Meconium: a marker for peripartum infection.
OBJECTIVE
To test the hypothesis that the presence of meconium-stained amniotic fluid (AF) is associated with maternal and neonatal infection, both before and after delivery.


METHODS
Nine hundred thirty-six laboring women were analyzed for the presence of meconium in amniotic fluid and occurrence of peripartum infection. Meconium was assessed clinically as thin, moderate, or thick. Intra-amniotic infection and endometritis were diagnosed by standard definitions. All patients were tested for vaginal group B streptococcus, bacterial vaginosis, and other aerobic organisms.


RESULTS
Meconium-stained AF was present in 28% of the study participants (9% thin, 12% moderate, 7% thick). The presence of meconium was associated with increased intra-amniotic fluid (17% versus 9%, relative risk [RRI 1.98, 95% confidence interval [CI] 1.3, 3.1), endometritis (10% versus 5%, RR 2.38, 95% CI 1.3, 4.4), and total infection (25% versus 13%, RR 2.19, 95% CI 1.5, 3.2). Thick meconium had higher infection rates than clear AF (44% versus 13%, RR 5.18, 95% CI 2.9, 9.3). Meconium was associated independently with peripartum infection by multiple logistic regression (RR 1.28, 95% CI 1.1, 1.6).


CONCLUSIONS
Meconium-stained AF is associated with increased peripartum infection, independent of other risk factors for infection. Thick meconium, in particular, is associated with a marked increase in peripartum infectious morbidity.
Piper
J M
JM
Department of Obstetrics and Gynecology, The University of Texas Health Science Center at San Antonio 78284-7836, USA.
Newton
E R
ER
Berkus
M D
MD
Peairs
W A
WA
D000328:Adult; D000650:Amnion; D000653:Amniotic Fluid; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis; D004716:Endometritis / Q000175:diagnosis; D005260:Female; D006801:Humans; D008470:Meconium; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D014621:Vagina / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000175:diagnosis