The Value of Amniocentesis in Prolonged Pregnancy

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Abstract
A total of 2702 transabdominal amniocentesis performed were reviewed, with particular emphasis on 392 samples performed beyond 41 wk gestation. A significant rise in the percent of amniocentesis with meconium staining occurred at and beyond 39 wk. Meconium-stained fluid at amniocentesis was associated with an increased incidence of babies weighing > 4000 g, maternal diabetes mellitus and cesarean deliveries, in comparison to samples with clear amniotic fluid. Infants with meconium-stained fluid had an increased incidence of low 1-min Apgar scores, but all 5 min Apgar scores were 7 or greater. Ten perinatal deaths occurred after an amniocentesis with clear fluid in prolonged pregnancy, with 4 of these occurring within 7 days of amniocentesis. Lecithin/sphingomyelin (L/S) ratios less than 2.0 were found in 6% of amniocentesis performed beyond 41 wk. None of the newborns with low L/S ratios developed subsequent neonatal respiratory distress syndrome. Amniotic fluid creatinine values or blood-contaminated fluid were not correlated with fetal outcome. No fetal mortality was attributable to amniocentesis. In view of the significant amount of false-positive and false-negative results and the rare inherent danger associated with amniocentesis, its use solely to demonstrate the presence or absence of meconium staining appears to be of questionable value in the management of prolonged pregnancy.

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