Perinatal and maternal outcome in meconium stained amnioticfluid (thin and thick) at dhiraj general hospital, a rural tertiary health centre

Background: To determine the perinatal outcome of with Meconium-stained amniotic fluid (MSAF) compared with clear amniotic fluid at Dhiraj Hospital.Methods: A prospective observational study was carried out in obstetrics and gynaecology department of Dhiraj Hospital, Sumandeep Vidyapeeth from March 2021 to August 2021. All patients fulfilling inclusion and exclusion criteria as mentioned above were taken for the study. All the categorial variables were analysed independently with the help of chi square test and fisher’s exact test and all the continuous variables were analysed with independent ‘t test’.Results: Out of 500 patients selected for the present study which had inclusion criteria, 13.6% were meconium stained out of which 50 (73.5%) cases had thin meconium and 18 (26.4%) cases had thick meconium. Fetal CTG abnormalities were more common in MSAF group and were noted in 38.2% of cases which is significantly increased compared to control group with CTG abnormalities in 8.3%. The difference was significant with p value of <0.001. 32(47.0%) patients with meconium-stained amniotic fluid had normal vaginal delivery, while in control group out of 432, 360 (83.3%) delivered normally. Incidence of LSCS and assisted vaginal delivery was more in meconium-stained amniotic fluid.Conclusions: Meconium-stained amniotic fluid is associated with more frequency of operative delivery, birth asphyxia, neonatal sepsis, and neonatal intensive care unit admissions compared to clear amniotic fluid. Better perinatal outcome in clear amniotic fluid compared to meconium stained liquor.

Prevalence and associated factors of perinatal asphyxia in newborns admitted to neonatal intensive care unit at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, Ethiopia

Background Perinatal asphyxia is one of the leading causes of neonatal mortality and morbidity in Ethiopia. Understanding associated factors of perinatal asphyxia are important to identify vulnerable groups and to improve care during the perinatal period. Thus, this study aimed to assess the prevalence and associated factors of perinatal asphyxia among newborns admitted to NICU at the Gondar University Comprehensive Specialized Hospital Northwest Ethiopia, Ethiopia. Method Institutional based cross-sectional study was conducted on 364 newborns from November 2018 - August 2019. Data was collected using a structured and pre-tested questionnaire. It was then cleaned, coded, and entered using EPI INFO version 7, then analyzed with SPSS statistics version 20.0. Binary logistic regression analysis was used to identify variables with p < 0.2. An adjusted odds ratio (AOR) with a 95% CI and P-value of <0.05 was used to identify significantly associated variables with perinatal asphyxia. Result The prevalence of perinatal asphyxia in this study was 19.8, 95%CI (15.9, 24.2). Absence of maternal formal education (AOR = 4.09, 95%CI: 1.25, 13.38), pregnancy-induced hypertension (AOR = 4.07, 95%CI: 1.76, 9.40), antepartum hemorrhage (AOR = 6.35, 95%CI: 1.68, 23.97), prolonged duration of labor (AOR = 3.69, 95%CI: 1.68, 8.10), instrumental delivery (AOR = 3.17, 95%CI: 1.22, 8.21), and meconium-stained amniotic fluid (AOR = 4.50, 95%CI: 2.19, 9.26) were significantly associated with perinatal asphyxia. Conclusion The prevalence rate of perinatal asphyxia in this study was comparable to other resource poor countries. The absence of maternal formal education, pregnancy-induced hypertension, and Antepartum hemorrhage, prolonged duration of labor, Instrumental assisted delivery, and meconium-stained amniotic fluid was having significant association with perinatal asphyxia in this study.

A study of maternal and fetal outcome in meconium-stained amniotic fluid-a prospective hospital-based study

Background: Meconium is a collection of secretions and desquamated cells from the digestive tract, and waste products from ingested amniotic fluid. It is a viscous, dark-green substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions. Intra uterine passage of meconium occurs in case of fetal distress; Important causes of in utero passage of meconium are oligohydramnios, placental insufficiency, preeclampsia.Methods: The present prospective observational study is conducted at department of obstetrics and gynecology of tertiary care centre, Lokmanya Tilak municipal medical college and hospital, Mumbai. All antenatal women attending hospital in active phase of labour who fulfilled the inclusion criteria of single term pregnancy in cephalic presentation were included. A predesigned pretested interview schedule questionnaire was prepared in accordance with study objectives and was conducted in the language which they best understood. Permission was obtained from the institutional ethics committee. Maternal outcome: Increased incidence of cesarean and instrumental deliveries, wound infection, post-partum hemorrhage. Perinatal outcome: Birth asphyxia, meconium aspiration syndrome (MAS), respiratory distress syndrome (RSD), septicemia.Results: Maximum women 71% were having gestational age of 37-40 weeks. most common maternal high-risk factors were post-dated pregnancy (29%) followed by oligohydramnios (19%). Deliveries by caesarean section were more (71.4%), most common indication being fetal distress (44.7%). Perinatal complications were birth asphyxia, MAS, RDS, low Apgar score.Conclusions: Early identification of meconium-stained amniotic fluid (MSAF) in labouring women during intra-partum monitoring and availability of operation theatre for immediate intervention is required to reduce the perinatal morbidity and mortality.

