[Stained amniotic fluid and meconium amniotic fluid: Should they change our obstetric management ?] / Liquide amniotique teinté ou méconial : doivent-ils modifier notre prise en charge obstétricale ?

OBJECTIVES: To assess if a stained or meconial amniotic fluid during labor is correlated with a greater risk of neonatal metabolic acidosis. METHODS: In a retrospective case-control study carried out in a level 3 maternity from 1st of January to 31st of December 2014, all patients who delivered a singleton eutrophic fetus in cephalic presentation after 37WG and with a stained or meconial amniotic fluid during labor were included. Obstetrical and neonatal outcomes were compared according to the amniotic fluid's color. RESULTS: At all, 302 patients in the group « Abnormal amniotic fluid¼ (198 patients with stained amniotic fluid, 104 with meconial amniotic fluid) vs. 302 in the group « clear amniotic fluid¼ were included. No significant difference on the rate of neonatal severe acidosis between the two groups were found. Fetal heart rhythm abnormalities were more frequent in case of meconial amniotic fluid (11,3% vs. 31,7%, P<0,0001). The composite endpoint, defined by the association of umbilical arterial pH <7,0±base excess ≥12mmol/L±Apgar score at 5min <7, was more frequent in case of meconial amniotic fluid (4,0% vs. 12,5%, P=0,0018). CONCLUSION: The occurrence of severe neonatal metabolic acidosis was not more frequent in case of stained or meconial amniotic fluid, but with an increase in the use of fetal scalp pH and cesaerian deliveries when the fluid was meconial.

[Emergency caesarean sections in primary care maternity: Impact of a color code]. / Césariennes en urgence en maternité de type 1 : impact de l'utilisation d'un code couleur.

OBJECTIVES: To estimate the impact of the introduction of color code on the decision to birth-delay (DDB) used to prioritize the emergency caesarean sections in a primary care maternity. MATERIALS AND METHODS: All patients who had an emergency caesarean section, for a single fetus, were included. The obstetrician, the anesthesiologist and the nurse of operating theatre were not on call in the maternity in nighttime. The study was divided into phase I corresponding to the period before the introduction of the color code and phase II, the period after introduction of the color code. The DDB was studied for each phase and for each color code in phase II, and depending on the day or night period. RESULTS: Two hundred and seventy-six patients were included. In phase I, the average DDB was 54minutes against 44minutes in phase II (P=0.0003). The average time between the decision and caesarean birth for the green code was 62minutes, 42minutes for orange code, 22minutes for red code (P<0.001). There was no action on the time of caesarean decision on the choice of color code. There was no time difference between daytime and nighttime either in phases I or II. CONCLUSION: The introduction of color code for emergency caesarean sections was a benefit in reducing the DDB. There was no observed difference between day or night periods regarding DDB or color codes.

[Correlation between fetal scalp samples and umbilical cord samples]. / Corrélation entre prélèvements au scalp fœtal et prélèvements artériels au cordon.

OBJECTIVE: The objective was to evaluate the correlation between fetal scalp base excess (BE) and umbilical cord BE. Respective value of fetal scalp pH, BE and lactate for the prediction of neonatal metabolic acidosis were also evaluated. METHODS: A retrospective monocentric study was conducted in a French tertiary care academic maternity. All the patients who had a fetal scalp sampling during labor in 2010, less than 90 minutes before delivery were included. Fetal heart rate abnormalities (FHRA) were classified by degree of severity, according to the French guidelines. The differences between fetal scalp samples and umbilical cord samples over time and in relation with the type of FHRA were analyzed for pH and BE. The differences between fetal scalp pH and cord pH over time and in relation with scalp BE were analyzed. The correlation between fetal scalp samples and cord samples for pH, BE and lactate was estimated. Receiver operating characteristics (ROC) curves for fetal scalp pH, lactate and BE to predict umbilical cord pH under 7.20 were calculated. RESULTS: Seventy-one cases were included. The difference between fetal scalp sample and cord sample was lower when the sample was made closest to delivery both for pH and BE. The gravity of FHRA was not predictive of a faster decrease of pH or BE over time. The correlation was significant for pH (r=0.23, p=0.03) between scalp samples and cord samples, as for BE (r=0.49, p=0.001) and lactate (r=0.52, p=0.001). The ROC curves for pH, BE and lactate displayed a similar pattern. CONCLUSION: Fetal scalp and umbilical cord samples, for pH, BE and lactate were significantly correlated but their respective predictive value for cord pH less or equal to 7.20 was poor.