Intrapartum amnioinfusion reduces meconium aspiration syndrome and improves neonatal outcomes in patients with meconium-stained fluid: a systematic review and meta-analysis

Intrauterine fetal resuscitation: from maternal repositioning to the latest pharmacological strategies

Intrauterine resuscitation includes different interventions which aim to improve fetal oxygenation when intrapartum fetal hypoxic stress leading to abnormal CTG features is suspected. Based on the etiology of the hypoxic stress, prompt institution of specific conservative measures, aiming to restore fetal oxygenation and normalize the features of the CTG trace, may reduce the incidence of unnecessary operative deliveries. However, there is paucity of evidence supporting the effectiveness of intrauterine resuscitation measures: based on available data, routine administration of fluid boluses is not recommended and should be limited only to volume-depleted patients, in which intravenous hydration has been associated with potential benefits. Similarly, amnioinfusion and maternal oxygen administration cannot be recommended as previous studies on their efficacy reported conflicting results, and some have suggested that these measures may be potentially harmful. On the other hand, changing maternal position seems to be a potentially useful maneuver with no side effects in cases of supine hypotension syndrome or in cases of suspected sustained umbilical cord compression. Administration of tocolytics for ongoing excessive uterine activity is associated with fetal heart rate improvement; within the most used tocolytic drugs, terbutaline (a beta-agonist) is often recommended as the first-choice agent to be administered for intrapartum acute tocolysis due to its efficacy, ease of administration and side effect profile.

The Yield of Amnioinfusion in the Prevention of Postpartum Hemorrhage

Although amnioinfusion decreases the rate of uterine atony, its effect on postpartum hemorrhage (PPH) is uncertain. This study aimed to assess whether amnioinfusion reduces the risk of PPH in laboring individuals.A retrospective study of all laboring singletons at a tertiary center between January 2013 and December 2022 at ≥34 weeks. Individuals with known major fetal anomalies, stillbirths, or missing delivery records were excluded. The primary outcome was PPH. Neonatal and secondary maternal outcomes were also explored. Adjusted odds ratios (aOR) were estimated using multivariable regression models.Out of 113,816 deliveries during the study period, 83,152 (77.1%) met inclusion criteria, and among them 4,597 (4.03%) had amnioinfusion. Laboring individuals with amnioinfusion were more commonly nulliparous, had more polyhydramnios, oligohydramnios, preeclampsia, gestational diabetes, and fetal growth restriction. Furthermore, individuals with amnioinfusion had a higher rate of labor induction (54.54 vs. 27.8%; p < 0.01) and a higher cesarean rate (36.9 vs. 9.5%; p < 0.01). Following multivariable regression, there was no significant difference in the rate of PPH among individuals who had an amnioinfusion (2.6%) versus those who did not (3.1%; aOR: 0.95, 95% confidence interval [CI]: 0.87, 1.27). The rates of endometritis (aOR: 1.4; 95% CI: 1.04-1.89) and postpartum fever (aOR: 1.70; 95% CI: 1.36-2.12) were higher in those who had amnioinfusion compared with those that did not.Among laboring individuals ≥ 34 weeks, intrapartum amnioinfusion was not associated with a reduction in the rate of PPH and was associated with a higher likelihood of infectious morbidity. · PPH stands as the foremost contributor to maternal mortality.. · There is limited information regarding the yield of amnioinfusion in the reduction of PPH.. · We evaluate whether amnioinfusion reduces the rate of PPH in laboring individuals ≥ 34 weeks..

Impact of meconium-stained amniotic fluid thickness on maternal infectious morbidity: a comprehensive clinical and microbiological analysis

PURPOSE

The aim of this study was to investigate the correlation between the thickness of meconium-stained amniotic fluid (MSAF) and maternal infectious morbidity.

METHODS

A retrospective study of 15,950 term singleton pregnancies at a tertiary hospital (2020-2024). Women were categorized into four groups based on the presence and thickness of MSAF: clear, light, intermediate, and thick. The co-primary outcomes were clinical chorioamnionitis and puerperal endometritis, defined as a composite maternal infectious morbidity. In women with intrapartum fever (IPF), chorioamniotic swabs were obtained and compared according MSAF thickness. Multivariate analysis identified predictors of a composite maternal infections and adverse neonatal outcomes.

RESULTS

Of the cohort, 13,745 had clear amniotic fluid, and 2,205 had MSAF (561 light, 1,426 intermediate, 218 thick). The incidence of maternal infections increased with MSAF thickness, with thick MSAF showing the highest rates of clinical chorioamnionitis (4.1%, p < 0.001) and endometritis (1.4%, p = 0.039). In IPF cases, thicker MSAF was associated with a higher prevalence of positive swab cultures, particularly of Enterobacteriaceae (61.9%). Group B Streptococcus (GBS) remained consistent across all MSAF groups. Multivariate analysis showed that MSAF levels were associated with increased maternal infectious morbidity (p < 0.001). Additional risk factors for maternal infections included nulliparity (p < 0.001), catheter balloon insertion (p = 0.004), prolonged ROM (p < 0.001), and cesarean delivery (p < 0.001). In contrast, only intermediate (p < 0.001) and thick MSAF (p < 0.001) correlated with adverse neonatal outcomes.

CONCLUSION

Greater severity of MSAF is associated with increased maternal infectious morbidity, especially infections related to Enterobacteriaceae. Studies about preventive measures in cases of thick MSAF are warranted.

