RESUMEN
OBJECTIVES: To assess if a stained or meconial amniotic fluid during labor is correlated with a greater risk of neonatal metabolic acidosis. METHODS: In a retrospective case-control study carried out in a level 3 maternity from 1st of January to 31st of December 2014, all patients who delivered a singleton eutrophic fetus in cephalic presentation after 37WG and with a stained or meconial amniotic fluid during labor were included. Obstetrical and neonatal outcomes were compared according to the amniotic fluid's color. RESULTS: At all, 302 patients in the group « Abnormal amniotic fluid¼ (198 patients with stained amniotic fluid, 104 with meconial amniotic fluid) vs. 302 in the group « clear amniotic fluid¼ were included. No significant difference on the rate of neonatal severe acidosis between the two groups were found. Fetal heart rhythm abnormalities were more frequent in case of meconial amniotic fluid (11,3% vs. 31,7%, P<0,0001). The composite endpoint, defined by the association of umbilical arterial pH <7,0±base excess ≥12mmol/L±Apgar score at 5min <7, was more frequent in case of meconial amniotic fluid (4,0% vs. 12,5%, P=0,0018). CONCLUSION: The occurrence of severe neonatal metabolic acidosis was not more frequent in case of stained or meconial amniotic fluid, but with an increase in the use of fetal scalp pH and cesaerian deliveries when the fluid was meconial.
Asunto(s)
Acidosis/epidemiología , Líquido Amniótico , Meconio , Puntaje de Apgar , Estudios de Casos y Controles , Parto Obstétrico , Femenino , Sangre Fetal , Frecuencia Cardíaca Fetal , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Trabajo de Parto , Embarazo , Estudios Retrospectivos , Factores de Riesgo , Arterias UmbilicalesRESUMEN
OBJECTIVES: Evaluate the two main immunochromatographic tests of premature rupture of membranes (PROM): Actimprom(®) based on the discovery of insulin-like growth factor binding protein-1 (IGFBP-1) and Amnisure(®) based on the discovery of placental alpha 1-microglobulin (PAMG -1). The comparison was made voluntarily in clinical practice and is interested in a population whose failure is not clean break. MATERIALS AND METHODS: Prospective and comparative study performed on 2012, at the university hospital of Caen, in 85 patients with PROM suspected between 24 SA and 36 SA. The presence of blood, semen or vaginal infection has been notified. Frank rupture of membranes was an exclusion criterion. RESULTS: Actimprom(®) and Amnisure(®) were detected PROM with a specificity, sensitivity, PPV and NPV respectively 89.4% (CI 79.4-95.6%), 68.4% (CI 43.5-87.4%), 65% (CI 40.8-84.6%) and 90.8% (CI 81-96.5%). The results of both tests were not influenced by the presence of blood or inflammatory disease. CONCLUSION: Performance of these tests is probably related to the quality of the sample and the extraction step in bed of the patient. This work showed no significant difference between the two tests in terms of performance in the diagnosis of PROM. At present, there is no formally favor the use of one or the other.