The Impact of Bloody Amniotic Fluid on Delivery and Early Neonatal Outcomes

Information on the effect of bloody amniotic fluid during labor at term is scarce. This study assessed risk factors and obstetrical outcomes in labors complicated by bloody amniotic fluid. All nulliparas with singleton pregnancy, who underwent a trial of labor ≥37 weeks of gestation, in a single tertiary center, over six years were included. Obstetrical, delivery and neonatal outcomes were compared between deliveries with bloody amniotic fluid or clear amniotic fluid. Overall, 11,252 women were included. Among them, 364 (3.2%) had bloody amniotic fluid and 10,888 (96.7%) had clear amniotic fluid. Women with bloody amniotic fluid were characterized by shorter duration of the second stage of labor and higher rate of cesarean delivery due to non-reassuring fetal heart rate. The rates of cord pH < 7.1 and NICU admissions were also higher. In multivariate logistic regression analysis, cesarean delivery, cord blood pH < 7.1 and NICU admission were independently associated with increased odds ratio for bloody amniotic fluid. Bloody amniotic fluid at term is associated with adverse outcomes and must be considered during labor.