Öz
Aim: To determine any possible relationship between fetal distress signs on electronic fetal monitoring and birth outcomes, in case of meconnium stained amniotic fluid.
Material and Method: This retrospective cohort study included 107 pregnant women at the gestational age of 35-42 weeks, who were admitted to the labor room with signs of active labor process and meconium stained amniotic fluid leakage, between June and September 2016.
Results: There were no statistically significant difference between the groups in terms of gestational week at birth, gender of baby, birth length and weight, mode of delivery, and low 5th minute APGAR score (≤5). However, low 1st minute APGAR score (≤5) values, emergency cesarean delivery and neonatal intensive care unit admission were significantly higher in the fetal distress group (p=0.037, p<0.0001, p = 0.002, respectively).
Conclusion: Active labor management and induction of labor can be implemented with closely electronic fetal monitoring in the presence of meconium. However, the presence of stress findings should be taken into account. Cases with fetal distress findings are associated with increased poor perinatal outcomes in relation to chronic stress. Moreover, to choose cesarean section as the mode of delivery did not seem to improve perinatal outcomes.
Anahtar Kelimeler
Apgar score fetal distress meconium stained amniotic fluid thick meconium perinatal outcome
Kaynakça
- 1. Tissier, H. (1900) Recherches sur la flore intestinale des nourissons (etat normal et pathologique). Paris Thèses: University of Paris School of Medicine.
- 2. Jiménez, E., Marín, M. L., Martín, R., Odriozola, J. M., Olivares, M., Xaus, J.,et al. Is meconium from healthy newborns actually sterile?. Research in microbiology.2008;159:187-193.
- 3. Rapoport, S., & Buchanan, D. J. The composition of meconium: isolation of blood-group-specific polysaccharides. Abnormal composition of meconium in meconium ileus . Science. 1950;112:150-3.
- 4.Balci, B. K., & Goynumer, G. Incidence of echogenic amniotic fluid at term pregnancy and its association with meconium. Archives of gynecology and obstetrics. 2018; 1-4.
- 5. Whitfield, J. M., Charsha, D. S., & Chiruvolu, A. Prevention of meconium aspiration syndrome: an update and the Baylor experience. In Baylor University Medical Center Proceedings. 2009; 22:128-31.
- 6. Cleary, G. M., & Wiswell, T. E.Meconium-stained amniotic fluid and the meconium aspiration syndrome: an update. Pediatric Clinics. 1998; 45:511-29.
- 7. FANAROFF, A. A. Meconium aspiration syndrome: historical aspects. Journal of Perinatology, 2008; 28:3.
- 8. Clausson, B., Cnattingius, S., & Axelsson, O.Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstetrics & Gynecology, 1999;94:758-62.
- 9. Meydanli, M. M., Dilbaz, B., Çalişkan, E., Dilbaz, S., & Haberal, A. Risk factors for meconium aspiration syndrome in infants born through thick meconium. International journal of gynecology & obstetrics. 2001;72: 9-15.
- 10.Özdemir, R., Akçay, A., Dizdar, E. A., Oğuz, Ş. S., Yurttutan, S., Yapar, E. G.,et al.Mekonyum aspirasyon sendromu sıklığı ve prognostik faktörler: tek merkez deneyimi. Çocuk Sağlığı ve Hastalıkları Dergisi. 2011;54:211-5.
- 11. Matthews, T. G., & Warshaw, J. B. Relevance of the gestational age distribution of meconium passage in utero. Pediatrics. 1979;64:30-1.
- 12. Rawat, M., Nangia, S., Chandrasekharan, P., & Lakshminrusimha, S. Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence? American journal of perinatology.2018 doi: 10.1055/s-0037-1620269. [Epub ahead of print]
- 13. Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J Clin Diagn Res 2013;7:2874–76.
- 14. Doherty, L., & Norwitz, E. R. Prolonged pregnancy: when should we intervene?. Current opinion in Obstetrics and Gynecology.2008;20: 519-27.
- 15. Singh, B. S., Clark, R. H., Powers, R. J., & Spitzer, A. R. Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. Journal of perinatology. 2009;29: 497.
- 16. Rossi EM, Philipson EH, William TG, Kalhan SC. Meconium aspiration syndrome: intrapartum and neonatal attributes. Am J Obstet Gynecol. 1989;161:1106-10.
- 17. Sienko, A., & Altshuler, G. Meconium‐Induced Umbilical Vascular Necrosis in Abortuses and Fetuses: A Histopathologic Study for Cytokines. Obstetrics & Gynecology. 1999;94: 415-20.
- 18. Ghidini, A., & Spong, C. Y. Severe meconium aspiration syndrome is not caused by aspiration of meconium. American Journal of Obstetrics & Gynecology. 2001;185: 931-38.
Öz
Amaç: Koyu mekonyum varlığında elektronik fetal
monitorizasyonda fetal sıkıntı olup olmama durumuna göre travay özellikleri ile
doğum sonuçları arasındaki ilişkiyi
değerlendirmektir.
