1002 MECONIUM STAINED (MS) AMNIOTIC FLUID - A USEFUL ANTENATAL INDEX OF FETAL MATURITY AND RISK TO HMD

Abstract

A negative implication is commonly associated with MS amniotic fluid. Most frequently, it is indicative of fetal distress or asphyxia. We report that the finding of MS amniotic fluid has a positive, clinical usefulness. It is a highly accurate antenatal index of fetal maturity and the risk of the infant to HMD.

From 1973-1976, we reviewed the maturity and incidence of HMD among 1165 MS infants. Gestational age in LBW infants was assessed by the Dubowitz score. Of the total 1165 infants, 909 (78%) were mature; 170 (15%) were postmature and 77 (7%) were premature. Among the premature infants, 82% were ≥35 wks; 10% were 34 wks; 7% were 32-33 wks and 1% was <32 wks. Since asphyxia is a potent stimulus to the fetal passage of meconium, we determined the incidence of MS amniotic fluid in a group of infants with 1 minute Apgar ≥6 (N=555). Of the 555 infants, 36.3% of the full-term and 68.2% of the postmature passed meconium, as compared to only 2.6% of the prematures (p<0.01). The exception was noted in infants of drug dependent mothers (IDDM). Out of 56 premature IDDM with low Apgar, 20% had MS amniotic fluid.

The incidence of HMD among MS infants was very low (0.5%). Thus, the finding of MS fluid surpasses the predictability of many antenatal tests of fetal lung maturity including the L/S ratio. The incidence of HMD among premature MS infants was 8% as compared to 17% in our general premature population (p<0.05). This difference is related to the large percentage (82%) of premature MS infants being ≥35 wks gestation.

CONCLUSION: MS amniotic fluid correlates highly to fetal maturity. Only in 7% will the infants be premature and most (82%) will be ≥35 wks. The only exception is with the IDDM, because of the association of MS with fetal drug withdrawal. The incidence of HMD among MS infants is 0.5%. Thus MS amniotic fluid can be an accurate indicator of fetal lung maturity.

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