Perinatal Outcome in Meconium Stained Amniotic Fluidat Dhiraj General Hospital, a Tertiary Health Care Centre in Rural Gujarat: A Prospective Study

Abstract

Introduction: Meconium in amniotic fluid is a serious sign of fetal compromise and associated with a perinatal complications and outcome, including low APGAR scores, increased incidence of chorioamnionitis, increased incidence of neonatal intensive care admission and high rate of perinatal death. It is less likely for a fetus to pass meconium before 34 weeks of gestation. After 37 weeks its incidence increases steadily with increasing gestational age. It reflects maturation of fetal myelination and parasympathetic innervations. Aspiration can occur in utero with fetal gasping or with the first breath of life after birth. However most of the infants with meconium in liquor do not have low APGAR score, acidosis or clinical illness compared to the infants born with clear amniotic fluid. Material and method: A prospective observational study was conducted in obstetrics and gynaecology department of Dhiraj Hospital, Sumandeep Vidyapeeth from March 2019 to August 2020. Methodology: After history and clinical examination,all patients were allowed to go in labour and were watched throughout labour. • Patients who had meconium stained liquor on spontaneous or artificial rupture of membrane were taken as cases. • Other patients who did not have meconium stained liquor throughout labour were taken as controls. • Time of meconium passage, consistency of meconium was noted in each case. • Thin meconium and thick meconium cases were seperately identified. • Fetal heart rate patterns were monitored throughout labour. • Type of delivery whether spontaneous, oper-ative vaginal or LSCS was noted in each case. • APGAR scoring at 1 and 5 minutes, need for resuscitation, stomach wash and endotracheal intubation in baby was noted. • Need for NICU admission for complications like respiratory distress syndrome, aspiration pneumonia, birth asphyxia, septicemia, jaundice, convulsion, hypoxic ischemic encephalopathy was noted. • Duration of hospital stay of neonate was noted. Statisical method: As this was a prevalence study, purposive sampling was done. All the categorial variables were analysed with the help of chi square test and fisher’s exact test and all the continuous variables were analysed with independent ‘t test’. Conclusion: Thus to conclude Thick MSL is associated with abnormal CTG changes, higher incidence of LSCS, low apgar score and more NICU admissions due to Meconium Aspiration Syndrome (MAS), Hypoxic ischaemic encephalopathy (HIE), and sepsis as compared to thin MSL.