with inflammatory markers peaking at 12 to 48 HOL; however, antibiotics should not be determined based on them as their correlation for illness severity or blood culture is poor.

Adverse Maternal and Perinatal Outcomes of Meconium-Stained Amniotic Fluid in Term Labor at Hospitals in South Gondar Zone, Northwest Ethiopia: A Prospective Cohort Study

Background

The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia.

Methods

A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI.

Result

There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups.

Conclusion

Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up.

Maternal antibiotic administration during gestation can affect the memory and brain structure in mouse offspring

Maternal antibiotics administration (MAA) is among the widely used therapeutic approaches in pregnancy. Although published evidence demonstrates that infants exposed to antibiotics immediately after birth have altered recognition memory responses at one month of age, very little is known about in utero effects of antibiotics on the neuronal function and behavior of children after birth. Therefore, this study aimed to evaluate the impact of MAA at different periods of pregnancy on memory decline and brain structural alterations in young mouse offspring after their first month of life. To study the effects of MAA on 4-week-old offspring, pregnant C57BL/6J mouse dams (2-3-month-old; n = 4/group) were exposed to a cocktail of amoxicillin (205 mg/kg/day) and azithromycin (51 mg/kg/day) in sterile drinking water (daily/1 week) during either the 2nd or 3rd week of pregnancy and stopped after delivery. A control group of pregnant dams was exposed to sterile drinking water alone during all three weeks of pregnancy. Then, the 4-week-old offspring mice were first evaluated for behavioral changes. Using the Morris water maze assay, we revealed that exposure of pregnant mice to antibiotics at the 2nd and 3rd weeks of pregnancy significantly altered spatial reference memory and learning skills in their offspring compared to those delivered from the control group of dams. In contrast, no significant difference in long-term associative memory was detected between offspring groups using the novel object recognition test. Then, we histologically evaluated brain samples from the same offspring individuals using conventional immunofluorescence and electron microscopy assays. To our knowledge, we observed a reduction in the density of the hippocampal CA1 pyramidal neurons and hypomyelination in the corpus callosum in groups of mice in utero exposed to antibiotics at the 2nd and 3rd weeks of gestation. In addition, offspring exposed to antibiotics at the 2nd or 3rd week of gestation demonstrated a decreased astrocyte cell surface area and astrocyte territories or depletion of neurogenesis in the dentate gyrus and hippocampal synaptic loss, respectively. Altogether, this study shows that MAA at different times of pregnancy can pathologically alter cognitive behavior and brain development in offspring at an early age after weaning.

Neonatal morbidity and mortality in Hargeisa, Somaliland: an observational, hospital based study

Introduction

Hargeisa Group Hospital, Somaliland, opened a neonatal unit in 2013. We aimed to study causes of admission, risk factors for neonatal death and post-discharge care to address modifiable factors.

Methods

we analysed hospital records from June-October 2013 (n=164). In addition, we reached primary caregivers of 94 patients for further information after discharge.

Results

of the 164 patients, 65% were male, 31% weighed <2500 grams, 16% were premature, 43% were exposed to meconium and 29% had premature rupture of membranes (PROM). Twenty-seven percent were admitted after caesarean section and 36% had been bag-mask ventilated. The most common diagnoses for admission were asphyxia (34%), respiratory distress (27%), sepsis (16%) and prematurity (15%). The mortality before discharge was 15%, 23/1430 (1.6%) of live-born at the hospital. Half of the admitted preterm babies died (RR for death for preterm vs term born 4.6, 95% CI 2.3-9.0) as well as 28% of the patients with birth weight <2500 grams (RR 2.1, 95% CI 1.0-4.2). The mortality rate with or without PROM was 29% vs 15% (RR 2.0, 95% CI 1.0-3.9). At 28 days of age, 34% of the patients were exclusively breastfed and 44% had not yet been vaccinated. Diarrhoea, vomiting and/or respiratory distress after discharge were reported for 44%.

Conclusion

prematurity and low birth weight were important risk factors for neonatal death in this cohort, contributing to the high mortality rate. Low numbers of exclusively breastfed and vaccinated infants are also issues of concern to be targeted in the peri- and postnatal care.

