Maternal risk factors and perinatal outcome in meconium stained amniotic fluid: a cross sectional study
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20184136Keywords:
Maternal risk factor, Meconium staining of amniotic fluid, PregnancyAbstract
Background: Meconium staining of amniotic fluid has long been regarded as a sign of fetal distress and fetal asphyxia. Although exact cause is unknown, meconium is thought to be passed from fetal gastro-intestinal tract as a response to hypoxia, mesenteric vasoconstriction induced gut hyper peristalsis, vagal stimulation and normal physiologic function of a mature fetus. Overall frequency has ranged from 5 to 24.6%. Present study is undertaken to detect incidence, mode of delivery, fetal heart rate variability and neonatal outcome in neonates born through MSAF. The objective of the study was to maternal risk factors, mode of delivery and perinatal outcome in labors complicated with meconium stained amniotic fluid.
Methods: This is a cross sectional study done at Government Medical College, Thrissur on term, singleton pregnancies complicated with meconium stained amniotic fluid satisfying the inclusion criteria. Patients detailed history, gestational age, per abdominal examination, per speculum and per vaginal examination, admission tests including intrapartum cardiotocography (CTG) was recorded in a predesigned proforma.
Results: The age of the patients varied between above 19 and 30 years. Majority of the study population were 69.3% Primi gravidas. Out of 130 cases, 56.2% were grade 2 meconium stained liquor, 30.7% were grade 3 meconium stained and 13.1% were grade 1 meconium stained. Association between neonatal complications in relation to grades of meconium was found to be statistically significant (p = 0.001). NICU admission was 24.7% in grade 2 meconium group. Hypoxic Ischemic encephalopathy was high in grade 3 meconium group, 45%. Majority of babies born through grade 1 meconium were asymptomatic and 10% of babies in grade 3 meconium groups were asymptomatic. Meconium aspiration syndrome, Respiratory distress were more in babies born through deliveries complicated with grade 3 meconium.
Conclusions: The study indicated meconium stained amniotic fluid during labour increases the prevalence of abnormal intrapartum CTG, Caesarean section, lower Apgar score, increased duration of NICU and hospital stay, poor perinatal outcome and non-significant difference in incidence of lower birth weight in babies.
References
Oyelese Y. Placenta, umbilical cord and amniotic fluid: the not-less-important accessories. Clinical Obstet Gynecol. 2012;55(1):307-23.
Yurdakok M. Meconium aspiration syndrome: do we know?. Turkish J Pediatr. 2011;53(2):121-9.
Gongora MC, Wenger NK. Cardiovascular Complications of Pregnancy. Int J Mol Sci. 2015;16(10):23905-28.
Lee J, Romero R, Lee KA, Kim EN, Korzeniewski SJ, Chaemsaithong P, et al. Meconium aspiration syndrome: a role for fetal systemic inflammation. Am J Obstet Gynecol. 2016;214(3):366-e1.
Afsar S, Motwani NP, Sudhakar C, Chaturvedi U. Evaluation of neuro-developmental outcome among babies with meconium aspiration syndrome. Int J Contemp Pediatr. 2016;3(4):1185-8.
Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J Clinical Diagnost Res: JCDR. 2013;7(12):2874-6.
Galal M, Symonds I, Murray H, Petraglia F, Smith R. Postterm pregnancy. Facts Views Vis Obgyn. 2012;4(3):175-87.
Caughey AB, Snegovskikh VV, Norwitz ER. Postterm pregnancy: how can we improve outcomes? Obstet Gynecol Survey. 2008;63(11):715-24.
Boujenah J, Oliveira J, De La Hosseraye C, Benbara A, Tigaizin A, Bricou A, et al. Should fetal scalp blood sampling be performed in the case of meconium-stained amniotic fluid?. J Mat-Fet Neonat Med. 2016;29(23):3875-8.
Persson M, Razaz N, Tedroff K, Joseph KS, Cnattingius S. Five and 10 minute Apgar scores and risks of cerebral palsy and epilepsy: population based cohort study in Sweden. BMJ. 2018;360:k207.
Sakoda A, Ikuma S, Baba M, Sato M, Sumikura H. Review of 197 cases of urgent cesarean section performed in 2010 using NICE classification. Masui. Japanese J Anesthesiol. 2014;63(12):1339-43.
Shaikh EM, Mehmood S, Shaikh MA. Neonatal outcome in meconium stained amniotic fluid-one year experience. JPMA The Journal of the Pakistan Medical Association. 2010;60(9):711-4.
Sundaram R, Murugesan A. Risk factors for meconium stained amniotic fluid and its implications. Int J Reprod Contracept Obstet Gynecol. 2017;5(8):2503-6.
Naveen S, 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.
Pariente G, Peles C, Perri ZH, Baumfeld Y, Mastrolia SA, Koifman A, et al. Meconium-stained amniotic fluid–risk factors and immediate perinatal outcomes among SGA infants. J Mat-Fet Neonat Med. 2015;28(9):1064-7.
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.
Bansal N, Gupta V, Nanda A, Chaudhary P, Tandon A, Behl N. Intrapartum amnioinfusion in meconium-stained liquor: a case–control study. J Obstet Gynaecol India. 2013;63(3):164-7.
Qadir S, Jan S, Chachoo JA, Parveen S. Perinatal and neonatal outcome in meconium stained amniotic fluid. Int J Reprod Contracept Obstet Gynecol. 2017;5(5):1400-5.
