Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20170579Keywords:
Abnormal, Amniotic fluid, Meconium, Outcome, TraceAbstract
Background: This study assesses the role of abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid and its association with perinatal outcomes.
Methods: Prospective unmatched case-control study on 2 groups of 136 subjects each- cases had thick MSAF and controls had clear liquor with abnormal fetal heart rate tracings on cardiotocography.
Results: Gestational age (GA) >40 weeks, was found to have a significant association with MSAF (p value 0.01556 CI 95%). Premature Rupture of membranes at term (PROM) showed a significant association with MSAF with an OR of 2.25 (95% CI 1.37, 3.7); Post datism had significantly higher odds for being a risk factor for MSAF with an OR (3.194) (CI 95% 1.003-10.165). MSAF was not found to be significantly associated with abnormal trace on CTG. Neonatal morbidity (MAS, birth asphyxia, sepsis, HIE) had statistically higher odds in cases 1.669 (0.884-3.150) as compared to controls.
Conclusions: No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labor. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.References
Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J of Clin Diagnost Res. 2013;7(12):2874-6.
Lee KA, Lee SM, Yang HJ, Park CW, Mazaki-Tovi S. The frequency of meconium-stained amniotic fluid increases as a function of the duration of labor. J Matern Fetal Neonatal Med. 2011;24(7):880-5.
Kumari R, Srichand P, Shah SZ, Devrajani BR. Fetal outcome in patients with meconium stained liquor. J Pak Med Assoc. 2012;62(5):474-6.
Tayade S. The significance of meconium stained amniotic fluid- a cross sectional study in a rural setup. Int J Bio Adv Res. (2012);03(12):861-6.
Vijayasree M, Geetha L, Shobankumar DVC, Murthy SGK. Study of maternal and fetal outcomes in parturients with meconium stained amniotic fluid at term gestation- role of intrapartum amnio infusion. Scholars J App Med Sci. 2014;2(2C):752-6.
Intrapartum Care NICE Clinical Guideline 55 September 2007.
Fischer C, Rybakowski C, Ferdynus C. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43weeks of gestation. Int J Pediatr. 2012;2012:1-7.
Zhu L, Wong F, Bai J. The epidemiology of meconium stained amniotic fluid on hospital basis. Zhongguo yi xue ke xue Yuan xue Bao. Acta Academiae Medicinae Sinicae.2003;25(1):63-5.
Osava, Ruth Hitomi. Meconium-stained amniotic fluid and maternal and neonatal factors associated. Rev. SaúdePública [online]. 2012;46(6):1023-9.
Gurubacharya SM, Rajbhandari S, Gurung R, Rai A, Mishra M, Sharma KR, et al. Risk factors and outcome of neonates born through meconium stained amniotic fluid in a tertiary hospital of Nepal. J Nepal Paediatr Soc. 2015;35(1):44-8.
Manohar R, Kavyashree G. Retrospective study of various maternal factors responsible for meconium stained amniotic fluid and its impact on perinatal outcome. Int J Recent Trends Sci Tech. 2013;1:129-35.
Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium- stained amniotic fluid. Obstet Gynecol. 2011;117(4):828-35.
Blackwell SC, Wolfe HM, Redman ME, Hassan SS. Relationship between meconium staining and amniotic fluid volume in term pregnancies. Fetal diagn Ther. 2002;17(2):78-82.
Odongo BE, Ndavi PM, Gachuno OW, Sequeira E. Cardiotocography and perinatal outcome in women with and without meconium stained liquor. East Afr Med J. 201087(5):199-204.
Xu H, Mas-Calvet M, Wei SQ, Luo ZC, Fraser WD. Abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid: associations with perinatal outcomes. Am J Obstet Gynecol. 2009;200(3):283.e1-7.
Grignaffini A, Soncini E, Ronzoni E, Piazza E. Meconium-stained amniotic fluid and fetal oxygen saturation measured by pulse oximetry during labor. Acta Bio Medica Ateneo Parmense. 2004;75(1):45-52.
Shaikh EM, Mehmood S. Neonatal outcome in meconium stained amniotic fluid-one year experience. J Pak Med Assoc. 2010;60(9):711-4.
Chakraborty A, Mitra P, Seth S, Das A . Study on risk factors of meconium stained amniotic fluid and comparison of pregnancy outcome in clear and meconium stained amniotic fluid in a tertiary hospital, Kolkata, India. Int J Biol Med Res. 2013;4(2):3084-7.
Hiersh L, Krispin E, Aviram A, Wiznitzer A. Effect of meconium-stained amniotic fluid on perinatal complications in low-risk pregnancies at term. Am J Perinatol. 2015;33(4):378-84.
