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Is Meconium Passage a Risk Factor for Maternal Infection in Term Pregnancies?

From the Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas; and Information Systems/Decision Sciences Department, University of South Florida, Tampa, Florida.

Address reprint requests to: Allahyar Jazayeri, MD, PhD, Texas Tech University Health Sciences Center, Department of Obstetrics and Gynecology, 3601 4th Street, Lubbock, TX 79430; E-mail: allahyar.jazayeri{at}ttmc.ttuhsc.edu.

OBJECTIVE: To study the association between meconium and maternal infection.

METHODS: This was a retrospective cohort study of 678 pregnant women. All term deliveries during a 31-month period with meconium passage were included. Each meconium delivery was matched with a consecutive delivery without meconium at the same gestational age.

RESULTS: The overall infection rate was 16%, with 13% of the infections directly related to the pregnancy, labor, and delivery. The endometritis rate was 5%, with 7.1% and 3% in the meconium and no-meconium group, respectively. The chorioamnionitis rate was 8.3%, with 9.5% in the meconium and 7.1% in the no-meconium group. Factors found to be associated with overall obstetric infections had the following odds ratios (ORs) and 95% confidence intervals (CIs): meconium (OR 1.8, 95% CI 1.1, 2.8), internal monitoring (OR 3.4, 95% CI 1.9, 5.9), amnioinfusion (OR 2.0, 95% CI 1.3, 3.3), number of vaginal exams (OR 4.5, 95% CI 2.8, 7.1), length of labor (OR 2.8, 95% CI 1.8, 4.4), and cesarean (OR 3.1, 95% CI 1.9, 5.1). Logistic regression analyses revealed the following ORs and 95% CIs: 1) for endometritis–cesarean (OR 4.2, 95% CI 1.9, 8.9), internal monitoring (OR 2.5, 95% CI 1.1, 5.9), and meconium (OR 2.5, 95% CI 1.1, 5.5), and 2) for chorioamnionitis–length of labor greater than 10 hours (OR 2.7, 95% CI 1.4, 5.6), number of vaginal exams greater than seven (OR 3.4, 95% CI 1.7, 6.6), and use of internal monitors (OR 2.5, 95% CI 1.2, 5.3).

CONCLUSION: Meconium passage increases the risk of post-partum endometritis but not chorioamnionitis. Length of labor, internal monitoring, and number of vaginal exams are risk factors for chorioamnionitis.