Original Research Article
Year: 2017 | Month: Aug | Volume: 7 | Issue: 8 | Pages: 44-53
A Prospective Clinical Study of Babies born with Meconium Stained Liquor Delivered by Caesarean and Pervaginal Delivery
Dr. Vishwajeet Bhimrao Patil1, Dr. Vaibhav Bhagwan Sonwane2, Dr. Sangeeta Kumbhojkar3, Dr. Sudhir Sarawade4
1Assistant Professor, 2Student, 3Associate Professor, 4Professor R.C.S.M Government Medical College, Kolhapur Maharashtra, India
Corresponding Author: Dr. Vishwajeet Bhimrao Patil
Introduction: Meconium staining of the amniotic fluid (MSAF) is a common problem occurring in 11-22% of all deliveries. Yoder et al documented a decline in the incidence of MAS from 5.8% to 1.5% over the period 1990 to 1997, which they attributed to 33% reduction in the incidence of births at more than 41 weeks gestation. MAS remains a serious problem in developing and newly industrialized countries, MAS accounts for about 10% of all cases of respiratory failure with 39% mortality rate. It has been attempted to identify antepartum, intrapartum or postpartum factors that may increase the risk for MAS. Over the years various recommendations also have been made based on these studies to identify and anticipate the occurrence of MAS in neonates born through MSAF, so that early intervention can be done
Aims: To study the etiology, clinical presentation, risk factor, complication and outcome of babies born with me conium stained liquor.
Materials and methods: Present prospective Observational study was conducted in nicu of Chhatrapati Pramila Raje hospital, Kolhapur in study population consisting of newborns delivered through me conium stained amniotic fluid satisfying the inclusion criteria. Period of data collection for study was from 1st Jan 2015 to 31st March 2016. Sample size was 712 newborns satisfying inclusion criteria. Data regarding the antenatal factors were collected from the obstetric records. Maternal characteristics like age, parity, antenatal checkups, gestational age (in weeks) and maternal risk factor were studied. Gestational age assessment in the antenatal period was done. Intrapartum characteristics were also abstracted from the mother's medical records. Deliveries of all babies born through MSAF were attended by a Pediatric resident and subjected to care as per the clinical condition of the baby. Neonatal medical records were reviewed and the following data were collected: mode of delivery, sex, gestational age, birth weight. Parameters such as Apgar scores at one and five minutes were also studied. NICU admission and outcomes such as MAS, PPHN, HIE, Ventilator requirement and mortality were also noted. The babies were observed for the outcome only during their hospital stay. The babies requiring Neonatal Intensive Care Unit (NICU) care were managed as per the protocol followed in NICU.
Results: During this study period, total numbers of deliveries were 7246 out of which 712 (9.82%) had me conium stained liquor.62.78% babies were born through thin meconium stained amniotic fluid and 37.21% babies were born through thick meconium stained amniotic fluid. 7.16% were preterm deliveries, 44.24% deliveries were of term gestational and majority 48.60% of the deliveries were post term deliveries.24.9% babies born through thick me conium stained liquor had fetal distress during intrapartum monitoring and 7.38% babies in the thin category had fetal distress. Apgar score of ≤7 at 5 min was found in 21.89% of babies born through thick MSAF.52.53% babies were normal, 47.47% babies were admitted in NICU, Respiratory distress was present in 47.47% babies, 37.07% had transient respiratory distress, MAS was diagnosed in 10.53% babies. 3.37%babies were diagnosed MAS+HIE(hypoxic ischemic encephalopatyhy), 2.38% babies were diagnosed MAS+PPHN(persistent pulmonary hypertension), Ventilator support was required in 4.92%. The mortality 4.63%, the cause of death was MAS and with its complication.
Conclusions: Incidence of MSAF (meconium stained amniotic fluid) was more in post term delivery, Complications were more common with the thick meconium category neonates. Fetal distress was more with thick me conium group. MAS (meconium aspiration syndrome) and its complication was the major cause of death in neonate born with MSAF.
Key words:post-term newborn, meconium stained amniotic fluid, meconium aspiration syndrome, fetal distress, HIE(hypoxic ischemic encephalopathy),persistent pulmonary hypertension.