Acid-base significance of meconium discovered prior to labor

Susan M. Ramin, Larry C. Gilstrap, Kenneth J. Leveno, Jody S. Dax, Bertis B. Little

Research output: Contribution to journalArticle

Abstract

It has been postulated that meconium is a sign of fetal hypoxia and acidosis. Previous work in this field has been limited. First, previous reports have included only patients with the intrapartum passage of meconium; second, birth asphyxia has been inadequately defined, with reliance only on Apgar scores. There is little information regarding the significance of meconium passage discovered before labor. This paper reports on 40 pregnancies with meconium passage diagnosed before labor. Thirty-three gestations had the diagnosis made at the time of elective repeat cesarean delivery. Seven pregnancies had the diagnosis made at the time of amniocentesis for lung maturity. The seven pregnancies with meconium diagnosed at amniocentesis were promptly delivered by cesarean because of the meconium. Forty uncomplicated pregnancies with clear amniotic fluid at elective cesarean delivery were selected as controls. The umbilicial artery was sampled and an acid-base analysis was performed. Using an umbilical blood artery blood pH cutoff of 7.19 to define acidemia, there were twice as many neonates in the meconium group with respiratory acidemia. This difference did not reach statistical significance. Most importantly, there was not a single infant with metabolic acidemia in either group. All infants had uncomplicated hospital courses. No infant had the meconium aspiration syndrome (Table 1). The authors are reassured by their finding that no neonate had metabolic acidemia and that all had uncomplicated hospital courses. They conclude that meconium discovered before labor is not necessarily a marker of immediate or chronic fetal compromise. Because all gestations were promptly delivered upon the diagnosis of meconium passage, the authors warn against assuming that nonintervention is appropriate when meconium is diagnosed in the antepartum period.

Original languageEnglish (US)
Pages (from-to)599-600
Number of pages2
JournalObstetrical and Gynecological Survey
Volume48
Issue number9
StatePublished - 1993

Fingerprint

Meconium
Acids
Pregnancy
Amniocentesis
Meconium Aspiration Syndrome
Newborn Infant
Fetal Hypoxia
Umbilical Arteries
Apgar Score
Asphyxia
Amniotic Fluid
Acidosis
Arteries
Parturition

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Ramin, S. M., Gilstrap, L. C., Leveno, K. J., Dax, J. S., & Little, B. B. (1993). Acid-base significance of meconium discovered prior to labor. Obstetrical and Gynecological Survey, 48(9), 599-600.

Acid-base significance of meconium discovered prior to labor. / Ramin, Susan M.; Gilstrap, Larry C.; Leveno, Kenneth J.; Dax, Jody S.; Little, Bertis B.

In: Obstetrical and Gynecological Survey, Vol. 48, No. 9, 1993, p. 599-600.

Research output: Contribution to journalArticle

Ramin, SM, Gilstrap, LC, Leveno, KJ, Dax, JS & Little, BB 1993, 'Acid-base significance of meconium discovered prior to labor', Obstetrical and Gynecological Survey, vol. 48, no. 9, pp. 599-600.
Ramin, Susan M. ; Gilstrap, Larry C. ; Leveno, Kenneth J. ; Dax, Jody S. ; Little, Bertis B. / Acid-base significance of meconium discovered prior to labor. In: Obstetrical and Gynecological Survey. 1993 ; Vol. 48, No. 9. pp. 599-600.
@article{b05d0f1e063b41f0a109a6869e6c3d96,
title = "Acid-base significance of meconium discovered prior to labor",
abstract = "It has been postulated that meconium is a sign of fetal hypoxia and acidosis. Previous work in this field has been limited. First, previous reports have included only patients with the intrapartum passage of meconium; second, birth asphyxia has been inadequately defined, with reliance only on Apgar scores. There is little information regarding the significance of meconium passage discovered before labor. This paper reports on 40 pregnancies with meconium passage diagnosed before labor. Thirty-three gestations had the diagnosis made at the time of elective repeat cesarean delivery. Seven pregnancies had the diagnosis made at the time of amniocentesis for lung maturity. The seven pregnancies with meconium diagnosed at amniocentesis were promptly delivered by cesarean because of the meconium. Forty uncomplicated pregnancies with clear amniotic fluid at elective cesarean delivery were selected as controls. The umbilicial artery was sampled and an acid-base analysis was performed. Using an umbilical blood artery blood pH cutoff of 7.19 to define acidemia, there were twice as many neonates in the meconium group with respiratory acidemia. This difference did not reach statistical significance. Most importantly, there was not a single infant with metabolic acidemia in either group. All infants had uncomplicated hospital courses. No infant had the meconium aspiration syndrome (Table 1). The authors are reassured by their finding that no neonate had metabolic acidemia and that all had uncomplicated hospital courses. They conclude that meconium discovered before labor is not necessarily a marker of immediate or chronic fetal compromise. Because all gestations were promptly delivered upon the diagnosis of meconium passage, the authors warn against assuming that nonintervention is appropriate when meconium is diagnosed in the antepartum period.",
author = "Ramin, {Susan M.} and Gilstrap, {Larry C.} and Leveno, {Kenneth J.} and Dax, {Jody S.} and Little, {Bertis B.}",
year = "1993",
language = "English (US)",
volume = "48",
pages = "599--600",
journal = "Obstetrical and Gynecological Survey",
issn = "0029-7828",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Acid-base significance of meconium discovered prior to labor

