| Objective:A retrospective controlled study was conducted to analyze the effects of amniotic fluid meconium contamination on the pregnancy outcomes of mothers and infants during vaginal delivery,and to summarize the related risk factors for adverse pregnancy outcomes.Methods:A total of 35,088 pregnant women with complete clinical data who received regular obstetric examination and hospitalized delivery in Fujian Maternal and Child Health Hospital from September 2013 to December 2018 were selected as the research subjects According to the post-amniotic fluid characters,the patients were divided into two groups: meconium contamination(MSAF)group(8,060 cases)and normal amniotic fluid character(27,028 cases)as control group(MSAF).According to the degree of fecal contamination in amniotic fluid,the meconium contamination group was further divided into two subgroups: meconium staining(MSL)significant group(2,882cases)and MSL insignificant group(5,178 cases).Clinical data of pregnant women and puerperas in each group were collected and analyzed retrospectively :(1)general clinical data: gestational age at birth;(2)Pregnancy complications: gestational hypertension disease,premature rupture of membranes,gestational diabetes mellitus,gestational intrahepatic cholestasis syndrome;(3)Maternal pregnancy outcome: vaginal delivery with postpartum hemorrhage and long hospital stay for chorioamnionitis;(4)Perinatal outcome: Apgar score at birth,neonatal asphyxia,high bilirubinemia,birth weight,NICU hospitalization rate,septicemia,hypoxic ischemic encephalopathy,meconium inhalation syndrome,neonatal pneumonia.Results:1.Comparison of general information(1)Compared with the control group,the average gestational age of the MSAF group was larger,and the proportion of primiparas was more,and the difference was statistically significant((P<0.05))there was no significant difference in the age of pregnant women between the two groups(P>0.05)The data of the two subgroups of significant and insignificant MSL group showed that the number of primiparas in the significant MSL group was more than that in the insignificant MSL group,the difference was statistically significant P<0.05);There was no significant difference in the age and gestational age of pregnant women between the two subgroups(P>0.05).(2)Comparison of length of labor: No matter the number of labor,the length of the first stage of labor,the second stage of labor and the total length of labor in the MSAF group were all longer than those in the control group,and the differences were statistically significant(P<0.05))and the first stage of labor,the second stage of labor and the total length of labor in the significant MSL group were greater than those in the insignificant MSL group,and the differences were statistically significant(P<0.05).2.Comparison of complications during pregnancyUnivariate analysis showed that the incidence of premature rupture of membranes in the MSAF group was lower than that in the control group,and the difference was statistically significant(P<0.05);The incidence of overdue pregnancy,delayed pregnancy and intrahepatic cholestasis during pregnancy in MSAF group was higher than that in control group,and the difference was statistically significant(P<0.05);There was no significant difference in the incidence of hypertensive diseases during pregnancy between the MSAF group and the control group(P>0.05).3.Comparison of maternal pregnancy outcomes(1)The incidence of forcep-assisted perineotomy in the MSAF group was higher than that in the control group,and the difference was statistically significant(P<0.05)Further subgroup analysis showed that the incidence of forceps-assisted perisiotomy in chorioamnitis in the significant MSL group was higher than that in the non-significant MSL group,and the difference was statistically significant(P<0.05),but there was no statistically significant difference in the rate of severe postpartum hemorrhage and length of hospital stay between the two subgroups(P>0.05).(2)The postpartum hemorrhage was further compared between the two groups:(1)The incidence of PPH in the MSAF group was 3.62%(292/8060),significantly higher than that in the control group(2.72%(736/27028))(p <0.001),is a risk factor for PPH,OR: 1.34(95%CI: 1.16-1.51).The OR value of MSAF to PPH and SPPH was1.26(95%CI: 1.08～1.44)and 1.87(95%CI:1.32～2.48),respectively,and the OR value of MSAF to PPH was 1.69(95%CI: 1.40 ～ 1.94)in neonatal women.(2)The relationship between the duration of labor and postpartum blood loss was analyzed.In general,the average postpartum blood loss increased with the duration of labor,and the total length of labor in MSAF group was >18h postpartum blood loss increased significantly.(3)According to the blood loss at different postpartum time periods,the total blood loss at 30 min postpartum and 120 min postpartum in the MSAF group was higher than that in the control group,and the differences were statistically significant(P<0.05)4.Comparison of neonatal outcomes(1)The incidence of hyperbilirubinemia,NICU hospitalization rate,MAS,neonatal pneumonia,HIE and sepsis in MSAF group were higher than those in control group,and the differences were statistically significant(P<0.05),there were no significant differences in Apgar score at birth and neonatal asphyxia rate between the two groups(P > 0.05).(2)The incidence of hyperbilirubinemia,NICU hospitalization,MAS,HIE and septicemia in the significant MSL group were higher than those in the non-significant MSL group,and the differences were statistically significant(P<0.05),there were no significant differences in Apgar score at birth and neonatal asphyxia rate between the two groups(P > 0.05).Conclusions:1.Pregnant women with late pregnancy,delayed pregnancy,and intrahepatic cholestasis during pregnancy are at increased risk of developing MSAF during vaginal delivery.2.MSAF increases the occurrence of maternal adverse pregnancy outcomes,and is a risk factor for PPH OR:OR:1.34(95%CI:1.16-1.51).MSAF has a more obvious effect on primiparas,which may be related to the prolonged labor process of primiparas.MSAF should pay attention to control the length of labor process during vaginal delivery,especially when the total labor process is> 18 hours,active prevention of PPH should be paid attention to.3.There was no significant correlation between MSAF and neonatal asphyxia,but the incidence of high bilirubinemia,NICU hospitalization rate,meconium inhalation syndrome(MAS),neonatal pneumonia,neonatal hypoxic ischemic encephalopathy(HIE),and the incidence of septicemia was significantly increased,and the risk was positively correlated with the degree of MSLNeonates with MSAF need to strengthen monitoring for early prevention and treatment of complications. |
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