Neonatal outcome in meconium stained amniotic fluid: a hospital based study
Background: Amniotic fluid surrounds the baby in utero and provides a protective and low resistance environment and acts as a cushion for the baby. It is secreted by amniotic membranes, foetal skin and fetal urine. The objectives of this study was to identify the incidence of meconium stained amniotic fluid, perinatal outcome and the risks during pregnancy leading to in utero passage of meconium.
Methods: A prospective study conducted in Sri Guru Ram Das University, Amritsar, between 1st December 2014 to 1st June 2016. All live births with meconim stained amniotic fluid without congenital malformation, twin or multiple organ dysfunction were taken as subjects of this study. Maternal obstetric history and risk factors were asked and foetal parameters including gestational age, fetal presentation, mode of delivery, birth weight, sex, Apgar score, age at onset of respiratory distress, treatment and outcome were observed.
Results: Out of 1121 admissions in NICU, 12% of inborn and 9.6% of outborn were with MSAF, out of which 34% developed MAS. Majority of neonates were observed to be males (73.6%), term neonates (67.2%), weight 2.5-3.5 kg (76.9%) with mean weight being 2.701 kg±0.558 kg and 16% mortality including 9 inborn and 11 outborn neonates. Mean age at onset of respiratory distress was 18.43 minutes±11.52 minutes. Neonatal outcome was significantly related to weight, APGAR score at 5 mins, and development of complications like MAS, hypoxic ischemic encephalopathy, necrotizing enterocolitis, acute renal failure and severe thrombocytopenia. Culture proven septicaemia was seen in 21.6% cases. Mean duration of stay in NICU was 6.48 days±0.54 days.
Conclusions: MSAF has significant effect on perinatal outcome and close observation is required to prevent and treat complications thus reducing mortality.
Ross MG. Meconium aspiration syndrome - more than intrapartum meconium. N Engl J Med. 2005;353:946-8.
Locatelli A, Regalia AL, Patregnani C, Ratti M, Toso L, Ghidini A. Prognostic value of change in amniotic fluid color during labor. Fetal Diagn Ther. 2005;20:5-9.
Rossi EM, Elliot H, Philipson, Thomas G. Meconium aspiration syndrome: Intrapartum and Neonatal Attributes. American journal of obstetrics and gynaecology. 1989;161:1106.
Nizami SQ, Arif MA. Reapiratory distress syndrome among hospital born infants. Pak Paediatr J. 1985;9:276-82.
Wiswell TA, Bent RC. Meconium staining and the meconium aspiration syndrome, unresolved issues, In Pediatric clinics of North America. Updates on Neonatalogy. 1993;40:955-81.
Brown BL, Gleicher N. Intrauterine meconium aspiration. Obstet Gynecol. 1981;57:26-9.
Cochran WG. Sampling techniques. 3rd ed. New York. John Wiley and Sons; 1977:81.
Orimadegun AE, Akinbami FO, Tongo OO, Okereke JO. Comparison of neonates born outside and inside hospitals in a children emergency unit, Southwest of Nigeria. Pediatr Emerg Care. 2008;24:354-8.
Owa JA, Osinaike AI. Neonatal morbidity and mortality in Nigeria. Indian J Pediatr. 1998;65:441-9.
Roy RN, Nandy S, Shrivastava P, Chakraborty A, Dasgupta M, Kundu TK. Mortality pattern of hospitalized children in a tertiary care hospital of Kolkata. Indian J Community Med. 2008;33:187-9.
Morbidity and mortality among outborn neonates at 10 tertiary care institutions in India during the year 2000. J Trop Pediatr. 2004;50:170-4.
Jeena S, Singh A, Arya A. Perinatal outcomes associated with meconium stained non-vigorous babies in a tertiary centre of Uttarakhand. J Biomed Pharma Res. 2014;3(1):81-7.
Saldana LR, Schulman H, Lin C. Routine amnioscopy at term. Obstet Gynecol. 1976;47:521-4.
Hanoudi BM, Murad AM, Ali AD. Meconium staining of amniotic fluid: a clinical study. British J Med Res. 2014;4(3):914-21.
Sharma U, Garg S, Tiwari K, Hans PS, Kumar B. Perinatal outcome in meconium stained amniotic fluid. J Evol Med Dent Sci. 2015;(48):8319-27.
Sankhyan N, Kumar SV, Ritu S, Kushia P. Predictors of meconium stained amniotic fluid: A possible strategy to reduce neonatal morbidity and mortality. J Obstet Gynecol India. 2006;56(6):514-7.
Afsar S, Motwani NP, Sudhakar C, Chaturvedi U. Assessment of incidence, determinants and co-morbidities associated with meconium aspiration syndrome: a hospital based study. Internat J Contem Pediatr. 2016;3(4):1216-20.
Malik AS, Hilman D. Meconium aspiration syndrome and neonatal outcome in a developing country. Ann Trop Pediatr. 1994;14:47-51.
David AN, Njokanma OF, Iroha E. Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hospital. J Obstet Gynaecol. 2006;26:518-20.
Gauchan E, Basnet S, Malla T. Meconium aspiration syndrome and neonatal outcome: a prospective study. Amer J Pub Health Res. 2015;28:3(5A):48-52.
Errkola R. Meconium aspiration syndrome. Ann Chir Gynecol Supple. 1994;208:106-9.
Eiden RD, Seitert CS, Winegar A. Perinatal characteristics of uncomplicated postdates pregnancy. Obstect Gynecol. 1987;151:731.
Ashtekar SD, Gaikwad RSNK. Clinical study of meconium aspiration syndrome in relation to birth weight and gestational maturity at general hospital Sangli. Internat Med J. 2014;1(5):189-92.
Goud P, Krishna U. Significance of meconium stained amniotic fluid in labour. J Obst Gynecol India. 1989;39:523-6.
Narang A, Nair PMC, Bhakoo ON, Vashist K. Management of meconium stained amniotic fluid- A team approach. Indian Pediatr. 1993;30:9-13.
Gregory GA, Charles A, Roderic H. Meconium aspiration in infants: a prospective study. J Paediatr. 1974;85:848.
Miller FC, Sacks DA, Yeh SY. Significance of meconium during labor. Am J Obstet Gynecol. 1975;122:573-80.
Anwar Z, Butt TK, Anjum F, YaqubKazi Md. Mortality in meconium aspiration syndrome in hospitalized babies. J Col Physic Surg Pak. 2011;21(11):695-9.
Narlı N, Kırımi E, Satar M, Türkmen M, Halaza M, Yapıcıoğlu H. Evaluation and management of neonates with meconium stained amniotic fluid. East J Med. 2001;6(1):18-21.
Priyadharshini M. Meconium stained liquor and its fetal outcome - retrospective study. IOSR-JDMS. 2013;6(2):27-31.