Retrospective analysis of risk factors for low 1-minute Apgar scores in term neonates

The current study was designed to investigate the perinatal risk factors for low 1-min Apgar scores in term neonates. We retrospectively analyzed the maternal and neonatal clinical data of 10,550 infants who were born through vaginal delivery from 37 weeks 0 days to 41 weeks 6 days of single gestation from January 2013 to July 2018. Because the 1-min Apgar score reflects neonatal status at birth, we analyzed the risk factors for low (score <7) 1-min Apgar scores through logistic regression. Among these 10,550 neonates, 339 (3.2%) had low (score <7) 1-min Apgar scores. Among them, 321 (94.7%) were admitted to the neonatology department for further observation or treatment. Multivariate analysis revealed that educational background, body mass index, gestational age, pathological obstetrics, longer duration of the second stage of labor, forceps delivery or vacuum extraction, neonatal weight, neonatal sex, and meconium-stained amniotic fluid were independent risk factors for 1-min Apgar scores <7. Neonates who had low 1-min Apgar scores were more frequently admitted to the neonatology department for further observation or treatment. Early detection of risk factors and timely intervention to address these factors may improve neonatal outcomes at birth and reduce the rate of admission to the neonatology department.

Prevalence of meconium stained amniotic fluid and its associated factors among women who gave birth at term in Felege Hiwot comprehensive specialized referral hospital, North West Ethiopia: a facility based cross-sectional study

BACKGROUND

Meconium stained amniotic fluid is one of the risk factors to increase the rate of perinatal morbidity and mortality both in developed and developing countries. Due to a multitude of factors associated with socioeconomic and quality of service, the ill effect of meconium stained amniotic fluid is even worse in developing countries. But very little information is known about the situation in Ethiopia, particularly the study area to design appropriate prevention strategies. Hence, this study aimed to determine the prevalence of meconium-stained amniotic fluid and its associated factors among women who gave birth at term in Felege Hiwot Referral Hospital, North West Ethiopia.

METHODS

Institutional based cross-sectional study was conducted at Felege Hiwot Referral Hospital from March 02-May 27, 2018. A total of 495 mothers were included in the study. The study participants were selected by systematic random sampling technique. A combination of chart review and interview were used to collect the data. Data entry and analysis were made by using Epi-data version 3.1 and SPSS versions 23 respectively. Both descriptive & analytical statistics were computed. Statistical significance was considered at P < 0.05 and the strength of association was assessed by using adjusted odds ratio.

RESULT

The prevalence of meconium stained amniotic fluid was found to be 17.8%. Women whose age greater than 30 years [AOR =5.63, 95%CI =3.35-9.44], duration of labor greater than 24 h [AOR = 7.1, 95%Cl =1.67-29.68], induced labor [AOR = 2.60, 95% CI =1.39-4.87], preeclampsia [AOR = 3.45, 95%CI =1.26-9.37] and obstructed labor [AOR =5.9, 95%CI =1.29-29.68] were found to be associated with meconium stained amniotic fluid.

CONCLUSIONS

The prevalence of meconium stained amniotic fluid was similar as compared to the international standard. Preeclampsia, maternal age, obstructed labor, induced labor and longer duration of labor were factors associated with an increased risk for meconium-stained amniotic fluid. Thus, early detection and timely intervention are mandatory to decrease prolonged and obstructed labor.

New Evidence to Support Antibiotic Prophylaxis in Meconium-Stained Amniotic Fluid in Low-Risk Women in Labor a Prospective Cohort Study

Purpose of study

To assess the maternal and perinatal complications associated with meconium-stained amniotic fluid (MSAF) in low-risk women in labor.

Methods

This prospective cohort study was conducted at CMC Hospital, Vellore, India. Two hundred low-risk women who had artificial or spontaneous rupture of membranes after admission with MSAF were included in the study. Two hundred similar women with clear liquor were taken as controls. The primary outcomes considered were the incidence of chorioamnionitis and endomyometritis in the mothers. The secondary outcomes included postpartum hemorrhage and retained placenta in the mothers and respiratory distress, meconium aspiration, sepsis, and NICU admission in the newborn. Statistical analysis was done using Fischer exact test. Odds ratio, 95% confidence interval, and P value were estimated.

