Meconium-stained amniotic fluid: a risk factor for postpartum hemorrhage

Background/aim Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population. Patients and methods A retrospective cohort study evaluated 78,542 consecutive women who had a vaginal delivery between 24th and 44th weeks of gestation. The women who had undergone cesarean section were excluded to avoid possible bias. Postpartum blood loss was measured with graduated blood sack. Postpartum blood loss between 1,000 and 2,000 mL and >2,000 mL were classified as moderate and severe PPH, respectively. Results A total of 74,144 patients were available for analysis. According to the color of amniotic fluid (AF), two groups of patients were identified: MSAF (n=10,997) and clear AF (n=63,147). The rates of severe and massive PPH were found to be significantly higher in the MSAF group than that of clear AF group (OR=1.3, 95% CI: 1.2\u20131.5, p<0.001 and OR=2.5, 95% CI: 1.5\u20134.2, p<0.001). Operative vaginal delivery rate was found to be higher in the MSAF group than that of clear AF group, but the difference was only borderline significant (OR=1.5, 95% CI: 1.0\u20132.2, p=0.05). There were no significant differences between the MSAF and the clear AF groups with respect to episiotomies, second- or third-degree perineal tears, vaginal\u2013perineal thrombus, cervical lacerations, vaginal births after cesarean section, twin deliveries, and placental retention rates. Conclusion To the best of our knowledge, this is the first clinical study that has investigated the role of MSAF as a risk factor for PPH after vaginal delivery in an unselected population. Our results suggest that MSAF is significantly associated with higher risk of moderate and severe PPH than clear AF

Indicazioni della IUI

L\u2019inseminazione intrauterina (IUI) ha come razionale il superamento della barriera mucosa cervicale e l\u2019aumento della percentuale di spermatozoi mobili, con forme normali, a livello del sito di fertilizzazione. Le procedure di lavaggio riducono la concentrazione di prostaglandine, linfochine, citochine e radicali dell\u2019ossigeno da parte di agenti infettivi, spermatozoi non mobili, leucociti, cellule immature, portando cos\uec ad un miglioramento della qualit\ue0 del liquido seminale, con aumento della percentuale di fertilizzazione, in vitro ed in vivo. Questa tecnica, semplice, non invasiva e poco costosa, offre numerosi vantaggi, quali la necessit\ue0 di avere attrezzature minime, il ridotto disagio psicologico per la paziente, i rischi minimi di Sindrome da Iperstimolazione Ovarica (OHSS) e di gravidanze multiple (7), garantendo quindi una compliance per l\u2019IUI maggiore rispetto alla fecondazione in vitro (IVF). Ciononostante tale procedura \ue8 ancora oggetto di discussione clinica (1,2). Le principali indicazioni all\u2019IUI, con o senza stimolazione ormonale, sono l\u2019infertilit\ue0 femminile da fattore cervicale, l\u2019infertilit\ue0 maschile e la sterilit\ue0 sine causa