Gereç ve Yöntem: Bu retrosprektif çalışmada, tersiyer bir merkezde
Haziran-Eylül 2016 tarihlerinde 35-42 hafta arası sancılı gebelik
endikasyonuyla doğum salonuna yatırılan ve koyu mekonyumlu amniyon sıvısı
saptanan 107 gebenin klinik özellikleri ve doğum sonuçları değerlendirildi.
Bulgular: İstatistiksel
olarak doğumun gerçekleştiği gebelik haftası, yenidoğan cinsiyet, boy ve kilo,
doğum şekilleri, düşük 5. dakika APGAR skoru(≤ 5) değerleri
açısından gruplar arasında anlamlı farklılık yoktu. Ancak düşük 1. dakika APGAR
skoru (≤ 5) değerleri, acil şartlarda sezaryen olma ve yenidoğan
yoğun bakım kabulü fetal distres grubunda anlamlı olarak daha fazlaydı(p değerleri
verilen sırası ile p=0.037, p <0.0001, p=0.002).
Sonuç: Mekonyum varlığında elektronik
fetal monitorizasyonla yakın takiple aktif travay yönetimi ve doğum indüksiyonu
denenebilir. Ancak stres bulguları varlığında dikkatli olunmalıdır. Bu olgular
kronik stresle ilişkili olarak artmış kötü perinatal sonuçlarla birliktedir.
Artmış sezaryen oranları fetal sonuçların düzelmesinde yeterli olmamıştır.
Anahtar Kelimeler
Apgar skoru fetal sıkıntı koyu mekonyum mekonyumla boyalı amnion sıvısı doğum sonuçları
Kaynakça
- 1. Tissier, H. (1900) Recherches sur la flore intestinale des nourissons (etat normal et pathologique). Paris Thèses: University of Paris School of Medicine.
- 2. Jiménez, E., Marín, M. L., Martín, R., Odriozola, J. M., Olivares, M., Xaus, J.,et al. Is meconium from healthy newborns actually sterile?. Research in microbiology.2008;159:187-193.
- 3. Rapoport, S., & Buchanan, D. J. The composition of meconium: isolation of blood-group-specific polysaccharides. Abnormal composition of meconium in meconium ileus . Science. 1950;112:150-3.
- 4.Balci, B. K., & Goynumer, G. Incidence of echogenic amniotic fluid at term pregnancy and its association with meconium. Archives of gynecology and obstetrics. 2018; 1-4.
- 5. Whitfield, J. M., Charsha, D. S., & Chiruvolu, A. Prevention of meconium aspiration syndrome: an update and the Baylor experience. In Baylor University Medical Center Proceedings. 2009; 22:128-31.
- 6. Cleary, G. M., & Wiswell, T. E.Meconium-stained amniotic fluid and the meconium aspiration syndrome: an update. Pediatric Clinics. 1998; 45:511-29.
- 7. FANAROFF, A. A. Meconium aspiration syndrome: historical aspects. Journal of Perinatology, 2008; 28:3.
- 8. Clausson, B., Cnattingius, S., & Axelsson, O.Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstetrics & Gynecology, 1999;94:758-62.
- 9. Meydanli, M. M., Dilbaz, B., Çalişkan, E., Dilbaz, S., & Haberal, A. Risk factors for meconium aspiration syndrome in infants born through thick meconium. International journal of gynecology & obstetrics. 2001;72: 9-15.
- 10.Özdemir, R., Akçay, A., Dizdar, E. A., Oğuz, Ş. S., Yurttutan, S., Yapar, E. G.,et al.Mekonyum aspirasyon sendromu sıklığı ve prognostik faktörler: tek merkez deneyimi. Çocuk Sağlığı ve Hastalıkları Dergisi. 2011;54:211-5.
- 11. Matthews, T. G., & Warshaw, J. B. Relevance of the gestational age distribution of meconium passage in utero. Pediatrics. 1979;64:30-1.
- 12. Rawat, M., Nangia, S., Chandrasekharan, P., & Lakshminrusimha, S. Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence? American journal of perinatology.2018 doi: 10.1055/s-0037-1620269. [Epub ahead of print]
- 13. Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J Clin Diagn Res 2013;7:2874–76.
- 14. Doherty, L., & Norwitz, E. R. Prolonged pregnancy: when should we intervene?. Current opinion in Obstetrics and Gynecology.2008;20: 519-27.
- 15. Singh, B. S., Clark, R. H., Powers, R. J., & Spitzer, A. R. Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. Journal of perinatology. 2009;29: 497.
- 16. Rossi EM, Philipson EH, William TG, Kalhan SC. Meconium aspiration syndrome: intrapartum and neonatal attributes. Am J Obstet Gynecol. 1989;161:1106-10.
- 17. Sienko, A., & Altshuler, G. Meconium‐Induced Umbilical Vascular Necrosis in Abortuses and Fetuses: A Histopathologic Study for Cytokines. Obstetrics & Gynecology. 1999;94: 415-20.
- 18. Ghidini, A., & Spong, C. Y. Severe meconium aspiration syndrome is not caused by aspiration of meconium. American Journal of Obstetrics & Gynecology. 2001;185: 931-38.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 10 Sayı: 3 |
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