Meconium‐stained amniotic fluid and neonatal morbidity in nulliparous patients with prolonged pregnancy

Introduction Our objective was to study the strength of the association between meconium‐stained amniotic fluid and severe morbidity among neonates of nulliparas with prolonged pregnancies. Material and methods This was a secondary analysis of the NOCETER randomized trial that took place between 200...

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Published in:Acta obstetricia et gynecologica Scandinavica 2023-08, Vol.102 (8), p.1092-1099
Main Authors: Attali, Isabelle, Korb, Diane, Azria, Elie, Lepercq, Jacques, Goffinet, François, Schmitz, Thomas
Format: Article
Language:English
Subjects:
Amniotic fluid
Feces
Morbidity
Newborn babies
nulliparas
Original
Pregnancy
prolonged pregnancy
severe neonatal morbidity
thick meconium
thin meconium
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cited_by cdi_FETCH-LOGICAL-c4499-af75a8e564d50550b38bfabbbe614cfc523a6c48cc4b35836bf9f1149aed39613
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container_title Acta obstetricia et gynecologica Scandinavica
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creator Attali, Isabelle
Korb, Diane
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description Introduction Our objective was to study the strength of the association between meconium‐stained amniotic fluid and severe morbidity among neonates of nulliparas with prolonged pregnancies. Material and methods This was a secondary analysis of the NOCETER randomized trial that took place between 2009 and 2012 in which 11 French maternity units included 1373 nulliparas at 41+0 weeks of gestation onwards with a single live fetus in cephalic presentation. This analysis excluded patients with a cesarean delivery before labor and those with bloody amniotic fluid or of unreported consistency. The principal end point was a composite criterion of severe neonatal morbidity (neonatal death, 5‐minute Apgar
doi_str_mv 10.1111/aogs.14619
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Material and methods This was a secondary analysis of the NOCETER randomized trial that took place between 2009 and 2012 in which 11 French maternity units included 1373 nulliparas at 41+0 weeks of gestation onwards with a single live fetus in cephalic presentation. This analysis excluded patients with a cesarean delivery before labor and those with bloody amniotic fluid or of unreported consistency. The principal end point was a composite criterion of severe neonatal morbidity (neonatal death, 5‐minute Apgar &lt;7, convulsions in the first 24 h, meconium aspiration syndrome, mechanical ventilation ≥24 h, or neonatal intensive care unit admission for 5 days or more). The neonatal outcomes of pregnancies with thin or thick meconium‐stained amniotic fluid were compared with those with normal amniotic fluid. The association between the consistency of the amniotic fluid and neonatal morbidity was tested by univariate and then multivariate analysis adjusted for gestational age at birth, duration of labor, and country of birth. Results This study included 1274 patients: 803 (63%) in the group with normal amniotic fluid, 196 (15.4%) in the thin amniotic fluid group, and 275 (21.6%) in the thick amniotic fluid group. The neonates of patients with thick amniotic fluid had higher rates of neonatal morbidity than those of patients with normal amniotic fluid (7.3% vs. 2.2%; p &lt; 0.001; adjusted relative risk [aRR] 3.3, 95% confidence interval [CI] 1.7–6.3), but those of patients with thin amniotic fluid did not (3.1% vs. 2.2%; p = 0.50; aRR 1.0, 95% CI, 0.4–2.7). Conclusions Among nulliparas at 41+0 weeks onwards, only thick meconium‐stained amniotic fluid is associated with a higher rate of severe neonatal morbidity. Among nulliparas at 41+0 weeks onwards, only thick meconium‐stained amniotic fluid is associated with a higher rate of severe neonatal morbidity.</description><identifier>ISSN: 0001-6349</identifier><identifier>EISSN: 1600-0412</identifier><identifier>DOI: 10.1111/aogs.14619</identifier><identifier>PMID: 37377254</identifier><language>eng</language><publisher>United States: John Wiley &amp; Sons, Inc</publisher><subject>Amniotic fluid ; Feces ; Morbidity ; Newborn babies ; nulliparas ; Original ; Pregnancy ; prolonged pregnancy ; severe neonatal morbidity ; thick meconium ; thin meconium</subject><ispartof>Acta obstetricia et gynecologica Scandinavica, 2023-08, Vol.102 (8), p.1092-1099</ispartof><rights>2023 The Authors. published by John Wiley &amp; Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).