DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20211149

Meconium-stained liquor and its impact on maternal and neonatal outcome

Shweta Kashikar, Monika K. Kotpalliwar, Pooja R. Uttarwar

Abstract


Background: Meconium stained amniotic fluid (MSAF) is predictor of adverse fetal outcomes. However, all fetuses with meconium passage do not have an adverse outcome and it is important to distinguish those who develop fetal distress promptly to prevent and intervene the sequalae accordingly. Hence this study was undertaken to study the grades of meconium stained liquor and its effect on intrapartum management and relation with maternal and neonatal outcome.

Methods: A prospective observational study was conducted on term pregnancy patients. Firstly, the detailed case history and examination was performed. When membranes ruptured the colour of liquor was noted. Fetal monitoring by cardiotocography (CTG) was done continuously throughout labour. The mode of delivery, cord pH and base excess were noted. After the delivery Apgar score and weight of the baby, need for resuscitation, neonatal intensive care unit (NICU) admissions and neonatal complications were noted.

Results: Of the 3117 deliveries conducted during the study period, 321 cases (10.29%) had meconium stained liquor out of whom, 183 women (57%) were with thin meconium and 138 (43%) had thick meconium. There was no risk factor identified in the majority of women. The CTG was reactive in most women with thin meconium (71.5%). There was a significantly higher incidence of pathological CTG’s in women with thick meconium (36.3%) (p value = 0.001). There was no significant difference in birth weight Apgar scores, cord pH, base excess in both the groups and rate of NICU admission.

Conclusions: Maximum patients with thin meconium and reactive CTG included in our study delivered normally with good neonatal outcome. However presence of thick meconium in addition to other factors such as fetal heart rate alterations should be viewed seriously as it may pose a potential danger for the baby.


Keywords


Fetal distress, Meconium stained amniotic fluid

Full Text:

PDF

References


Mohammad N, Jamal T, Sohaila A, Ali SR. Meconium stained liquor and its neonatal outcome. Pak J Med Sci. 2018;34(6):1392-6.

Addisu D, Asres A, Gedefaw G, Asmer S. Prevalence of meconium stained amniotic fluid and its associated factors among women who gave birth at term in Felege Hiwot comprehensive specialized referral hospital, North West Ethiopia: a facility based cross-sectional study. BMC Pregnanc Childbirth. 2018;18(1):429.

Khatun MHA, Arzu J, Haque E, Kamal M, Al Mamun MA, Khan MFH, et al. Fetal outcome in deliveries with meconium stained liquor. Bangladesh J Child Health. 2009;33(2):41-5.

Desai D, Maitra N, Patel P. Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):1030-5.

Sori D, Belete A, Wolde M. Meconium stained amniotic fluid: factors affecting maternal and perinatal outcomes at Jimma University specialized teaching hospital, south West Ethiopia. Gynecol Obstet. 2016;6(394):1-6.

Jain PG, Sharma R, Bhargava M. Perinatal outcome of meconium stained liquor in pre-term, term and post-term pregnancy. Indian J Obstet Gynecol Res. 2017;4(2):146-50.

Desai D, Chauhan K, Chaudhary S. A study of meconium stained amniotic fluid, its significance and early maternal and neonatal outcome. Int J Reprod Contracept Obstet Gynecol. 2013;2(2):190-3.

Parvin I, Khanam N, Alam A. Management practices in cases with meconium stained amniotic fluid (MSAF) Babies. 2008;6(12):102-5.

Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J Clin Diagn Res. 2013;7(12):2874-6.

Jain PG, Sharma R, Bhargava M. Perinatal outcome of meconium stained liquor in pre-term, term and post-term pregnancy. Indian J Obstet Gynecol Res. 2017;4(2):146-50

Walsh MC, Fanaroff JM. Meconium stained fluid: Approach to the mother and the baby. Clin Perinatol. 2007;34(4):653-65.

Patil KP, Swamy MK, Samatha K. A one year cross sectional study of management practice of meconium stained amniotic fluid and perinatal outcome. J Obstet Gynecol India. 2006;56:128-30.

Miller FC, Sacks DA, Yeh SY, Paul RH, Schifrin BS, Martin CB, et al. Significance of meconium during labor. Am J Obstet Gynecol. 1975;122:573-80.

Ziadeh SM, Sunna E. Obstetric and perinatal outcome of pregnancies with term labour and meconium stained amniotic fluid. Arch Gynecol Obstet. 2000;264:84-7.