Results

Compared to controls, those with MSAF had significantly higher rates of chorioamnionitis (2 vs. 8%, P = 0.006) and endomyometritis (3 vs. 9.5% P = 0.007). Among the secondary end points, only neonatal respiratory distress (8.5 vs. 1.5%; P = 0.001) and meconium aspiration (4 vs. 0%; P = 0.007) were found to be significantly increased in the meconium group.

Conclusion

Statistically significant increased incidence of chorioamnionitis and endomyometritis in women with MSAF in labor established in our study strongly supports the use of prophylactic antibiotics in these women to prevent immediate and long-term consequences.

Meconium aspiration syndrome: risk factors and predictors of severity

PURPOSE

To identify risk factors and predictors of severity associated with meconium aspiration syndrome (MAS) in the patients admitted to the neonatal intensive care unit (NICU).

MATERIALS AND METHODS

Retrospective study including newborns admitted, between 2005 and 2015, with a diagnosis of MAS.

RESULTS

Of the newborns admitted to the NICU, 0.66% were diagnosed with MAS. These had higher prevalence of caesarean delivery (p < .001), nonreassuring or abnormal cardiotocography (CTG) (p < .001), intrapartum maternal fever (p = .002), Apgar scores at the first minute <7 (p < .001) and need of endotracheal intubation at birth (p < .001). Newborns with severe MAS had higher median reactive C protein (86.9 versus 9.65, p = .001) and 73.3% had pulmonary hypertension (p = .027). They required significantly more days of oxygen therapy, mechanical ventilation, nitric oxide, inotropic, and surfactant therapy, as well as longer hospital stay.

CONCLUSIONS

Nonreassuring or abnormal CTG and low Apgar score at the first minute were established as risk factors for MAS and need of surfactant therapy as a predictor of severity.

Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews

BACKGROUND

Cerebral palsy is an umbrella term encompassing disorders of movement and posture, attributed to non-progressive disturbances occurring in the developing fetal or infant brain. As there are diverse risk factors and causes, no one strategy will prevent all cerebral palsy. Therefore, there is a need to systematically consider all potentially relevant interventions for their contribution to prevention.

OBJECTIVES

To summarise the evidence from Cochrane reviews regarding the effects of antenatal and intrapartum interventions for preventing cerebral palsy.

METHODS

We searched the Cochrane Database of Systematic Reviews on 7 August 2016, for reviews of antenatal or intrapartum interventions reporting on cerebral palsy. Two authors assessed reviews for inclusion, extracted data, assessed review quality, using AMSTAR and ROBIS, and quality of the evidence, using the GRADE approach. We organised reviews by topic, and summarised findings in text and tables. We categorised interventions as effective (high-quality evidence of effectiveness); possibly effective (moderate-quality evidence of effectiveness); ineffective (high-quality evidence of harm or of lack of effectiveness); probably ineffective (moderate-quality evidence of harm or of lack of effectiveness); and no conclusions possible (low- to very low-quality evidence).

