[Meconium and its significance].
OBJECTIVE
A review of meconium patophysiology and its contribution to the incidence of perinatal infection.


METHODS
Review article.


METHODS
Department of Gynaecology and Obstetrics, Charles University and Faculty Hospital Plzen, Czech Republic.


METHODS
The reported incidence of meconium-stained amniotic fluid varies between 7 and 22%. The patophysiology of the presence of meconium in the amniotic fluid is not sufficiently explained. Meconium in fetal bowels is under hormonal and neurol control. The presence of the meconium-stained amniotic fluid was always considered to be a potential risk for the fetal and neonatal well-being. The review is further divided in to three chapters. (II. Meconium and meconium aspiration syndrome, III. Meconium and postnatal neurological handicap).


CONCLUSIONS
The first chapter on deals with meconium risk in the development of perinatal infection: intraamniotic infection/chorioamnionitis, postnatal endometritis, infection of the abdominal wound after Caesarean and neonatal infection. The incidence of clinical chorioamnionitis is 15% with the presence of meconium compared to 3% in controls. The incidence of puerperal endometritis is 10% in comparison to 3% under normal conditions. Two main mechanisms of development (or coincidence) of intraamniotic infection in the presence of meconium exist. 1) Infection may be a cause of meconium passage. 2A) Alteration of Zn/P ratio in the amniotic fluid can promote bacterial growth. 2B) Meconium attached to macrophages or absorbed by phagocytosis can impair cellular immune response. The antibiotic prophylaxis is discussed.
Gynek.-porod. klinika LF UK a FN Plzen. kalis@cmail.cz
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Kalis
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Turek
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Hudec
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Rokyta
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Rokyta
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Mejchar
D000653:Amniotic Fluid / Q000737:chemistry; D002585:Cesarean Section; D002821:Chorioamnionitis / Q000209:etiology; D004716:Endometritis / Q000209:etiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology; D008470:Meconium / Q000502:physiology; D011247:Pregnancy; D011645:Puerperal Infection / Q000209:etiology; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology