Meconium and Its Significance

Overview

Objective:
A review of meconium patophysiology and its contribution to the incidence of perinatalinfection.Design: Review article.Setting: Department of Gynaecology and Obstetrics, Charles University and Faculty HospitalPlzeň, Czech Republic.Method: The reported incidence of meconium-stained amniotic fluid varies between 7 and 22 %.The patophysiology of the presence of meconium in the amniotic fluid is not sufficiently explai-ned. Meconium in fetal bowels is under hormonal and neurol control. The presence of the meconi-um-stained amniotic fluid was always considered to be a potential risk for the fetal and neonatalwell-being. The review is further divided in to three chapters. (II. Meconium and meconiumaspiration syndrome, III. Meconium and postnatal neurological handicap).Results and conclusion: The first chapter on deals with meconium risk in the development ofperinatal infection: intraamniotic infection/chorioamnionitis, postnatal endometritis, infection ofthe abdominal wound after Caesarean and neonatal infection. The incidence of clinical chorioam-nionitis is 15% with the presence of meconium compared to 3% in controls. The incidence ofpuerperal endometritis is 10% in comparison to 3% under normal conditions. Two main mecha-nisms of development (or coincidence) of intraamniotic infection in the presence of meconiumexist. 1) Infection may be a cause of meconium passage. 2A) Alteration of Zn/P ratio in the amnio-tic fluid can promote bacterial growth. 2B) Meconium attached to macrophages or absorbed byphagocytosis can impair cellular immune response. The antibiotic prophylaxis is discussed.

Key words:
meconium, perinatal infection