Clinical Profile and Outcome of Neonates with Meconium Aspiration Syndrome at an Indian Tertiary Care: An Observational Study

Background

Meconium aspiration syndrome (MAS) is still a major contributor to newborn respiratory morbidity and mortality. Many centres lack advanced modalities such as high-frequency oscillatory ventilation and inhaled nitric oxide. Very few studies in developing countries have focused on its clinical profile, management, respiratory morbidity and mortality.

Objectives

The aim of this study was to determine the incidence, risk factors, complications and outcomes in neonates with MAS.

Methods

A retrospective observational study was conducted in a level III neonatal intensive care unit of an outborn tertiary referral centre in South India. Case sheets of neonates, born out of meconium-stained liquor who had respiratory distress at admission and were diagnosed as MAS, were included. The primary outcome was to study the clinical profile of neonates with MAS. The secondary outcomes were to estimate the proportion of neonates who developed complications of MAS.

Results

The incidence of MAS over a 5-year period, out of total 8,990 neonates admitted at our centre, was 161 (1.79 %). Data of 161 neonates were analysed. The neonates were admitted at a median duration of 5 h of life (interquartile range 3–14). Mean gestational age and weight were 38.7 (1.41) weeks and 2900 (530) g, respectively. Associated morbidities like shock were seen in 55 (34.1%), persistent pulmonary hypertension of newborns in 40 (24.8 %), hypoxic ischemic encephalopathy in 23 (14.2%), seizures in 16 (9.9%), pneumothorax in 8 (4.96%) and sepsis in 34 (21.1%). On logistic regression analysis, age at admission >24 h, small for gestational age (SGA) and need for resuscitation at birth were risk factors associated with severe MAS. Mortality in MAS was 7 (4.34%).

Conclusion

Need for resuscitation, SGA at birth and age at admission >24 h were associated with severe MAS. Timely referral of neonates with a risk factor for severe MAS can improve outcomes.

Impact of perinatal factors on meconium aspiration syndrome in full-term newborns and the construction of a column chart prediction model: An observational study

To explore the influence of perinatal-related factors on meconium aspiration syndrome (MAS) in full-term neonates and construct a nomogram prediction model for risk stratification of neonatal MAS and adoption of preventive measures. A total of 424 newborns and their mothers who were regularly examined at our hospital between January 2020 and December 2023 who had meconium-contaminated amniotic fluid during delivery were retrospectively selected as participants. Neonates were divided into MAS and non-MAS groups based on whether MAS occurred within 3 days after birth. Data from the 2 groups were analyzed, and factors influencing MAS were screened using multivariate logistic regression analysis. The R3.4.3 software was used to construct a nomogram prediction model for neonatal MAS risk. Receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the performance of the model, and its clinical effectiveness was evaluated using a decision curve. Among the 424 neonates with meconium-stained amniotic fluid, 51 developed MAS within 3 days of birth (12.03%). Multivariate logistic regression analysis showed that a low amniotic fluid index before delivery (OR = 2.862, P = .019), advanced gestational age (OR = 0.526, P = .034), cesarean section (OR = 2.650, P = .013), severe amniotic fluid contamination (OR = 4.199, P = .002), low umbilical cord blood pH (OR = 2.938, P = .011), and low neonatal Apgar 1-min score (OR = 3.133, P = .006) were influencing factors of MAS in full-term neonates. Based on the above indicators, a nomogram prediction model for MAS risk of full-term newborns was constructed. The area under the ROC curve of the model was 0.931. The model was also tested for goodness-of-fit deviation (χ2 = 3.465, P = .903). Decision curve analysis found that the model was clinically effective in predicting the net benefit of MAS risk in neonates with meconium-stained amniotic fluid. The construction of a column chart prediction model for neonatal MAS risk based on prenatal amniotic fluid index, gestational age, delivery method, amniotic fluid contamination level, newborn umbilical blood pH value, and Apgar 1-min score has a certain application value.

Vaginal microbiota transplantation is a truly opulent and promising edge: fully grasp its potential

Vaginal microbiota transplantation (VMT) is a cutting-edge treatment modality that has the potential to revolutionize the management of vaginal disorders. The human vagina is a complex and dynamic ecosystem home to a diverse community of microorganisms. These microorganisms play a crucial role in maintaining the health and well-being of the female reproductive system. However, when the balance of this ecosystem is disrupted, it can lead to the development of various vaginal disorders. Conventional treatments, such as antibiotics and antifungal medications, can temporarily relieve the symptoms of vaginal disorders. However, they often fail to address the underlying cause of the problem, which is the disruption of the vaginal microbiota. In recent years, VMT has emerged as a promising therapeutic approach that aims to restore the balance of the vaginal ecosystem. Several studies have demonstrated the safety and efficacy of VMT in treating bacterial vaginosis, recurrent yeast infections, and other vaginal conditions. The procedure has also shown promising results in reducing the risk of sexually transmitted infections and preterm birth in pregnant women. However, more research is needed to establish optimal donor selection, preparation, and screening protocols, as well as long-term safety and efficacy. VMT offers a safe, effective, and minimally invasive treatment option for women with persistent vaginal problems. It could improve the quality of life for millions of women worldwide and become a standard treatment option shortly. With further research and development, it could potentially treat a wide range of other health problems beyond the scope of vaginal disorders.

Parturition at term: induction, second and third stages of labor, and optimal management of life-threatening complications-hemorrhage, infection, and uterine rupture

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information.