Joy
Greenwood et al's recent study of 8394 'low risk' labouring women with
clear amniotic fluid at early amniotomy found that meconium passage in
labour occurred in only 435 (5.2%) cases. Despite this, there was clear
evidence of an association between moderate or severe acidosis at birth
(arterial pH < 7.05 or venous pH < 7.12 or base deficit > 12) and
meconium passage: OR 4.33, 95% CI 3.17-5.93. Nevertheless, 247/300
(82.3%) of babies born acidotic did not develop meconium-stained
amniotic fluid in labour. The clinical implication of this finding is
that, although meconium-stained amniotic fluid is related to increased
perinatal morbidity, the identification of clear amniotic fluid cannot
be taken to be reassuring about the fetal acid-base status.
Greenwood C, Lalchandani S, MacQuillan K et al 2003 Meconium passed in
labor: how reassuring is clear amniotic fluid? Obstetrics & Gynecology
102: 89-93
Declan
Declan Devane,
Doctoral Student / Midwifery Research Assistant,
School of Nursing and Midwifery Studies,
University of Dublin Trinity College,
Trinity Centre for Health Sciences Education,
St. James's Hospital,
Dublin 8.
Tel: 087 659 6923
Email: [log in to unmask]
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-----Original Message-----
From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of Joy
Kemp
Sent: 21 July 2003 22:30
To: [log in to unmask]
Subject: Transfer to Hospital
Dear All
Apologies if you get this message twice.
I have been asked to assist in drawing up evidence based guidelines for
homebirth - which is a big step forward for our trust (even
acknowledging homebirth as a priority).
Does anyone know of any evidence supporting the transfer (or
non-transfer) of women to hospital if various scenarios present
themselves? ie is there evidence for the need to transfer with meconium
stained liquor etc - or is this generally just based on tradition and
the individual midwife's comfort zones?
Would also appreciate hearing from anyone working in areas with high
homebirth rates if you have guidelines for midwives which we could sneak
a look at.
Many thanks
Joy Kemp
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