Meconium aspiration syndrome and neonatal outcome in a developing country

Objective: determine the neonatal outcome in patients with meconium stained liquor. Setting: Gynaecology Deptt, Unit-III, Jinnah Hospital, Lahore. Methodology: In this study we included a total of 150 cases with singleton pregnancy (on USG), Cephalic presentation (on USG), Gestational age 37 completed weeks to 42 weeks (calculated from LMP) with meconium stained liquor observed during labour by the attending doctor whereas those with breech presentation, they were excluded by clinical examination and ultrasound, Still birth, they were excluded by ultrasound, and Congenital fetal anomalies, they were excluded by ultrasound. Complete abdominal pelvic examination was done. The subjects were followed till delivery and neonatal outcome i.e. birth asphyxia & meconium aspiration syndrome by the researcher herself. Results: In our study, most of the patients i.e. 64.67%(n=97) were between 18-30 years of age range, mean age was 27.93+4.82 yrs while frequency of neonatal outcome in patients with meconium stained liquor reveals as 2.67%(n=4) having Birth asphyxia while 34.67%(n=52) had Meconium aspiration syndrome. Conclusion: The frequency of meconium aspiration syndrome(MAS) is higher among patients with meconium stained liquor. Keywords: Meconium stained liquor, neonatal outcome, birth asphyxia, meconium aspiration syndrome, frequency.

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Maternal and Neonatal Outcome in Meconium Stained Amniotic Fluid at Term in Labour - A Retrospective Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/36 ◽

2021 ◽

Vol 8 (04) ◽

pp. 190-194

Author(s):

Dinesh Bhasin ◽

Anish Kumar Vishal ◽

Biju Babu ◽

Anurakshat Bhasin

Keyword(s):

Retrospective Study ◽

Caesarean Section ◽

Amniotic Fluid ◽

Neonatal Outcome ◽

Meconium Aspiration Syndrome ◽

Vaginal Route ◽

Endotracheal Suctioning ◽

Meconium Aspiration ◽

Meconium Stained Amniotic Fluid ◽

In Pregnancy

BACKGROUND Meconium stained amniotic fluid (MSAF) occurs in 12 - 15 % of all deliveries and is frequently associated with adverse outcome in pregnancy. The present study was carried out to find out the maternal and fetal outcome in pregnancy complicated by meconium stained liquor in labour METHODS This retrospective study was carried out at a tertiary care centre at Pune. A total of 340 cases who had meconium stained liquor during labour or was detected on amniotomy was analysed. RESULTS Out of 340 cases, 252 (74.1 %) had thin and 88 (25.9 %) had thick meconium. MSAF was detected more in early labour (244, 71.8 %), as compared to advanced labour (96, 28.2 %). 212 (84.13 %) patients with thin meconium delivered by vaginal route. 30 (34.09 %) patients with thick meconium delivered by vaginal route. 40 (15.87 %) patients with thin meconium delivered by LSCS and 58 (65.91 %) with thick meconium delivered by LSCS. This difference was statistically significant (< 0.001). Being multiparous was a protective factor both for mother and baby against the presence of MSAF. A majority of neonates, 199 (58.53 %) were asymptomatic at birth both in thin and thick MSAF group. Endotracheal suctioning was done in 101 (29.7 %) neonates in both groups. 40 neonates (11.77 %) were admitted to NICU for severe birth asphyxia. Meconium aspiration syndrome (MAS) was observed in 20 cases (5.88 %), out of which 18 (90 %) had thick meconium and 02 (10 %) had thin meconium. A total of 04 (1.18 %) neonatal deaths occurred due to MAS. They were born to primigravida, had induced onset of labour with detection of thick meconium and delivered vaginally. CONCLUSIONS Meconium stained amniotic fluid (MSAF) is associated with increased incidence of caesarean section, lower Apgar score, NICU admissions, development of meconium aspiration syndrome and neonatal death. Obstetrician should be more vigilant while dealing with cases of thick type of MSAF. A timely caesarean section improves the neonatal outcome. KEYWORDS Meconium Stained Amniotic Fluid (MSAF), Meconium Aspiration Syndrome (MAS)

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Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension

Children ◽

10.3390/children8070594 ◽

2021 ◽

Vol 8 (7) ◽

pp. 594

Author(s):

Amy L. Lesneski ◽

Payam Vali ◽

Morgan E. Hardie ◽

Satyan Lakshminrusimha ◽

Deepika Sankaran

Keyword(s):

Blood Flow ◽

Pulmonary Hypertension ◽

Oxygen Saturation ◽

Ductus Arteriosus ◽

Neonatal Resuscitation ◽

Meconium Aspiration Syndrome ◽

Ovine Model ◽

Neurodevelopmental Outcomes ◽

Meconium Aspiration ◽

Blood Flows

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85–94%) and high (95–99%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4–10.8) min) compared to standard SpO2 target (31.5 (21–66.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted.

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