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Bile-stained amniotic fluid: a case report
© The Author(s). 2017
Received: 8 June 2017
Accepted: 6 August 2017
Published: 6 September 2017
Green-stained amniotic fluid does not always indicate that meconium was passed in utero.
We report the case of a 2280-g Hispanic preterm female born at 32 weeks of gestation with congenital jejunal atresia. The amniotic fluid was greenish stained; the initial impression was meconium-stained amniotic fluid. Postnatal findings revealed no meconium in her rectum. The content of her first stool appeared sticky and white.
In the absence of meconium in the rectum, the pediatrician should consider the possibility that the greenish amniotic fluid is not meconium stained, but rather stained with bile due to the fetus vomiting in utero secondary to intestinal obstruction.
KeywordsIntestinal obstruction Amniotic fluid Bile-stained amniotic fluid Neonate
Amniotic fluid (AF) can be stained green by bile pigments if the fetus has hemolytic disease, passes meconium, or vomits bile in utero. In 1972, the first case reported of bilious vomiting in utero was in a neonate with an atretic jejunum . If there is green-stained AF and the baby lacks meconium in the rectum, clinicians should be aware of the possibility of intestinal obstruction. There may be a delay in diagnosing intestinal obstruction in a newborn because of the assumption that the green AF was due to meconium passed in utero. Our case highlights the fact that green-stained AF could be due to bile secondary to in utero bilious vomiting, and not necessarily due to meconium.
Approximately 10% of pregnancies have meconium-stained AF at delivery [2, 3]; however, one quarter of these cases have no evidence of hypoxia. Peristaltic activity has been reported to occur in the fetal bowel as early as 8 weeks of gestation , and fetal defecation is a routine physiological event in early and mid-pregnancy . The fetus routinely defecates in utero until 16 weeks gestation and finally ceases to defecate by 18 to 20 weeks . Babies born with an anorectal malformation usually have a large dilated rectosigmoid portion of the distal bowel full of meconium, which suggests that there is prevention of fetal defecation in utero .
Clinical details of 13 neonates with bile-stained amniotic fluid
Gestational age (weeks)
Birth weight (g)
 Goedvolk and Yap, 2004
 Vijayakumar and Koh, 2001
High intestinal obstruction
 Swarte et al., 1997
High intestinal obstruction
 Akindele, 1994
Congenital intestinal obstruction
 Archer, 1988
Congenital intestinal obstruction
 Griffith and Burge, 1988
Posterior urethral valve/Microcolon
 Williams et al., 1978
 Daw, 1973
 Shrand, 1972
Britton and Britton (1995) reported that the mean gastric volume of a normal newborn was 4.9 ± 0.2 mL . In babies with high and low types of intestinal obstruction, the mean gastric aspirate volume was 58.6 ± 6.1 mL . In our patient, the gastric aspirate volume was 35 mL in the delivery room and additional 35 mL was obtained upon admission to the NICU. Although routine determination of gastric aspirate volume is not indicated for all newborns, it may be helpful in the initial evaluation of babies with suspected congenital intestinal obstruction.
There is no reported incidence of BSAF in neonates with congenital intestinal obstruction. Because there are few case reports, it is not common. It is noteworthy that only half of fetuses with esophageal atresia, and two thirds of fetuses with duodenal or proximal jejunal atresia develop polyhydramnios. Questions about AF dynamics remain unanswered . We speculate that bilious regurgitation would occur if there was marked bowel distension secondary to increased fetal swallowing and decreased gastrointestinal (GI) absorption of the AF.
We report a case of a baby with jejunal atresia who presented with BSAF. A large volume of bilious gastric aspirates was noted in the delivery room and, later, some sticky white meconium was noted in her rectum. Our case is a reminder that the greenish staining of AF could be secondary to in utero bilious vomiting or regurgitation and not necessarily due to meconium.
We thank Sylvia Sutton-Thorpe, Chrystal Puvabanditsin, and Christina Puvabanditsin for supporting this effort and preparing the manuscript.
No funding was received for writing this case report.
Availability of data and materials
Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.
SP, MSM, and SV have analyzed and interpreted the patient data and contributed in writing the manuscript. LW and CW revised the manuscript critically. All authors read and approved the final manuscript.
Ethics approval and consent to participate
This case report was not required to be approved and consented by the Ethical Committee at our institution.
Consent for publication
Written informed consent was obtained from the patient’s legal guardian(s) for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
The authors declare that they have no competing interests.
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