Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Amniotic fluid transitioning from clear to meconium stained during labor—prevalence and association with adverse maternal and neonatal outcomes

Journal of Perinatology volume 39, pages 1349–1355 (2019)Cite this article

Subjects

Abstract

Objective

The objective of this study is to compare pregnancy outcomes in deliveries complicated by primary meconium-stained amniotic fluid (MSAF, present at membrane rupture) and secondary MSAF (transitioned from clear to MSAF during labor).

Methods

The medical records and neonatal charts of all deliveries ≥ 370/7 weeks between October 2008 and July 2018 were reviewed. The primary outcome was composite adverse neonatal outcome that included early neonatal complications.

Results

Of 30,215 deliveries during the study period, 4302 (14.2 %) were included: 3845 (89.4%) in the primary MSAF group and 457 (10.6%) in the secondary MSAF group. The rate of the primary outcome was higher in the secondary MSAF group (p = 0.006). This association remained significant after controlling for background confounders. The secondary MSAF group had higher rate of cesarean deliveries (CDs) and assisted vaginal deliveries. There was a higher rate of composite adverse neonatal outcome when secondary MSAF was diagnosed < 3 vs. >3 h before delivery (p = 0.004).

Conclusion

Secondary MSAF was associated with higher rates of adverse neonatal outcome, CDs, and assisted vaginal deliveries, compared with primary MSAF.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Whitfield JM, Charsha DS, Chiruvolu A. Prevention of meconium aspiration syndrome: an update and the Baylor experience. Proc (Bayl Univ Med Cent). 2009;22:128–31. https://doi.org/10.1080/08998280.2009.11928491

    Article  Google Scholar 

  2. David AN, Njokanma OF, Iroha E. Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hospital. J Obstet Gynaecol (Lahore). 2006;26:518–20. https://doi.org/10.1080/01443610600797426

    Article  CAS  Google Scholar 

  3. Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol. 2011;117:828–35. https://doi.org/10.1097/AOG.0b013e3182117a26

    Article  Google Scholar 

  4. Addisu D, Asres A, Gedefaw G, Asmer S. 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. BMC Pregnancy Childbirth. 2018;18:429. https://doi.org/10.1186/s12884-018-2056-y

  5. Hiersch L, Krispin E, Aviram A, Wiznitzer A, Yogev Y, Ashwal E. Effect of meconium-stained amniotic fluid on perinatal complications in low-risk pregnancies at term. Am J Perinatol. 2016;33:378–84. https://doi.org/10.1055/s-0035-1565989

    Article  Google Scholar 

  6. Ziadeh SM, Sunna E. Obstetric and perinatal outcome of pregnancies with term labour and meconium-stained amniotic fluid. Arch Gynecol Obstet. 2000;264:84–7. https://doi.org/10.1007/s004040000088

    Article  CAS  Google Scholar 

  7. Maymon E, Chaim W, Furman B, Ghezzi F, Shoham Vardi I, Mazor M. Meconium stained amniotic fluid in very low risk pregnancies at term gestation. Eur J Obstet Gynecol Reprod Biol 1998. https://doi.org/10.1016/S0301-2115(98)00122-5

    Article  PubMed  Google Scholar 

  8. American College of Obstetricians and Gynecologists Women’s Health Care Physicians (ACOG). ACOG Practice Bulletin No. 138. Inherited thrombophilias in pregnancy. Obstet Gynecol. 2013;122:706–17. https://doi.org/10.1097/01.AOG.0000433981.36184.4e

  9. Committee on Practice Bulletins—Obstetrics, American College of Obstetricians and Gynecologists. Practice Bulletin No. 132: Antiphospholipid syndrome. Obstet Gynecol. 2012;120:1514–21. https://doi.org/10.1097/01.AOG.0000423816.39542.0f

  10. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 101: Ultrasonography in pregnancy. Obstet Gynecol. 2009;113:451–61. https://doi.org/10.1097/AOG.0b013e31819930b0

  11. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classificatin of diabetes mellitus. Diabetes Care. 2002;26:S5–20. https://doi.org/10.2337/diacare.25.2007.S5

  12. American College of Obstetricians and Gynecologists, Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122:1122–31. https://doi.org/10.1097/01.AOG.0000437382.03963.88