</rights><rights>2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley &amp; Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4499-af75a8e564d50550b38bfabbbe614cfc523a6c48cc4b35836bf9f1149aed39613</citedby><cites>FETCH-LOGICAL-c4499-af75a8e564d50550b38bfabbbe614cfc523a6c48cc4b35836bf9f1149aed39613</cites><orcidid>0000-0002-0574-3749 ; 0000-0002-3074-8269</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10377997/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10377997/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,11562,27924,27925,46052,46476,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37377254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Attali, Isabelle</creatorcontrib><creatorcontrib>Korb, Diane</creatorcontrib><creatorcontrib>Azria, Elie</creatorcontrib><creatorcontrib>Lepercq, Jacques</creatorcontrib><creatorcontrib>Goffinet, François</creatorcontrib><creatorcontrib>Schmitz, Thomas</creatorcontrib><creatorcontrib>Groupe de Recherche en Obstétrique et Gynécologie (GROG)</creatorcontrib><creatorcontrib>for the Groupe de Recherche en Obstétrique et Gynécologie (GROG)</creatorcontrib><title>Meconium‐stained amniotic fluid and neonatal morbidity in nulliparous patients with prolonged pregnancy</title><title>Acta obstetricia et gynecologica Scandinavica</title><addtitle>Acta Obstet Gynecol Scand</addtitle><description>Introduction Our objective was to study the strength of the association between meconium‐stained amniotic fluid and severe morbidity among neonates of nulliparas with prolonged pregnancies. Material and methods This was a secondary analysis of the NOCETER randomized trial that took place between 2009 and 2012 in which 11 French maternity units included 1373 nulliparas at 41+0 weeks of gestation onwards with a single live fetus in cephalic presentation. This analysis excluded patients with a cesarean delivery before labor and those with bloody amniotic fluid or of unreported consistency. The principal end point was a composite criterion of severe neonatal morbidity (neonatal death, 5‐minute Apgar &lt;7, convulsions in the first 24 h, meconium aspiration syndrome, mechanical ventilation ≥24 h, or neonatal intensive care unit admission for 5 days or more). The neonatal outcomes of pregnancies with thin or thick meconium‐stained amniotic fluid were compared with those with normal amniotic fluid. The association between the consistency of the amniotic fluid and neonatal morbidity was tested by univariate and then multivariate analysis adjusted for gestational age at birth, duration of labor, and country of birth. Results This study included 1274 patients: 803 (63%) in the group with normal amniotic fluid, 196 (15.4%) in the thin amniotic fluid group, and 275 (21.6%) in the thick amniotic fluid group. The neonates of patients with thick amniotic fluid had higher rates of neonatal morbidity than those of patients with normal amniotic fluid (7.3% vs. 2.2%; p &lt; 0.001; adjusted relative risk [aRR] 3.3, 95% confidence interval [CI] 1.7–6.3), but those of patients with thin amniotic fluid did not (3.1% vs. 2.2%; p = 0.50; aRR 1.0, 95% CI, 0.4–2.7). Conclusions Among nulliparas at 41+0 weeks onwards, only thick meconium‐stained amniotic fluid is associated with a higher rate of severe neonatal morbidity. Among nulliparas at 41+0 weeks onwards, only thick meconium‐stained amniotic fluid is associated with a higher rate of severe neonatal morbidity.</description><subject>Amniotic fluid</subject><subject>Feces</subject><subject>Morbidity</subject><subject>Newborn babies</subject><subject>nulliparas</subject><subject>Original</subject><subject>Pregnancy</subject><subject>prolonged pregnancy</subject><subject>severe neonatal morbidity</subject><subject>thick meconium</subject><subject>thin meconium</subject><issn>0001-6349</issn><issn>1600-0412</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp9kcFqFTEUhoNU7LW68QEk0E0RpiaTTGayKqVoFSpdqOtwksncpmSSaTLTcnc-gs_ok5jrrcV2YQiEQz4-_uRH6A0lx7Ss9xDX-ZhyQeUztKKCkIpwWu-hFSGEVoJxuY9e5nxdprrl3Qu0z1rWtnXDV8h9sSYGt4y_fvzMM7hgewxjcHF2Bg9-cWUMPQ42BpjB4zEm7Xo3b7ALOCzeuwlSXDKeYHY2zBnfufkKTyn6GNZFNiW7DhDM5hV6PoDP9vX9eYC-f_zw7exTdXF5_vns9KIynEtZwdA20NlG8L4hTUM06_QAWmsrKDeDaWoGwvDOGK5Z0zGhBzlQyiXYnklB2QE62XmnRY-2NyVUAq-m5EZIGxXBqcc3wV2pdbxVlJRPkbIthqN7Q4o3i82zGl021nso37BkVXeMiJZ2LS_o4RP0Oi4plPcVijNSNt1GerejTIo5Jzs8pKFEbStU2wrVnwoL_Pbf_A_o384KQHfAnfN28x-VOr08_7qT_gav9qrR</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Attali, Isabelle</creator><creator>Korb, Diane</creator><creator>Azria, Elie</creator><creator>Lepercq, Jacques</creator><creator>Goffinet, François</creator><creator>Schmitz, Thomas</creator><general>John Wiley &amp; Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0574-3749</orcidid><orcidid>https://orcid.org/0000-0002-3074-8269</orcidid></search><sort><creationdate>202308</creationdate><title>Meconium‐stained amniotic