Association Between Meconium-stained Amniotic Fluid and Obstetric Perineal Wound Infection
Article Sidebar
Main Article Content
Abstract
Objectives: Meconium-stained amniotic fluid (MSAF) has been associated with higher rates of surgical site infection. The present study aimed to investigate the association between MSAF and obstetric perineal wound infections, and other puerperal infections, to inform the preventive strategies.
Materials and Methods: This retrospective cohort study reviewed medical records of women delivered at King Chulalongkorn Memorial Hospital from January 1, 2018 to December 31, 2020. Women who underwent vaginal delivery with episiotomy or had an obstetric perineal wound and were followed up at 6 weeks postpartum were included. The cohort comprised of pregnancies complicated by MSAF (n = 366) and those without MSAF (n = 1,464). The primary outcomes were the incidence of infected episiotomy wounds and wound dehiscence. Percentages and 95% confidence intervals (CI) were calculated for categorical variables and odds ratios (OR) with 95% CI were used for comparisons between groups.
Results: A total of 1,830 patients were included, with a mean age of 29.5 years. The rate of infected episiotomy wound in the MSAF group (3.55%, 95% CI 1.89 to 6.07) did not significantly differ from that of the non-MSAF group (3.55%, 95% CI 2.65 to 4.66), yielding an OR of 1.00 (95% CI 0.54 to 1.86). Similarly, there was no significant difference in the rate of wound dehiscence, chorioamnionitis, and other puerperal infections between the groups.
Conclusion: Our findings suggested that MSAF was not associated with an increased risk of obstetric perineal wound infection. Therefore, antibiotic prophylaxis to prevent such infections in women with MSAF may not be necessary.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Rawat M, Nangia S, Chandrasekharan P, Lakshminrusimha S. Approach to infants born through meconium stained amniotic fluid: evolution based on evidence? Am J Perinatol 2018;35:815-22.
Unsworth J, Vause S. Meconium in labour. Obstet Gynecol Reprod Med 2010;20:289-94.
Hiersch L, Krispin E, Aviram A, Wiznitzer A, Yogev Y, Ashwal E. Effect of meconium-stained amniotic fluid on perinatal complications in low-risk pregnancies at term. Am J Perinatol 2016;33:378-84.
Tran SH, Caughey AB, Musci TJ. Meconium-stained amniotic fluid is associated with puerperal infections. Am J Obstet Gynecol 2003;189:746-50.
Pakniat H, Mohammadi F, Ranjkesh F. Meconium amniotic fluid is associated with endomyometritis. J Obstet Gynaecol India 2016;66(Suppl 1):136-40.
Ma’ayeh M, Snyder A, Oliver EA, Gee SE, Rood KM. Meconium-stained amniotic fluid and the risk of postcesarean surgical site infection. J Matern Fetal Neonatal Med 2021;34:1361-7.
Florman AL, Teubner D. Enhancement of bacterial growth in amniotic fluid by meconium. J Pediatr 1969;74:111-4.
Romero R, Hanaoka S, Mazor M, Athanassiadis AP, Callahan R, Hsu YC, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991;164:859-62.
Romero R, Yoon BH, Chaemsaithong P, Cortez J, Park CW, Gonzalez R, et al. Bacteria and endotoxin in meconium-stained amniotic fluid at term: could intra-amniotic infection cause meconium passage? J Matern Fetal Neonatal Med 2014;27:775-88.
Clark P, DuE P. Inhibition of neutrophil oxidative burst and phagocytosis by meconium. Am J Obstet Gynecol 1995;173:1301-5.
Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 198: Prevention and management of obstetric lacerations at vaginal delivery. Obstet Gynecol 2018;132:e87-e102.
Jiang H, Qian X, Carroli G, Garner P. Selective versus routine use of episiotomy for vaginal birth. Cochrane Database Syst Rev 2017;2:CD000081.
Jones K, Webb S, Manresa M, Hodgetts-Morton V, Morris RK. The incidence of wound infection and dehiscence following childbirth-related perineal trauma: A systematic review of the evidence. Eur J Obstet Gynecol Reprod Biol 2019;240:1-8.
Cunningham F, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, et al. Williams Obstetrics, 25th ed. New York: McGraw Hill 2018:666-79.
Bernard R. Fundamentals of biostatistics, 8th ed. Boston: Cengage learning; 2016.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC defnitions for nosocomial infections. Am J Infect Control 1988;16:128-40.
Gommesen D, Nohr EA, Drue HC, Qvist N, Rasch V. Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study. Arch Gynecol Obstet 2019;300:67-77.
Pazandeh F, Savadzadeh S, Mojab F, Alavi Majd H. Effects of chamomile essence on episiotomy healing in primiparous women. J Ardabil Uni Med Sci 2008;8:364-70.
Gommesen D, Nohr EA, Drue HC, Qvist N, Raschet V. Obstetric perineal tears: risk factors, wound infection and dehiscence: a prospective cohort study. Arch Gynecol Obstet 2019;300:67-77.
Puissegur A, Accoceberry M, Rouzaire M, Pereira B, Herault M, Bruhat C, et al. Risk factors for perineal wound breakdown in early postpartum: A retrospective case–control study. J Clin Med 2023;12:3036-43.
Hudelist G, Gelle’n J, Singer C, Ruecklinger E, Czerwenka K, Kandolf O, et al. Factors predicting severe perineal trauma during childbirth: role of forceps delivery routinely combined with mediolateral episiotomy. Am J Obstet Gynecol 2005;192:875-81.
Thongtip N, Srilar A, Luengmettakul J. The incidence and associated factors of perineal wound infection following vaginal delivery in Charoenkrung Pracharak Hospital, Bangkok, Thailand. Thai J Obstet Gynaecol 2023;31:145-53.
Sani R, Abubakar M. Episiotomy and its complications: A review. J Perinat Med 2022;50:8-14.
Wertheimer A, Shemer A, Hadar E, Berezowsky A, Wiznitzer A, Krispin E. The effect of meconium-stained amniotic fluid on perinatal outcome in pregnancies complicated by preterm premature rupture of membranes. Arch Gynecol Obstet 2020;301:1181-7.