  13. Kehl S, Schelkle A, Thomas A, Puhl A, Meqdad K, Tuschy B, et al. Single deepest vertical pocket or amniotic fluid index as evaluation test for predicting adverse pregnancy outcome (SAFE trial): a multicenter, open-label, randomized controlled trial. Ultrasound Obstet Gynecol. 2016;47:674–9. https://doi.org/10.1002/uog.14924

    Article  CAS  Google Scholar 

  14. Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES. Birthweight standards in the live-born population in Israel. Isr Med Assoc J. 2005;7:311–4. https://doi.org/10.3389/fped.2015.00063

  15. Tita ATN, Andrews WW. Diagnosis and management of clinical chorioamnionitis. Clin Perinatol. 2010;37:339–54. https://doi.org/10.1016/j.clp.2010.02.003

    Article  Google Scholar 

  16. Ciftci AO, Tanyel FC, Ercan MT, Karnak I, Büyükpamukçu N, Hiçsönmez A. In utero defecation by the normal fetus: a radionuclide study in the rabbit. J Pediatr Surg. 1996;31:1409–12. https://doi.org/10.1016/S0022-3468(96)90841-6

    Article  CAS  Google Scholar 

  17. Meis PJ, Hall M, Marshall JR, Hobel CJ. Meconium passage: A new classification for risk assessment during labor. Am J Obstet Gynecol. 1978;131:509–13. https://doi.org/10.1016/0002-9378(78)90111-4

    Article  CAS  Google Scholar 

  18. Hiersch L, Melamed N, Rosen H, Peled Y, Wiznitzer A, Yogev Y. New onset of meconium during labor versus primary meconium-stained amniotic fluid - Is there a difference in pregnancy outcome? J Matern Neonatal Med. 2014;27:1361–7. https://doi.org/10.3109/14767058.2013.858320

    Article  Google Scholar 

  19. Locatelli A, Regalia AL, Patregnani C, Ratti M, Toso L, Ghidini A. Prognostic value of change in amniotic fluid color during labor. Fetal Diagn Ther. 2005:20:5–9. https://doi.org/10.1159/000081359

    Article  Google Scholar 

  20. Meis PJ, Hobel CJ, Ureda JR. Late meconium passage in labor - A sign of fetal distress? Obstet Gynecol. 1982;59:332–5.

  21. Gluck O, Kovo M, Tairy D, Barda G, Bar J, Weiner E. Bloody amniotic fluid during labor – prevalence, and association with placental abruption, neonatal morbidity, and adverse pregnancy outcomes. Eur J Obstet Gynecol Reprod Biol 2019;234(October 2008):103–7. https://doi.org/10.1016/j.ejogrb.2019.01.011

    Article  PubMed  Google Scholar 

  22. Weiner E, Schreiber L, Grinstein E, Feldstein O, Rymer-Haskel N, Bar J, et al. The placental component and obstetric outcome in severe preeclampsia with and without HELLP syndrome. Placenta. 2016;47:99–104. https://doi.org/10.1016/j.placenta.2016.09.012

    Article  Google Scholar 

  23. Weiner E, Miremberg H, Grinstein E, Mizrachi Y, Schreiber L, Bar J, et al. The effect of placenta previa on fetal growth and pregnancy outcome, in correlation with placental pathology. J Perinatol. 2016;36:1073–78. https://doi.org/10.1038/jp.2016.140

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Meir Azran, Computing and Information Systems, E. Wolfson Medical Center, Holon, Israel, and Ela Smirin, archive, E. Wolfson Medical Center, Holon, Israel.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Daniel Tairy, Ohad Gluck, Ori Tal, Jacob Bar, Zvia Hiaev, Michal Kovo & Eran Weiner

  2. Department of Neonatal Intensive Care, the Edith Wolfson Medical Center, Holon, Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Neri Katz

Authors
  1. Daniel Tairy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ohad Gluck
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ori Tal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jacob Bar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Neri Katz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zvia Hiaev
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michal Kovo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eran Weiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eran Weiner.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tairy, D., Gluck, O., Tal, O. et al. Amniotic fluid transitioning from clear to meconium stained during labor—prevalence and association with adverse maternal and neonatal outcomes. J Perinatol 39, 1349–1355 (2019). https://doi.org/10.1038/s41372-019-0436-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41372-019-0436-4

This article is cited by

Search

Advanced search

Quick links