MAIN RESULTS

We included 15 Cochrane reviews. A further 62 reviews pre-specified the outcome cerebral palsy in their methods, but none of the included randomised controlled trials (RCTs) reported this outcome. The included reviews were high quality and at low risk of bias. They included 279 RCTs; data for cerebral palsy were available from 27 (10%) RCTs, involving 32,490 children. They considered interventions for: treating mild to moderate hypertension (two) and pre-eclampsia (two); diagnosing and preventing fetal compromise in labour (one); preventing preterm birth (four); preterm fetal maturation or neuroprotection (five); and managing preterm fetal compromise (one). Quality of evidence ranged from very low to high. Effective interventions: high-quality evidence of effectiveness There was a reduction in cerebral palsy in children born to women at risk of preterm birth who received magnesium sulphate for neuroprotection of the fetus compared with placebo (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.54 to 0.87; five RCTs; 6145 children). Probably ineffective interventions: moderate-quality evidence of harm There was an increase in cerebral palsy in children born to mothers in preterm labour with intact membranes who received any prophylactic antibiotics versus no antibiotics (RR 1.82, 95% CI 0.99 to 3.34; one RCT; 3173 children). There was an increase in cerebral palsy in children, who as preterm babies with suspected fetal compromise, were born immediately compared with those for whom birth was deferred (RR 5.88, 95% CI 1.33 to 26.02; one RCT; 507 children). Probably ineffective interventions: moderate-quality evidence of lack of effectiveness There was no clear difference in the presence of cerebral palsy in children born to women at risk of preterm birth who received repeat doses of corticosteroids compared with a single course (RR 1.03, 95% CI 0.71 to 1.50; four RCTs; 3800 children). No conclusions possible: low- to very low-quality evidence Low-quality evidence found there was a possible reduction in cerebral palsy for children born to women at risk of preterm birth who received antenatal corticosteroids for accelerating fetal lung maturation compared with placebo (RR 0.60, 95% CI 0.34 to 1.03; five RCTs; 904 children). There was no clear difference in the presence of cerebral palsy with interventionist care for severe pre-eclampsia versus expectant care (RR 6.01, 95% CI 0.75 to 48.14; one RCT; 262 children); magnesium sulphate for pre-eclampsia versus placebo (RR 0.34, 95% CI 0.09 to 1.26; one RCT; 2895 children); continuous cardiotocography for fetal assessment during labour versus intermittent auscultation (average RR 1.75, 95% CI 0.84 to 3.63; two RCTs; 13,252 children); prenatal progesterone for prevention of preterm birth versus placebo (RR 0.14, 95% CI 0.01 to 3.48; one RCT; 274 children); and betamimetics for inhibiting preterm labour versus placebo (RR 0.19, 95% CI 0.02 to 1.63; one RCT; 246 children).Very low-quality found no clear difference for the presence of cerebral palsy with any antihypertensive drug (oral beta-blockers) for treatment of mild to moderate hypertension versus placebo (RR 0.33, 95% CI 0.01 to 8.01; one RCT; 110 children); magnesium sulphate for prevention of preterm birth versus other tocolytic agents (RR 0.13, 95% CI 0.01 to 2.51; one RCT; 106 children); and vitamin K and phenobarbital prior to preterm birth for prevention of neonatal periventricular haemorrhage versus placebo (RR 0.77, 95% CI 0.33 to 1.76; one RCT; 299 children).

AUTHORS' CONCLUSIONS

This overview summarises evidence from Cochrane reviews on the effects of antenatal and intrapartum interventions on cerebral palsy, and can be used by researchers, funding bodies, policy makers, clinicians and consumers to aid decision-making and evidence translation. We recommend that readers consult the included Cochrane reviews to formally assess other benefits or harms of included interventions, including impacts on risk factors for cerebral palsy (such as the reduction in intraventricular haemorrhage for preterm babies following exposure to antenatal corticosteroids).Magnesium sulphate for women at risk of preterm birth for fetal neuroprotection can prevent cerebral palsy. Prophylactic antibiotics for women in preterm labour with intact membranes, and immediate rather than deferred birth of preterm babies with suspected fetal compromise, may increase the risk of cerebral palsy. Repeat doses compared with a single course of antenatal corticosteroids for women at risk of preterm birth do not clearly impact the risk of cerebral palsy.Cerebral palsy is rarely diagnosed at birth, has diverse risk factors and causes, and is diagnosed in approximately one in 500 children. To date, only a small proportion of Cochrane reviews assessing antenatal and intrapartum interventions have been able to report on this outcome. There is an urgent need for long-term follow-up of RCTs of interventions addressing risk factors for cerebral palsy, and consideration of the use of relatively new interim assessments (including the General Movements Assessment). Such RCTs must be rigorous in their design, and aim for consistency in cerebral palsy outcome measurement and reporting to facilitate pooling of data, to focus research efforts on prevention.

Antibiotics for neonates born through meconium-stained amniotic fluid

BACKGROUND

Approximately 1 in 10 pregnancies is affected by meconium passage at delivery, which can result in meconium aspiration syndrome (MAS). MAS can cause respiratory complications and, very rarely, death. Antibiotics have been prescribed for neonates exposed to meconium in amniotic fluid, with the intention of preventing infection due to potential bacterial contaminants.

OBJECTIVES

We conducted this review to assess the efficacy and safety of antibiotics for:1. prevention of infection, morbidity, and mortality among infants born through meconium-stained amniotic fluid (MSAF) who are asymptomatic at birth; and2. prevention of infection, morbidity, and mortality among infants born through MSAF who have signs and symptoms compatible with meconium aspiration syndrome (MAS).