AU - Ramin, Susan M.

AU - Gilstrap, Larry C.

AU - Leveno, Kenneth J.

AU - Dax, Jody S.

AU - Little, Bertis B.

PY - 1993

Y1 - 1993

N2 - It has been postulated that meconium is a sign of fetal hypoxia and acidosis. Previous work in this field has been limited. First, previous reports have included only patients with the intrapartum passage of meconium; second, birth asphyxia has been inadequately defined, with reliance only on Apgar scores. There is little information regarding the significance of meconium passage discovered before labor. This paper reports on 40 pregnancies with meconium passage diagnosed before labor. Thirty-three gestations had the diagnosis made at the time of elective repeat cesarean delivery. Seven pregnancies had the diagnosis made at the time of amniocentesis for lung maturity. The seven pregnancies with meconium diagnosed at amniocentesis were promptly delivered by cesarean because of the meconium. Forty uncomplicated pregnancies with clear amniotic fluid at elective cesarean delivery were selected as controls. The umbilicial artery was sampled and an acid-base analysis was performed. Using an umbilical blood artery blood pH cutoff of 7.19 to define acidemia, there were twice as many neonates in the meconium group with respiratory acidemia. This difference did not reach statistical significance. Most importantly, there was not a single infant with metabolic acidemia in either group. All infants had uncomplicated hospital courses. No infant had the meconium aspiration syndrome (Table 1). The authors are reassured by their finding that no neonate had metabolic acidemia and that all had uncomplicated hospital courses. They conclude that meconium discovered before labor is not necessarily a marker of immediate or chronic fetal compromise. Because all gestations were promptly delivered upon the diagnosis of meconium passage, the authors warn against assuming that nonintervention is appropriate when meconium is diagnosed in the antepartum period.

AB - It has been postulated that meconium is a sign of fetal hypoxia and acidosis. Previous work in this field has been limited. First, previous reports have included only patients with the intrapartum passage of meconium; second, birth asphyxia has been inadequately defined, with reliance only on Apgar scores. There is little information regarding the significance of meconium passage discovered before labor. This paper reports on 40 pregnancies with meconium passage diagnosed before labor. Thirty-three gestations had the diagnosis made at the time of elective repeat cesarean delivery. Seven pregnancies had the diagnosis made at the time of amniocentesis for lung maturity. The seven pregnancies with meconium diagnosed at amniocentesis were promptly delivered by cesarean because of the meconium. Forty uncomplicated pregnancies with clear amniotic fluid at elective cesarean delivery were selected as controls. The umbilicial artery was sampled and an acid-base analysis was performed. Using an umbilical blood artery blood pH cutoff of 7.19 to define acidemia, there were twice as many neonates in the meconium group with respiratory acidemia. This difference did not reach statistical significance. Most importantly, there was not a single infant with metabolic acidemia in either group. All infants had uncomplicated hospital courses. No infant had the meconium aspiration syndrome (Table 1). The authors are reassured by their finding that no neonate had metabolic acidemia and that all had uncomplicated hospital courses. They conclude that meconium discovered before labor is not necessarily a marker of immediate or chronic fetal compromise. Because all gestations were promptly delivered upon the diagnosis of meconium passage, the authors warn against assuming that nonintervention is appropriate when meconium is diagnosed in the antepartum period.

UR - http://www.scopus.com/inward/record.url?scp=84936615995&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84936615995&partnerID=8YFLogxK

M3 - Article

VL - 48

SP - 599

EP - 600

JO - Obstetrical and Gynecological Survey

JF - Obstetrical and Gynecological Survey

SN - 0029-7828

IS - 9

ER -