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Abstract
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.
Keywords
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References
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- birth and for studying diseases of potential environmental etiology. Environmental research. 2015 Jan 1; 136:470-81.
- Singh A, Mittal M. Neonatal microbiome–a brief review. The Journal of Maternal-Fetal & Neonatal Medicine. 2020 Nov
- ;33(22):3841-8. Arnoldi R, Leva E, Macchini F, Di Cesare A, Colnaghi M, Fumagalli M, Mosca F, Torricelli M. Delayed meconium
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- outcomes with the amniotic fluid volume distribution: a reassessment using the amniotic fluid index, single deepest pocket, and a dyedetermined amniotic fluid volume. Am J Obstet Gynecol. 2003 Jun;188(6):1523-7; discussion 1527-8.
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- Metti Hanoudi B, Mohammed Murad A, Duraid Ali A. Meconium staining of amniotic fluid: A clinical study. British Journal
- of Medicine and Medical Research. 2013 Oct 22;4(3):914-21.
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- weeks gestation. Pak J Surg 2011; 27(4): 292-8
References
Ten Broek CM, Bots J, Varela-Lasheras I, Bugiani M, Galis F, Van Dongen S. Amniotic fluid deficiency and congenital
abnormalities both influence fluctuating asymmetry in developing limbs of human deceased fetuses. PLoS One. 2013;8(11): e81824.
Geer LA, Pycke BF, Sherer DM, Abulafia O, Halden RU. Use of amniotic fluid for determining pregnancies at risk of preterm
birth and for studying diseases of potential environmental etiology. Environmental research. 2015 Jan 1; 136:470-81.
Singh A, Mittal M. Neonatal microbiome–a brief review. The Journal of Maternal-Fetal & Neonatal Medicine. 2020 Nov
;33(22):3841-8. Arnoldi R, Leva E, Macchini F, Di Cesare A, Colnaghi M, Fumagalli M, Mosca F, Torricelli M. Delayed meconium
passage in very low birth weight infants. European Journal of Pediatric Surgery. 2011 Dec;21(06):395-8.
Usta, I.; Mercer, B.; Sibai, B. Risk factors for meconium aspiration syndrome. Obstetrics and gynecology .2005;86 (2):230-4.
Mashiane SE, van Dyk B, Casmod Y. Ultrasound biosafety: Knowledge and opinions of health practitioners who perform
obstetric scans in South Africa. Health SA. 2019 Oct 17; 24:1028.
Magann EF, Chauhan SP, Doherty DA, Barrilleaux PS, Martin JN, Morrison JC. Predictability of intrapartum and neonatal
outcomes with the amniotic fluid volume distribution: a reassessment using the amniotic fluid index, single deepest pocket, and a dyedetermined amniotic fluid volume. Am J Obstet Gynecol. 2003 Jun;188(6):1523-7; discussion 1527-8.
Singh G, Archana G. Unraveling the mystery of vernix caseosa. Indian J Dermatol. 2008;53(2):54-60. doi: 10.4103/0019-
41645. PMID: 19881987; PMCID: PMC2763724.
Helewa M, Manning F, Harman C. Amniotic fluid particles: Are they related to a mature amniotic fluid phospholipid profile?
Obstetrical and Gynecology 1989; 74:893-6.
E Mungen, Unit of Perinatology, GATA Haydarpasa Training Hospital, Uskudar, Istanbul, Turkey. Int. Journal of Obstetrical
and Gynecology. 2005; 88:314-15.
Ahanya SN, Lakshmanan J, Morgan BL, Ross MG. Meconium passage in utero: mechanisms, consequences, and management.
Obstetrical and Gynecological Survey. 2005; 60:45-56. Quiz 73-74.
Oyelese Y, Culin A, Ananth CV, Kaminsky LM, Vintzileos A, Smulian JC. Meconium-stained amniotic fluid across gestation
and neonatal acid-base status. Obstet Gynecol. 2006; 108:345-9.
Becker S, Solomayer E, Dogan C, Wallwiener D, Fehm T. Meconium-stained amniotic fluid- perinatal outcome and obstetrical
management in low-risk suburban population. Eur J Obstet Gynecol Reprod Biol. 2007; 123(1):46-50.
Patil K P, Swamy MK, Samatha K. A one-year cross-sectional study of management practices of meconium-stained amniotic
fluid and perinatal outcome. J Obstet Gynecol India, 2006; 56(2): 12830.
Metti Hanoudi B, Mohammed Murad A, Duraid Ali A. Meconium staining of amniotic fluid: A clinical study. British Journal
of Medicine and Medical Research. 2013 Oct 22;4(3):914-21.
Stark A R, Jane S. L, Meconium aspiration, Manual of Neonatal Care, 2003; 5: 402-3.
Naqvi SB, Manzoor S. Association of meconium-stained amniotic fluid with perinatal outcome in pregnant women of 37-42
weeks gestation. Pak J Surg 2011; 27(4): 292-8