Routine induction before 41 weeks reduces perinatal mortality, but only shows a trend towards reduction of mas. Before the 2005 guidelines, management of a newborn with meconium stained amniotic fluid included suctioning of the oropharynx and nasopharynx on the perineum after the delivery of the head but before the delivery of the shoulders. Nonsignificant msl is defined as a thin yellow or greenish tinged fluid, containing nonparticulate meconium. During the care of a baby born at 40 weeks of gestation, the resuscitation team remained focused on the removal of meconium from the trachea with multiple episodes of intubation and suctioning. All the data was collected by using a predesigned proforma. During the study period the total numbers of deliveries conducted were 908. If the amniotic fluid has been clear in labour and then becomes meconium stained. Meconium stained liquor and its fetal outcome retrospective. Predictability of intrapartum cardiotocography with. Aims and objectives to determine the effect on mode of delivery and fetal outcome in meconium stained liquor. Materials and methods this is a retrospective study conducted from july 2019 to december 2019 on patients admitted to labour room, vgh. Thin meconium stained liquor is translucent, light yellow green in colour, thick meconium is opaque and deep green in color. Mar 20, 2017 meconium aspiration syndrome mas is the aspiration of stained amniotic fluid, which can occur before, during, or immediately after birth. It is an important cause of neonatal morbidity and mortality in otherwise healthy term and postterm infants, with a case fatality rate approaching 40% 3.
Prevalence of meconium stained amniotic fluid and its. The consistency of meconium has a direct correlation with foetal outcome. Table 6 neonatal outcome according to grades of meconium stained liquor grade of meconium stained liquor n250 n35 asymptomatic routine care at birth nicu admission ventilator mas birth asphyxia 1 79 7 8. Meconium stained amniotic fluid msaf is frequent in obstetric and neonatal practice. Meconium staining of the amniotic fluid is a common problem occurring in 1022% of all deliveries. None of the midwives completely agreed with the standard assessment for more than 85 percent of the cases. Meconium stained liquor msl is the passage of meconium by a fetus in utero during the antenatal period or in labour. Frequency of meconium stained liquor in pregnancies complicated with intrahepatic cholestasis 420 p j m h s vol. A process to rapidly identify which meconium stained babies would benefit from intubation and suctioning.
To study the perinatal outcome in meconium stained amniotic fluid. This retrospective study was conducted from january 2012 to december 2012 on patients admitted to labour ward,psgimsr. Meconium aspiration syndrome mas is a common clinical entity usually associated with high mortality and morbidity. Intralipid treatment for newborns with meconium stained. Perinatal outcome in term pregnancies with meconium stained. Pdf meconium stained liquor and its neonatal outcome. The stained amniotic fluid called meconium liquor or meconium stained liquor is recognized by medical staff as a possible sign of fetal. Delivery of a newborn with meconiumstained amniotic fluid acog. To provide guidance when there is meconium staining of the amniotic fluid msaf. Outcome in meconium stained liquor in iog dissertation submitted to the tamilnadu dr. Fetal outcome in deliveries with meconium stained liquor.
A registry to assess the effect of the 2015 change on the outcome of nonvigorous meconium stained infants in the united states and elsewhere around the world. The risk of perinatal death is increased five to seven times when a thick meconium is present at the onset of labour. Table 1 depicts the fetal heart rate patterns associated with various degrees of meconium stained amniotic fluid. Effectiveness of intrapartum antibiotics for meconium. How ever, some fetuses may pass meconium in utero leading to meconium staining of amniotic. Effectiveness of intrapartum antibiotics for meconiumstained. All babies with significant meconium stained liquor will have a set of observations done at birth, 2 hours and two hourly after for 12 hours, for a minimum of 12 hours. Grade i meconium was present in 15 21% cases, grade ii in 19 27% and grade iii in 36 51% cases.
