Posted: November 9th, 2023

In meconium-stained amniotic fluid, the perinatal outcome

In meconium-stained amniotic fluid, the perinatal outcome
Meconium-stained amniotic fluid (MSAF) is a common occurrence during labour and delivery, affecting about 10% to 15% of all births . Meconium is the first stool of the newborn, which is normally passed after birth. However, sometimes the fetus may pass meconium into the amniotic fluid before or during labour, due to various factors such as fetal distress, hypoxia, infection, or post-term pregnancy .

MSAF can have adverse effects on both the mother and the baby, depending on the severity and timing of meconium passage, the presence of fetal heart rate abnormalities, and the management of labour and delivery. Some of the possible complications of MSAF include:

– Increased risk of operative delivery, such as caesarean section or instrumental delivery, due to prolonged labour, fetal distress, or failure to progress .
– Increased risk of maternal infection, such as chorioamnionitis or endometritis, due to the presence of bacteria in the meconium .
– Increased risk of neonatal morbidity and mortality, such as low Apgar scores, birth asphyxia, meconium aspiration syndrome (MAS), neonatal sepsis, or neonatal death . MAS is a serious condition where the meconium enters the lungs of the baby and causes inflammation, obstruction, and infection of the airways .

Therefore, it is important to identify and manage MSAF appropriately to prevent or minimize these complications. Some of the recommended practices for MSAF include:

– Monitoring the fetal heart rate continuously during labour and delivery to detect any signs of fetal distress or hypoxia .
– Performing amnioinfusion if there is thick meconium or oligohydramnios (low amniotic fluid volume). Amnioinfusion is a procedure where saline solution is infused into the uterus through a catheter to dilute the meconium and improve the fetal blood flow .
– Avoiding routine suctioning of the mouth and nose of the baby before delivery of the shoulders, as this may stimulate gasping and increase the risk of MAS .
– Performing endotracheal suctioning of the baby after delivery if there is evidence of MAS, such as depressed breathing, low heart rate, or poor muscle tone. Endotracheal suctioning is a procedure where a tube is inserted into the windpipe of the baby to remove any meconium from the lungs .
– Providing resuscitation and supportive care to the baby as needed, such as oxygen therapy, antibiotics, or mechanical ventilation .

In conclusion, MSAF is a potentially hazardous condition that requires careful monitoring and management to prevent or reduce its negative impact on the mother and the baby. By following the evidence-based guidelines and protocols for MSAF, health care providers can improve the obstetric and perinatal outcome of pregnancies with term labour and MSAF.

References:

: Tolu LB, Birara M, Teshome T, Feyissa GT (2020) Perinatal outcome of meconium stained amniotic fluid among labouring mothers at teaching referral hospital in urban Ethiopia. PLoS ONE 15(11): e0242025. https://doi.org/10.1371/journal.pone.0242025

: Wiswell TE (2001) Meconium aspiration syndrome: historical aspects. Journal of Perinatology 21: S2-S7. https://doi.org/10.1038/sj.jp.7210624

: Yurdakök M (2011) Meconium aspiration syndrome: do we know? Turkish Journal of Pediatrics 53: 121-129. https://www.ncbi.nlm.nih.gov/pubmed/21980860

: Nayeri F, Shariat M (2012) Effects of meconium-stained amniotic fluid on perinatal complications in term pregnant women. Iranian Journal of Reproductive Medicine 10: 137-142. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941359/

: Kattwinkel J (ed.) (2011) Textbook of Neonatal Resuscitation (6th ed.). American Academy of Pediatrics and American Heart Association.

: American College of Obstetricians and Gynecologists (2019) Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Obstetrics and Gynecology 133: e110-e127. https://doi.org/10.1097/AOG.0000000000003078

: Hofmeyr GJ, Xu H, Eke AC (2014) Amnioinfusion for meconium-stained liquor in labour. Cochrane Database of Systematic Reviews 1: CD000014. https://doi.org/10.1002/14651858.CD000014.pub3

: Wyckoff MH, Aziz K, Escobedo MB, et al. (2015) Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 132: S543-S560. https://doi.org/10.1161/CIR.0000000000000267

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