Study of perinatal outcome of labour complicated with meconium stained liquor
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20183757Keywords:
Foetal outcomes, LSCS, Meconium stained liquor, Neonatal intensive careAbstract
Background: Meconium stained amniotic fluid occurs in 9 to 20% of deliveries. It has long been implicated as a factor influencing foetal wellbeing during the intrapartum and postpartum period. Many authors have suggested that the type and the time of passage of meconium are most significant factors affecting foetal outcome. This study was carried out to find out the effect of meconium stained liquor during labour and its perinatal outcome.
Methods: This prospective cross sectional and comparative study was carried out in a tertiary care hospital over a period of 1 year. The study group comprised of 118 women having MSAF during labour and the comparative group of 118 women with clear amniotic fluid which were randomly selected. The demographic data, obstetrical history, intrapartum findings and Apgar score were documented on predesigned proforma. Data collected was analysed using student t-test, chi square test, Z test for comparison of proportions and coefficient of variation for comparison of consistency of distributions.
Results: Out of 1192 cases studied 118 cases showed presence of meconium stained liquor (9.89%). Caesarean section was performed in 41.52% cases with meconium stained liquor versus 31.35% in clear liquor group. Apgar score at 1 minute was significantly lower in meconium stained liquor (p<0.01). In meconium stained liquor group 42.37% foetuses had normal, 36.44% had suspicious and 21.18% had abnormal heart rate patterns respectively. There was no significant difference in the number of cases requiring NICU admission in meconium stained liquor (14.4%) and clear liquor groups (9.3%) (Z=1.214, P>0.05).
Conclusions: Meconium staining is a commonly observed phenomenon. labour complicated with thick meconium stained liquor should ideally be categorised in to high risk obstetrics and managed in tertiary care with consultant obstetrician, consultant neonatologist and NICU in order to improve the perinatal outcome.
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References
Berkus MD, Langer 0, Samuelloff A, Xenakis EM, Field NT, Ridgeway LE. Meconium stained amniotic fluid: increased risk for adverse outcome. Obstet Gynecol. 1994;84:115-20
Nathan L, Leveno KJ, Camody TJ 3'd, Kelly MA Sherman ML. Meconium: a1990s perspective on an old obstetric hazard. Obstet Gynecol. 1994;83:329- 32.
Low JA, Pancham SR, Worthington, Bolton RW: The incidence of fetal asphyxia in 600 high risk monitored pregnancies. Am J Obstet Gynecol. 1975;121:456-9.
Meis PJ, Hall M, Marshall JR, Hobel CG. Meconium passage; a new classification for risk assessment during labour. Am J Obstet Gynecol. 1978;131:509-13.
Fujikura T, Klionsky B. The significance of meconium staining. Am J Obstet Gynecol. 1975;121:45-50.
Miller FC. Meconium staining of the amniotic fluid. Clinics Obstet Gynecol. 1979;6:359-65.
D.C. Dutta Text book of obstetrics 6th edition, Calcutta, New central book agency;2004:610.
Patil Kamal P, Swamy MK, Samatha K. A one year cross sectional study of management practices of meconium stained amniotic fluid and perinatal outcome, J Obstet Gynecol. 2006; 56(2):128-30.
Arulkumaran S, Yeoh SC, Gibb DM, Ingemarsson I, Ratnam SS. Obstetric outcome of meconium stained liquor in labour. Singapore Med J. 1985 Dec;26(7):523-6.
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 Jan 1;26(6):518-20.
Akhtar N, Fazilatunnesa, Yasmeen S. Mode of delivery and fetal outcome in meconium stained amniotic fluid (MSAF), Dhaka Medical College Hospital, Dhaka, Bangladesh;2006.
Khatun MH, Arzu J, Haque E, Kamal MA, Al Mamun MA, Khan MF, Hoque MM. Fetal outcome in deliveries with meconium stained liquor. Bangladesh J Child Health. 2009;33(2):41-5.
Espinheira MC, Grilo M, Rocha G, Guedes B, Guimarães H. Meconium aspiration syndrome: the experience of a tertiary center. Rev Port Pneumol. 2011;17(2):71-6.
Carson BS, Losey RW, Bowes WA Jr, Simmons MA. Combined obstetric and paediatric approach to prevent meconium aspiration syndrome. Am J Obstet Gynecol. 1976;126:712-5.
Falciglia HS, Henderschott C, Potter P, Helmchen R. Does Delee. Suction at the perineum prevent meconium aspiration syndrome? Am J Obstet Gynecol. 1992;167:1243-9.
Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, Weiss K, Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicentre, international collaborative trial. Pediatrics. 2000;105:1-7.
Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre randomised controlled trial. Lancet. 2004;364:597-602.
Harris AP, Sendak MJ, Donham RT. Changes in arterial oxygen saturation immediately after birth in the human neonate. J Pediatr. 1986;109:117-9.
Velaphi S, Vidyasagar D. lntrapartum and postdelivery management of infants born to mothers with meconium-stained amniotic fluid: evidence-based recommendations. Clin Perinatal. Mar 2006;33(1):29-42.
Wiswell TE. Advances in the treatment of the meconium aspiration syndrome. Acta Paediatr Suppl. 2001;90(436):28-30.