Clinical Effects of Echogenic Amniotic Fluid on Neonatal Outcome of Term Pregnancies / A Case Control Study

Abstract

Background: Throughout development, the embryo and fetus are surrounded by a clear, yellow
fluid called amniotic fluid (AF), which serves a variety of functions Meconium-stained amniotic fluid
occurs in 8-10% of all deliveries. It has been associated at times with suboptimal neonatal outcomes,
although this is controversial. Amniotic fluid may be quickly and non-invasively assessed using
ultrasound (U/S). It provides a secure real-time alternative with similar therapeutic results. This study
aimed to identify the role of U/S in detecting echogenic amniotic fluid and its association with
pregnancy outcomes.
Methods: A case-control study was carried out in the obstetrics & gynecology departments at AlElwyia (Baghdad) and Bunt Al-Huda (Dhi Qar) Teaching Hospitals. A total of 174 pregnant women
who presented with singleton viable pregnancies and decreased fetal movement were recruited and
they were classified into two groups according to echogenicity of AF by U/S. The first group included
87 women with positive echogenic AF (Case group) and the second group included 87 women with
negative echogenic AF (Control group). A structured questionnaire was designed, and it included
maternal characteristics and pregnancy outcomes. U\S was done by two specialists in the department
of radiology. Data analysis was done by using version 26 of the Statistical Packages for Social
Sciences. Pearson Chi-square test (α2-test) was used to examine the significance of the difference
between different percentages. A level of P- P-value < 0.05 was considered significant.
Results: Echogenic AF on U/S predicted a much higher proportion of meconium (60.9%) and
bloody-stained amniotic fluid (9.2%) compared to controls where only 14.9% had meconium and nonhad bloody stained AF, A positive test result had sensitivity and specificity in predicting meconium of
80.3% and 68.5% respectively. In positive echogenic AF and compared with controls, the rate of
preeclampsia, cesarean section, neonatal admission to the intensive care unit, and neonatal death were
significantly higher, while the mean Apgar score at 5 minutes was significantly lower.
Conclusions: This study concluded that the confidence of U/S was 37.9% in pregnant women with
meconium-stained AF, with sensitivity and specificity of 80.3%, and 68.5% respectively. A positive
test of echogenic AF on U/S was highly significant in the prediction of neonatal admission to the ICU
because of meconium aspiration syndrome. Training obstetrician residents to be experienced in
evaluating the echogenicity of amniotic fluid in obstetrical units & labor rooms is recommended.