Title: Perinatal Outcome in High-Risk Pregnancies with and without Meconium Stained Liquor Amnii
Authors: Lt Col (Dr.) Kaoser Jahan, Maj (Dr) Ariful Haque, Dr Lubna Jahan
Meconium leads to increased sleepiness of fetus in mother’s womb. Prevalence of meconium stained amniotic fluid (MSAF) is 12-16% of all the deliveries. In utero passage of meconium may simply represent the normal gastro intestinal maturation or may indicate an acute or chronic hypoxic event, thereby making it a warning sign of foetal compromise. Fetal assessment and wellbeing has traditionally been evaluated on the basis of fetal movements and color of the amniotic fluid. Presence of meconium in the amniotic fluid has long been considered as ominous sign for fetal distress. Meconium reduces the antibacterial property of amniotic fluid by altering the level of zinc in it which leads to intra amniotic infections. In case of hypoxia, gasping of fetus results in meconium aspiration which neutralizes the surfactant action and promotes inflammation of lung tissues, whereas persistent hypoxia after birth, aspirated meconium results in pulmonary vascular and pulmonary hypertension. Conflicting outcomes have been reported in the deliveries complicated by meconium staining, which differs with the degree of meconium staining.
The aim of this study is to know the association between the meconium stained amniotic fluid and its association with the perinatal outcome.
It is a cross-sectional design was considered suitable for the study. This study was carried out on the admitted patient in the department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka. The study was carried out during the period from February 2018 to July 2018, 6 months. Total 86 patients who admitted in "high-risk antenatal ward" in the department of Obstetrics and Gynecology to present hospital for delivery with meconium stained liquor during the study period were included in the study. Among sample patients 12 (14.0%) were found with meconium stained liquor (group A) and 74 (86.0%) cases were found without meconium stained liquor (group B). In group A common risk factors were prolonged pregnancy (33.3%) then hypertensive disorder 25.0%. In group B common risk factors were hypertensive disorders 23.0% then diabetes 18.9 %. Pattern of antenatal care was regular in 83.3% cases in group A which was 83.8% in group B. Gestational age was between 37-40 weeks in 50.0% cases in both group, Gestational age was found ≥ 40 weeks in 33.3% cases in group A, in comparison to 39.2% in group B. In group A vaginal delivery was 8.3%, LUCS 91.7% which was 16.2% and 83.8% in group B respectively. Still birth was 8.3% in Group A. In group B Still birth was 1.4% and neonatal death was 2.7%.Incidence of low birth weight (<2.5 Kg) was 33.3% in group A in comparison to 9.5% in group B. 27.0% baby of group A required resuscitation and 45.5% needed admission in neonatal care unit which was 8.2% and 16.4% in group B respectively. Among the study population (n=86) babies were found without complication 83.7%, still birth 2.3%, meconium aspiration 1.2%, birth asphyxia 10.5% and neonatal death was 2.3%.
In this study, it was observed that perinatal mortality was not directly related to meconium aspiration syndrome rather premature separation of placenta, placental insufficiency, prematurity & low birth weight were the main association. Present study showed that thick meconium is associated with more complications like increased operative interference, birth asphyxia, meconium aspiration syndrome, low Apgar score, prolonged NICU stay and overall increased perinatal mortality compared to thin meconium stained liquor.
Keywords: MAS (meconium aspiration syndrome), MSAF (meconium stained amniotic fluid), NICU (neonatal intensive care unit).