Association of gestational age, Apgar score and neonatal outcomes in newborns with meconium stained amniotic fluid
Keywords:Apgar score, Gestational age, Meconium stained amniotic fluid, Outcome
Background: Infants born with meconium stained fluid are at increased risk of fetal hypoxia, evidenced by increased rates of abnormalities indicated by fetal monitoring in labor, low neonatal Apgar scores, and fetal deaths. The study is conducted to determine association of gestational age, Apgar score and neonatal outcomes in newborn born with meconium stained amniotic fluid in tertiary care centre of central India.
Methods: The study was conducted over a period of 2 years from January 2012 to January 2014 in Department of Pediatrics, Sri Aurobindo Medical College and Hospital, Indore, Madhya Pradesh, India. One hundred newborns with meconium stained amniotic fluid (study group) and one hundred newborns with clear amniotic fluids (control group) were studied in this period. Gestational age, Apgar score and neonatal outcomes were compared among two groups.
Results: The mean gestational age in study group was 38.89±1.14 weeks and in control group was 38.59±0.99 weeks. The mean Apgar score at 1 min was 5.80±1.59 in study group and in the control group was 7.86±0.35. 32 babies in meconium stained liquor had hypoxia of which 11 had respiratory distress, 11 required mechanical ventilation (MAS 08, sepsis 03), 2 newborns had HIE stage 2 and 5 patients died. The above findings suggest higher gestational age, lower Apgar score and poor neonatal outcomes are associated with meconium stained liquor.
Conclusions: The study depicts significant co-relation with higher gestational age, lower Apgar at 1 and 5 minutes and poor neonatal outcome in babies with meconium stained amniotic fluid.
Adhikari M, Gouws E, Velaphi SC, Gwamanda P. Meconium aspiration syndrome: importance of the monitoring of labour. J Perinatol.1998;18:55-60.
Steer PJ, Eigbe F, Lissauer TJ, Beard RW. Interrelationships among abnormal cardiotocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH, and Apgar scores. Obstet Gynecol. 1989;74:715-21.
Yavner DL, Lage JM. Meconium peritonitis in still births. Pediatr Pathol. 1988;8:617-23.
Soukka HR, Kero PO, Kaapa PO. Biphasic increase in plasma endothelin concentration and pulmonary vascular resistance after meconium aspiration in pigs. Pediatric Res. 1996;39:350.
Gomella TL, Cunningham MD, Eyal FG. Neonatology: Management, Procedures, On-Call Problems, Diseases and Drugs. 7th Ed. Indian Edition. New Delhi: McGraw Hill Education Private Limited; 2013: 749-753.
Ostrea EM, Naqvi M. The influence of gestational age on the ability of the fetus to pass meconium in utero. Acta Obstet Gynecol Scand. 1982;61:275-9.
Mazor M, Furman B, Wiznitzer A, Vardi SI, Cohen J, Ghezzi F. Maternal and perinatal outcome of patients with preterm labor and meconium-stained amniotic fluid. Obstet Gynecol. 1995;86(5):830-3.
Kariniemi V, Harrela M. Significance of meconium staining of the amniotic fluid. J Perinat Med. 1990;18(5):345-9.
Darkhaneh RF, Asgharnia M, Yousefi TZ. Comparison of NRBC in term neonatal umbilical cord blood between neonate with meconium-stained amniotic fluid (MSAF) and clear amniotic fluid. J Turkish-German Gynecol Assoc. 2008;9(2):29-31.
Dollberg S, Livny S, Mordecheyev N, Mimouni FB. Nucleated red blood cells in meconium aspiration syndrome. Obstet Gynecol. 2001;97:593-6.
Wiswell TE, Henley MA. Intratracheal suctioning, systemic infection, and the meconium aspiration syndrome. Pediatrics. 1992;89:203-6.
Shivanna BS, Shivanna L, Rao R. Efficacy of Amnioinfusion for meconium stained liquor in labour in a rural hospital. IOSR J Dental Med Sci (IOSR-JDMS). 2014;13(5):7-11.
Eden RD, Seifert LS, Winegar A, Spellacy WN. Perinatal characteristics of uncomplicated postdate pregnancies. Obstet Gynecol. 1987;69:296-9.