The Pathological Mechanisms of Estrogen-Induced Cholestasis: Current Perspectives

Estrogens are steroid hormones with a wide range of biological activities. The excess of estrogens can lead to decreased bile flow, toxic bile acid (BA) accumulation, subsequently causing intrahepatic cholestasis. Estrogen-induced cholestasis (EIC) may have increased incidence during pregnancy, and within women taking oral contraception and postmenopausal hormone replacement therapy, and result in liver injury, preterm birth, meconium-stained amniotic fluid, and intrauterine fetal death in pregnant women. The main pathogenic mechanisms of EIC may include deregulation of BA synthetic or metabolic enzymes, and BA transporters. In addition, impaired cell membrane fluidity, inflammatory responses and change of hepatocyte tight junctions are also involved in the pathogenesis of EIC. In this article, we review the role of estrogens in intrahepatic cholestasis, and outlined the mechanisms of EIC, providing a greater understanding of this disease.

A comparative study on feto-maternal outcome in patients with meconium stained liquor versus clear liquor

Background: Meconium is sterile, thick, black-green, odourless material, formed by accumulation of debris in the fetal intestine. This meconium, when leaks out intra-natally, due to hypoxia, can change the whole scenario, increasing intra-natal foetal risk, morbidity, and possibly causing mortality, depending upon the operative factors. Aims and objectives were to know the perinatal outcome in patients with meconium stained amniotic fluid. To study the complications of meconium stained amniotic fluid in the neonates.Methods: Reverse-transcription polymerase chain reaction (RTPCR) negative women, gestational age >37 weeks with cephalic presentation and singleton pregnancy with meconium stained liquor (grade I, II, and III) after spontaneous or artificial rupture of membranes during labour. Delivery was expedited, when fetal heart rate abnormalities were detected, by safest mode of delivery. The Apgar score of neonates, neonatal intensive care unit (NICU) admission, number of days of hospitalization and birth asphyxia were recorded.Results: A Total 11 patients with pre-eclampsia which presented with meconium stained liquor (MSL). 6 patients with prolonged labour presented with MSL. 8 had thin, 15 had thick MSL and 3 patients of clear liquor. 2 children developed persistent pulmonary hypertension of the newborn (PPHN) in case of MSL group. 25 children required oxygen support and antibiotics after delivery. Mean hospital stay was 2.81 days in MSL and 1.33 days in clear liquor group.Conclusions: Chronic hypoxia is more damaging and dangerous than acute hypoxia, due to longer time it has continued the damage. This can be very effectively achieved by improving the Antenatal care, and intra natal vigilance. Proper monitoring of patients in intrapartum period of following parameters like fetal heart sound, uterine contractions, fetal movements.

Role of Antibiotics in Neonates Born through Meconium Stained Amniotic Fluid

The objective of our study was to compare the clinical course and infection related outcome in cases of meconium stained amniotic fluid neonates treated with or without antibiotic therapy. One hundred fifty eligible neonates were randomized to antibiotic group and non antibiotic group. Both groups were compared for development of sepsis screen and final outcome in both groups were compared. The incidence of sepsis screen positive was observed in both groups. In antibiotic group sepsis screen was positive in 5 cases and in non antibiotic group sepsis screen was positive in 4 cases. overall incidence of sepsis screen positive was similar in both antibiotic and non antibiotic group. The difference was not found to be statistically significant (p value = 1.00 and chi square value 0.118). Final outcome in both antibiotic group and non antibiotic group showed that in antibiotic group, out of 75 neonates 71 were discharged successfully and 4 were died. In non antibiotic group, 73 were discharged successfully and 2 died, out of 75 neonates. There was statistically no significant difference on final outcome between these two groups (p value 0.68 and chi square value 0.694). Conclusion: There was no difference in the incidence of infection and in final outcome in neonates born through meconium stained amniotic fluid treated with or without antibiotics. Keywords: Meconium Stained Amniotic Fluid, Neonates, Antibiotic Therapy.