Arulkumaran S, Yeoh SC, Gibb DMF, Ingemarsson I, Ratnam SS. Obstetric outcome of meconium stained liquor in labour. Singapor Med J. 1985;26(7):523-6.

Hiremath PB, Gane B, Meenal C, Bansal N, Ragaramya. The management practices and outcome of meconium stained amniotic fluid. Int J Biol Med Res. 2012;3(3):2204-7.

Bhatia P, Ela N. Fetal and neonatal outcome of babies in meconium stained amniotic fluid and meconium aspiration syndrome. J Obstet Gynecol India. 2007;57(7):501-4.

Leonard JL. The significance of meconium stained amniotic fluid in cephalic presentation. Obstet Gynecol. 1961;20(3):320-3.

Chhabra S, Dargan R, Nasare M. Post date pregnancies: management options. J Obstet Gynecol India. 2007;57(4):307-10.

Rao B, Chandrashekhar GS, Rao D, Hegde P, Ghate SV. Meconium stained amniotic fluid- a prospective study. Karnataka Paediatr J. 2011;25(1):21-6.

Gupta V, Bhatia BD, Mishra OP. Meconium stained amniotic fluid: Antenatal, intrapartum and neonatal attributes. J Indian Pediatr. 1996;33:293-7.

Benirschke K, Kaufmann P. Pathology of the Human Placenta. 4th edn. New York: Springer-Verlag; 2000:653-659.

Shaikh EM, Mehmood S, Shaikh MA. Neonatal outcome in meconium stained amniotic fluid- one year experience. J Pak Med Assoc. 2010;60(9):711-4.

Sasikala A, Raghavan S, Mishra N, Khatoon S, Bupathy A, Rani R. Perinatal outcome in relation to mode of delivery in meconium stained amniotic fluid. Indian J Pediatr. 1995;62(1):63-7.

Sankhyan N, Sharma VK, Sarin R, Pathania K. Predictor of meconium stained amniotic fluid: a possible strategy to reduce neonatal morbidity and mortality. J Obstet Gynecol India. 2006;56(6):514-7.

Narli N, Kirimi E, Satar M. Evaluation and Management of Neonates with meconium stained amniotic fluid. East J Med. 2001;6(1):18-21.

Pusl T, Beuers U. Intrahepatic cholestasis of pregnancy. Orphanet J Rare Dis. 2007:1-6.

Dang A, Agarwal N, Bathla S, Sharma N and Balani S. Prevalence of liver disease in pregnancy and its outcome with emphasis on obstetrics cholestasis: an Indian scenario. J Obstet Gynecol India. 2010;60:413-8.

Klufio CA, Amoa AB, Kariwiga G, Rageau O. A case control study of meconium staining of amniotic fluid in labour at Port Moresby General Hospital to determine associated risk factors and perinatal outcome. Papua New Guinea Med J. 1996;39:297-309.

Blackwell SC, Wolfe HM, Redman ME, Hassan SS, Berry SM, Treadwell MC, et al. Relationship between meconium staining and amniotic fluid volume in term pregnancies. Fetal Diagn Ther 2002;17(2):78-82.

Rathor AM, Singh R, Ramji S, Tripathi R. Randomized trial of amnioinfusion during labour with meconium stained amniotic fluid. Br J Obstet Gynaecol. 2002;109(1):17-20.

Starks GC. Correlation of meconium stained amniotic fluid, early intrapartum fetal pH and Apgar score as predictors of perinatal outcome. Obstet Gynecol. 1980;56:604-9.

Fujikura T, Klionsky B. The significance of meconium staining. Am J Obstet Gynecol. 1975;121:45-50.

Steer PJ, Eigbe F, Lissauer TJ, Beard RW. Interrelationships among abnormal cardiotocograms in labors, meconium staining of the amniotic fluid, arterial cord blood pH, and Apgar scores. Obstet Gynecol. 1989;74(5):715-21.

Shakira P. Umbilical cord article blood base excess as gold standard for foetal well-being screening test validity at term delivery. J Pak Med Assoc. 2010;60:347-50.

Jazayeri A, Politz L, Tsibris JC, Queen RN, Spellacy WN. Fetal erythropoietin levels in pregnancies complicated by meconium passage: does meconium suggest fetal hypoxia? Am J Obstet Gynecol. 2000;183(1):188-90.

Bhat RY, Rao A. Meconium stained amniotic fluid and meconium aspiration syndrome: a prospective study. Ann Trop Pediatr. 2008;28(3):199-203.