Meconium is the first intestinal discharge from newborns, a viscous, darkgreen substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions eg, bile. It is defined as a clinical syndrome characterised by meconium staining of amniotic fluid with or without its presence in oropharynx, trachea or both, development of respiratory distress after birth and radiological evidence of aspiration pneumonia. Medical university in partial fulfilment for the award of the degree of m. Ive often heard the term pea soup and seen it written in medical and nursing texts when speaking of meconium staining. To study the perinatal outcome in meconium stained. Antibiotics to identify and assess the characteristics, risk and outcome of neonates treated with empiric antibiotics for suspected early onset sepsis eos. Aug 01, 2016 meconium aspiration can happen in utero and this is precipitated by gasping of the fetus as a result of hypoxia. Meconium stained amniotic fluid msaf occurs as a result of the passage. Meconium stained amniotic fluid is associated with higher rate of caesarean delivery, increased need for neonatal resuscitation and meconium. Jan 19, 2018 meconium is composed of materials ingested during the time the infant spends in the uterus. No significant correlation was noted between maternal age and meconium staining of liquor but higher incidence of 11. Management of infants born through meconium stained amniotic. Original article neonatal outcome in cases of meconium.
Only a few studies from developing countries have looked at the. Original article foetal outcome in patients with meconium. Intrapartum amnioinfusion in meconiumstained liquor. For babies who are vigorous after exposure to meconium stained liquor, breathing or crying, good muscle tone, routine endotracheal suctioning discouraged because it does not alter their outcome is and may cause harm class a. All the 100 patients with meconium in amniotic fluid were electronically monitored during labour. All infants with meconium in the amniotic fluid, should have their nose, mouth and pharynx suctioned as soon as the head is delivered intrapartum suctioning regardless of whether the meconium is thin or thick.
To determine the prevalence of meconium stained liquor during labour associated risk factors and perinatal outcome in preterm, term and post term. When aspirated, meconium can cause obstruction, gas trapping, irritation and inflammation leading to damaged lung surfactant, pneumonitis and hypoxia. Broadly speaking there are two classifications of meconium stained liquor msl, nonsignificant and significant. Meconium stained amniotic fluid king edward memorial hospital.
Meconium in labour obstetrics, gynaecology and reproductive. Frequency distribution of meconium stained amniotic fluid meconium stained amniotic fluid frequency %age. Delivery of a newborn with meconiumstained amniotic fluid. Thorough and careful soft catheter suctioning of both the nasal and oral airway of an infant from a meconium stained liquor delivery is recommended. Meconium staining causes, prognosis, management, define. Meconium stained liquor msl in labour and management of the. Meconium stained liquor msl in labour and management of the newborn clinical guideline v2. Meconium stained liquor in labour and mode of delivery. Pdf perinatal outcome in meconium stained liquor iosr. Meconium stained liquor background meconium stained liquor occurs in 1020% of deliveries, increasing to over 30% after 42 weeks gestation meconium aspiration syndrome occurs in 25% of babies born through meconium stained liquor significant meconium at onset of labour carries the worst prognosis and is associated with. Meconium stained amniotic fluid grade ii 408793000 recent clinical studies. Association of meconium stained liquor with low amniotic. Louise van heijst is an independent midwife practicing in leiden.
Thick meconium stained amniotic fluid was associated with low apgar score, high rate of emergency cesarean section and meconium aspiration syndrome. Frequency of meconium stained liquor in pregnancies. This will be recorded in the baby observation chart and filed in either maternal or neonatal health care record. Management of babies born through meconiumstained liquor. The meconium stained amniotic fluid is a clinical diagnosis with no practical confirmatory test. Meconium staining of amniotic fluid is commonly observed phenomenon in labour and is frequently associated with prolonged labour. Assessing the risks of meconiumstained liquor ausmed. What is the effectiveness of scoringgrading systems for improving neonatal and maternal outcomes when there is meconium stained liquor. Pdf meconium stained liquor and perinatal outcome researchgate.
This will be recorded in the baby observation chart and filed in either maternal or. According to royal college of obstetricians and gynecologists rcog intrapartum care guideline, meconium stained amniotic fluid is. Meconium staining of amniotic fluid a poor indicator of. Declaration i solemnly declare that this dissertation study on risk factors and perinatal outcome in meconium stained liquor in iog was prepared by me under the guidance and supervision of prof.
Frequency distribution of meconium stained amniotic fluid meconium stained amniotic fluid frequency %age yes 42 29. Meconium stained amniotic fluid in labour international journal of. Management of infants born through meconium stained. Meconium is normally retained in the infants bowel until after birth, but sometimes it is expelled into the amniotic fluid also called amniotic liquor prior to birth or during labor and delivery. Meconium stained liquor msl in labour and management. Thirty nine percent had lms liquor, 43% had mms while 18% had tms.
