Umbilical cord blood Erythropoietin as a biomarker of subacute and chronic hypoxia in deliveries complicated by meconium stained amniotic fluid

Background: The presence of meconium stained amniotic fluid (MSAF) during labour is often associated with a lot of adverse outcomes and historically has been considered to be a predictor of bad neonatal outcome. It is associated with fetal hypoxia and leads to emergency C/S, instrumental vaginal delivery for fetal distress, low Apgar score at birth, meconium aspiration syndrome and neuro-developmental handicaps. Umbilical cord serum erythropoietin levels have been claimed to be elevated in response to fetal hypoxia. Objective: To evaluate the umbilical cord serum erythropoietin levels in neonates born through MSAF and to determine whether it is influenced by gestational age. Study Design: Prospective case control study. Materials & Methods: Women with term uncomplicated singlet on pregnancies at gestational age between (37-41 +6 ) weeks admitted to the labour room in the active phase of labour were enrolled to participate in this study. The studied population has been divided into two groups, women with thick meconium stained amniotic fluid (study group) and women with clear amniotic fluid (control group). Umbilical cord serum Erythropoietin levels will be measured for both groups by ELISA, after delivery and Apgar score will be assessed for neonates of both groups then statistical analysis will be performed. Results: A significant relationship was found between MSAF and elevated umbilical cord serum erythropoietin levels since the p value was P < 0.001. Apgar score was lower significantly after 1 minute in study group, but lower none significantly after 5 minutes, as P <0.001and 0.109 respectively. Conclusions: The elevated umbilical cord serum Erythropoietin levels in neonates born through MSAF suggest subacute or chronic fetal Hypoxia, independent of gestational age.