fluid and neonatal morbidity in nulliparous patients with prolonged pregnancy</title><author>Attali, Isabelle ; Korb, Diane ; Azria, Elie ; Lepercq, Jacques ; Goffinet, François ; Schmitz, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4499-af75a8e564d50550b38bfabbbe614cfc523a6c48cc4b35836bf9f1149aed39613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amniotic fluid</topic><topic>Feces</topic><topic>Morbidity</topic><topic>Newborn babies</topic><topic>nulliparas</topic><topic>Original</topic><topic>Pregnancy</topic><topic>prolonged pregnancy</topic><topic>severe neonatal morbidity</topic><topic>thick meconium</topic><topic>thin meconium</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Attali, Isabelle</creatorcontrib><creatorcontrib>Korb, Diane</creatorcontrib><creatorcontrib>Azria, Elie</creatorcontrib><creatorcontrib>Lepercq, Jacques</creatorcontrib><creatorcontrib>Goffinet, François</creatorcontrib><creatorcontrib>Schmitz, Thomas</creatorcontrib><creatorcontrib>Groupe de Recherche en Obstétrique et Gynécologie (GROG)</creatorcontrib><creatorcontrib>for the Groupe de Recherche en Obstétrique et Gynécologie (GROG)</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Wiley Free Archive</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Attali, Isabelle</au><au>Korb, Diane</au><au>Azria, Elie</au><au>Lepercq, Jacques</au><au>Goffinet, François</au><au>Schmitz, Thomas</au><aucorp>Groupe de Recherche en Obstétrique et Gynécologie (GROG)</aucorp><aucorp>for the Groupe de Recherche en Obstétrique et Gynécologie (GROG)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Meconium‐stained amniotic fluid and neonatal morbidity in nulliparous patients with prolonged pregnancy</atitle><jtitle>Acta obstetricia et gynecologica Scandinavica</jtitle><addtitle>Acta Obstet Gynecol Scand</addtitle><date>2023-08</date><risdate>2023</risdate><volume>102</volume><issue>8</issue><spage>1092</spage><epage>1099</epage><pages>1092-1099</pages><issn>0001-6349</issn><eissn>1600-0412</eissn><abstract>Introduction Our objective was to study the strength of the association between meconium‐stained amniotic fluid and severe morbidity among neonates of nulliparas with prolonged pregnancies. Material and methods This was a secondary analysis of the NOCETER randomized trial that took place between 2009 and 2012 in which 11 French maternity units included 1373 nulliparas at 41+0 weeks of gestation onwards with a single live fetus in cephalic presentation. This analysis excluded patients with a cesarean delivery before labor and those with bloody amniotic fluid or of unreported consistency. The principal end point was a composite criterion of severe neonatal morbidity (neonatal death, 5‐minute Apgar &lt;7, convulsions in the first 24 h, meconium aspiration syndrome, mechanical ventilation ≥24 h, or neonatal intensive care unit admission for 5 days or more). The neonatal outcomes of pregnancies with thin or thick meconium‐stained amniotic fluid were compared with those with normal amniotic fluid. The association between the consistency of the amniotic fluid and neonatal morbidity was tested by univariate and then multivariate analysis adjusted for gestational age at birth, duration of labor, and country of birth. Results This study included 1274 patients: 803 (63%) in the group with normal amniotic fluid, 196 (15.4%) in the thin amniotic fluid group, and 275 (21.6%) in the thick amniotic fluid group. The neonates of patients with thick amniotic fluid had higher rates of neonatal morbidity than those of patients with normal amniotic fluid (7.3% vs. 2.2%; p &lt; 0.001; adjusted relative risk [aRR] 3.3, 95% confidence interval [CI] 1.7–6.3), but those of patients with thin amniotic fluid did not (3.1% vs. 2.2%; p = 0.50; aRR 1.0, 95% CI, 0.4–2.7). Conclusions Among nulliparas at 41+0 weeks onwards, only thick meconium‐stained amniotic fluid is associated with a higher rate of severe neonatal morbidity. Among nulliparas at 41+0 weeks onwards, only thick meconium‐stained amniotic fluid is associated with a higher rate of severe neonatal morbidity.</abstract><cop>United States</cop><pub>John Wiley &amp; Sons, Inc</pub><pmid>37377254</pmid><doi>10.1111/aogs.14619</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-0574-3749</orcidid><orcidid>https://orcid.org/0000-0002-3074-8269</orcidid><oa>free_for_read</oa></addata></record>
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subjects Amniotic fluid
Feces
Morbidity
Newborn babies
nulliparas
Original
Pregnancy
prolonged pregnancy
severe neonatal morbidity
thick meconium
thin meconium
title Meconium‐stained amniotic fluid and neonatal morbidity in nulliparous patients with prolonged pregnancy
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