Meconium stained amniotic fluid occurs in approximately 12% of all deliveries and increases the risk of maternal complications e. Keirse is professor of obstetrics at the flinders university of south australia. According to royal college of obstetricians and gynecologists rcog intrapartum care guideline, meconium stained amniotic fluid is classified as significant msl and nonsignificant msl. Predictability of intrapartum cardiotocography with meconium. Out of 267 cases 165 cases61% delivered by caesarean section remaining 102 cases delivered vaginally. The incidence of abnormal fetal heart rate patterns, increased incidence of operative deliveries for impending fetal hypoxia, and poor neonatal outcomes is greater when there is thick meconium stained liquor. Godelieve van roosmalen is a midwife at leiden university hospital, leiden, the netherlands. Meconium stained liquor occurs in 1020% of deliveries, increasing to over 30% after 42 weeks gestation meconium aspiration syndrome occurs in 25% of babies born through meconium stained liquor significant meconium at onset of labour carries the worst prognosis and is associated with. Meconium stained amniotic fluid king edward memorial. If the amniotic fluid is merely colored or stained with meconium but there is no. Perinatal outcome of meconium stained amniotic fluid. Meconium stained liquor, meconium is a dark green liquid normally passed by the newborn baby.
Meconium aspiration syndrome mas is a result of ante or postpartum aspiration of meconium stained amniotic fluid in term or nearterm infants resulting in respiratory morbidity of varying severity. This not only assists in the prevention of acute upper airway obstruction and aspiration in the newborn but also, as in this case, of late onset upper airway obstruction by hardened meconium in the. Meconium stained amniotic fluid were associated with higher rate of caesarian delivery, increased need for neonatal resuscitation, increased rate of birth asphyxia with hypoxic ischemic encephalopathy, meconium aspiration syndrome, hospital admission and mortality. Predictors of mortality in neonates with meconium aspiration. In this study, it was observed factors like caesarean section and thick meconium increased risk of respiratory distress in the neonates born through meconium stained amniotic fluid who were vigorous. Meconium stained liquor and its neonatal outcome ncbi nih. Fetal outcome in deliveries with meconium stained liquor vaghela. Perinatal outcome of meconium stained liquor in preterm, term and. Meconium aspiration syndrome is a spectrum of respiratory distress in a neonate born through meconium stained liquor.
Labour, meconium stained liquor, perinatal outcome. Four samples each of clear and lightly thin, moderately, and heavily thick meconium. Therefore, tracheal suction is recommended for infants born depressed and with thick meconium stained amniotic fluid. When baby passes meconium in utero, making amniotic fluid light to dark green, it gives rise to a condition of meconium stained liquor.
To assess the frequency of meconium stained liquor and related factors. Meconium is a viscous dark green substance composed of intestinal. In our study 71 patients had thick meconium stained liquor and majority of them underwent l. In 2006, the american academy of pediatrics and the american heart association published the 2005 guidelines on neonatal resuscitation. In our study 71 patients had thick meconium stained liquor and majority of. The meconium staining of the amniotic fluid was divided in thin and thick meconium by visual examination after spontaneous or artificial rupture of membranes. Is the presence of meconium stained liquor always dangerous. Passage of meconium usually occurs within 48 hours after birth. Perveen f, khan a, ali t, rabia s j coll physicians surg pak 2015 sep. To determine the fetal outcome and mode of delivery in patients with meconium stained liquor during labour. Any baby with initial depression requiring more prolonged resuscitation or if meconium is aspirated from below the cords they should be assessed by the neonatal team and admission to the neonatal unit considered. Meconium stained liquor msl is a common problem in obstetrics, but its management at district level causes some specific questions.
Meconium stained liquor and its maternal and foetal outcome. Meconium stained liquor guideline gl877 royal berkshire. Out of 2124 deliveries,250 patients who met the inclusion criteria were enrolled in our study. The aim of this study is to know the association between the meconium stained amniotic fluid and its association with the perinatal. Management of babies born through meconium stained liquor situation during the care of a baby born at 40 weeks of gestation, the resuscitation team remained focused on the removal of meconium from the trachea with multiple episodes of intubation and suctioning. Meconiumstained amniotic fluid obstetrics, gynaecology and. This guideline gives guidance to midwives, obstetricians and neonatal staff on the management of meconium stained liquor in labour and the initial management of a baby born through meconium. Labour, meconium stained liquor, apgar score, caesarean section.
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