SEARCH METHODS

We performed a literature search using the following databases: MEDLINE (1966 to July 2016); Embase (1980 to July 2016); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to July 2016); and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 7) in the Cochrane Library. We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials that compared antibiotics administered via any route versus placebo or no treatment for prevention of infection among neonates exposed to MSAF, or who developed MAS. We excluded cohort, case control, and any other non-randomised studies and applied no language restrictions. We included studies of term and preterm infants, and we included studies examining use of any antibacterial antibiotics. We included studies that reported on any outcomes of interest.

DATA COLLECTION AND ANALYSIS

We assessed the methodological quality of included trials by reviewing information provided in study reports and obtained by personal communication with study authors. We extracted data on relevant outcomes, estimated effect size, and reported values as risk ratios (RRs), risk differences (RDs), and mean differences (MDs), as appropriate. We conducted subgroup analyses for treatment of MAS and for prophylaxis (asymptomatic neonates exposed to meconium).

MAIN RESULTS

Four randomised controlled studies including a total of 695 participants were eligible for inclusion. Three studies evaluated neonates with MAS, and one study assessed asymptomatic neonates exposed to meconium in amniotic fluid. These studies exhibited varying degrees of methodological rigour: Two studies were at low risk of bias, and two were at unclear risk. We graded evidence derived from these studies as low quality. We downgraded overall evidence owing to the large number of participants lost to follow-up in one trial, the small sample sizes of all trials, and unclear methodological details provided for two trials.The primary outcome was risk of early- and late-onset neonatal sepsis. Antibiotics did not decrease the risk of sepsis in neonates with a diagnosis of MAS (RR 1.54, 95% confidence interval (CI) 0.27 to 8.96; RD 0.00, 95% CI -0.02 to 0.03; 445 participants, three studies; I² = 0%) nor in asymptomatic neonates exposed to meconium in amniotic fluid (RR 0.76, 95% CI 0.25 to 2.34; RD -0.01, 95% CI -0.07 to 0.04; 250 participants, one study; I² = 0%). Results show no significant differences in mortality or duration of stay in hospital between groups given antibiotics and control groups of symptomatic and asymptomatic neonates. One study in asymptomatic neonates reported a significant reduction in duration of mechanical ventilation for the control group compared with the antibiotic group (MD 0.26, 95% CI 0.15 to 0.37; 250 participants, one study; I² = 0%).

AUTHORS' CONCLUSIONS

Upon review of available evidence, we found no differences in infection rates following antibiotic treatment among neonates born through meconium-stained fluid and those with meconium aspiration syndrome. The overall quality of evidence is low owing to the small number of included studies. Well-controlled studies of adequate power are needed.

Current Concepts in the Management of Meconium Aspiration Syndrome

In developing countries, meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among neonates. The concepts of pathophysiology and management of meconium stained amniotic fluid (MSAF) and meconium aspiration syndrome have undergone tremendous change in recent years. Routine intranatal and postnatal endotracheal suctioning of meconium in vigorous infants is no longer recommended. Recent studies have challenged its role even in non-vigorous infants. Supportive therapy like oxygen supplementation, mechanical ventilation and intravenous fluids are the cornerstone in the management of meconium aspiration syndrome. Availability of surfactant, inhaled nitric oxide, high frequency ventilators and extracorporeal membrane oxygenation has made it possible to salvage more infants with meconium aspiration syndrome. In this review the authors have discussed the current concepts in the pathophysiology and management of MAS. Drugs in trials and future therapeutic targets are also discussed briefly.

Meconium Amniotic Fluid is Associated with Endomyometritis

PURPOSE

This study aimed to determine whether MSAF is associated with endometritis after delivery.

METHODS

This cohort study was conducted from 2012 to 2013 in Kosar Hospital of Qazvin, Iran. All women with cesarean delivery (1239 women) beyond 37 weeks of gestational age participated in the study. Data were collected on rates of endomyometritis, quality of amniotic fluid and were analyzed with bivariate and multivariate statistics. Probability values of <.05 were considered statistically significant.

RESULTS

We found that among 1239 women with cesarean delivery at term 2.34 % were diagnosed with endometritis. Compared with deliveries with clear amniotic fluid, those with MSAF had higher rates of endomyometritis (1.5 vs 3.2 %, P < .04).

CONCLUSION

We found that the presence of MSAF is associated with puerperal infection even when being controlled for confounders.