Fetal outcomes of cord milking in term babies with meconium-stained amniotic fluid in a tertiary care centre: interventional type of study

Abstract

Background: Umbilical cord milking (UCM) is proposed for increasing placental transfusion when immediate care for the newborn is needed enables blood to be directed into the baby more quickly than delayed cord clamping (DCC)  at birth than waiting for this to happen physiologically. Any form of stress on the fetus and to mother can induce passage of meconium.⁶ Meconium-stained amniotic fluid results in increase the need of neonatal assistance, due to adverse outcomes such as respiratory distress, lower Apgar score, meconium aspiration syndrome and neonatal sepsis. From studies, it was observed that there was a gap in study of cord milking in term babies with MSAF. It was hypothesized that umbilical cord milking to be more beneficial that delayed as it can be performed more quickly, to babies with meconium-stained liquor requiring resuscitatory efforts. Therefore, a study was conducted to evaluate the maternal and fetal profile of term babies with meconium-stained liquor and their outcome on umbilical cord milking at the time of delivery.

Methods: A interventional type of study was conducted with a sample size of 200 labouring patients admitted in labour ward with gestational age between 37 to 42 weeks with meconium-stained amniotic fluid in Tertiary Care Centre. Details regarding patient’s demographics, detailed history of period of gestation, high risk factors, past history, patient’s entire obstetric history was noted. During delivery, if cord milking and clamping done was noted. Fetal wellbeing through APGAR score of baby, resuscitation required, hematocrit at 48 hours, DSPT required and their septic screening results; was evaluated.

Results: The present study was carried out on 200 labouring patients with meconium-stained amniotic fluid, admitted in labour ward in a tertiary health care centre. Baseline characteristics were comparable in both the groups. When we compared fetal profile in babies whose cord milking was done and in whom cord milking was not done, we observed that babies under UCM group, had better Apgar scores (at 1 min: 6.23 vs 5.77, p=0.0082) (at 5 min: 8.17 vs 7.36, p<0.0001), required less NICU admission, more hematocrit (53.58 vs 48.70, p<0.0001) and lower mortality (25% vs 75%) than non-milking group.

Conclusions: Meconium-stained amniotic fluid is worrisome as it is associated with increased frequency of operative delivery, neonatal sepsis and neonatal intensive care unit admissions which requires appropriate intrapartum care. UCM can be a used as a placental transfusion strategy in neonates with meconium-stained amniotic fluid, requiring resuscitation with some benefits and minimum adverse effects. It could be considered as an alternative for the current practice of delayed cord clamping.