Sudha Menon
BACKGROUND
Perinatal morbidity and mortality resulting from aspiration of Meconium-Stained Amniotic Fluid (MSAF) is due to the respiratory problems ranging from mild respiratory distress to meconium aspiration syndrome and meconium pneumonitis.
The aim of the study is to define the respiratory problems and to identify the determinants of respiratory distress in babies born through light, moderate and thick MSAF.
MATERIALS AND METHODS
This was a prospective observational study conducted in a university tertiary maternity care institute in Kerala. 150 term pregnancies with meconium-stained amniotic fluid were selected of which 50 cases were each of light, moderate and thick meconium staining.
RESULTS
Meconium-stained amniotic fluid was seen frequently in the age group between 20-25 years age than above age of 25 years (p<0.0001). Post-dated pregnancies and pregnancies complicated by pregnancy-induced hypertension and anaemia also showed a trend in increase occurrence of meconium-stained liquor. Severe birth asphyxia as indicated by Apgar score of <3 was seen in 72.7% of thick meconium staining compared to 18.2% and 9.1% with moderate and light staining of meconium (P=0.004). Respiratory distress in newborn was severe (meconium aspiration syndrome) in babies with thick meconium staining (80%) compared to 15% with moderate meconium and 5% with light meconium staining (P<0.0001). The hazard ratio for death was 8 times higher with meconium aspiration syndrome compared to newborns with aspiration of moderate or light meconium-stained amniotic fluid aspiration. The odds ratio was also very high with aspiration of thick meconium-stained amniotic fluid than the other groups (OR 11.43; 95%, CI 1.33 to 98.35; Z statistic 2.22; P=0.03).
CONCLUSION
Meconium staining of the liquor is an important warning signal of foetal distress and the likelihood is increased if associated with alterations in the foetal heart rate. Increased morbidity and mortality was found with aspiration of thick meconium. Meconium aspiration syndrome is a major cause of often preventable perinatal morbidity and mortality.
