Abstract
Objective: This study was done to evaluate the effectiveness of amnioinfusion (AI) in cases of thick meconium stained liquor:1) In reducing the perinatal morbidity associated with thick meconium.2) Decreasing operative intervention for fetal distress. Methods: The study was carried out in the department of OBG at K.V.G Medical College and Hospital, Sullia over two years from Aug 2011 to July 2013. A total of 150 patients were studied, out of which 100 were given amnioinfusion and 50 were not given amnioinfusion. Results: The rate of Caesarean section for fetal distress was 49% in the amnioinfusion group and 64% in the non infusion group. Although the incidence of caesarean section was high in both the study and control groups, the difference in between the two groups was statistically significant. The fetal outcome was found to be better in the amnioinfusion group. The perinatal outcome was recorded by Apgar score(14 vs 30% at 1 min, 2 vs 6% at 5 min), admission to the neonatal intensive care unit (NICU) (13 vs 30%), need for ventilatory support (0 vs 6%), incidence of meconium aspiration syndrome (10 vs 26%) and perinatal deaths (0 vs 6%). There were no maternal complications with amnioinfusion. Conclusion: The study revealed that amnioinfusion does reduce the perinatal morbidity associated with thick meconium stained amniotic fluid (MSAF). Although the incidence of caesarean section (CS) was high in both the study and control groups, there was a statistically significant reduction in the incidence of operative intervention for fetal distress (FD) in the amnioinfusion group.
Highlights
The presence of thick meconium in the amniotic fluid of a vertex presentation is considered to be a sign of fetal distress
Duration of stay in the hospital was significantly more in the babies in the control group than in the amnioinfusion group
The incidence of Meconium aspiration syndrome (MAS) was significantly lower in the study group 10% as compared to the control group (26%), (p value- 0.006) which was comparable to the results reported by Ashfaq et al (12% vs 35%)[11]
Summary
The presence of thick meconium in the amniotic fluid of a vertex presentation is considered to be a sign of fetal distress. Meconium aspiration syndrome (MAS) has been reported in 7-30% of these deliveries. Thick meconium passage in labour is associated with abnormal fetal heart rate patterns (late decelerations, severe variable decelerations and decreased variability), an increased incidence of operative intervention (forceps and caesarean delivery) and a significantly higher incidence of neonatal morbidity and mortality due to meconium aspiration syndrome (MAS). The case fatality rate of meconium aspiration is reported to range from 2-40%2. This highlights the need for various modalities to treat and prevent meconium aspiration. Current methods include combined obstetric and paediatric approach as described by Carson[3]. This includes suctioning of the nasopharynx, mouth and hypopharynx as soon as the head is born. After delivery is completed, the oropharynx is suctioned and vocal cords are inspected by direct laryngoscopy by a paediatrician
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