MECONIUM STAINED

AMNIOTIC FLUID
MECONIUM – STAINED
 INTRODUCTION

• Meconium is the earliest stool of an infant.

• Meconium is composed of materials ingested during the time
the infant spends in the uterus:
intestinal epithelial cells, lanugo, mucus, amniotic
fluid, bile, and water.
• When Baby passes Meconium in utero, making Amniotic
fluid light to dark green, it gives rise to a condition of
Meconium Stained Liquor.
• It is rare in babies born at <34 weeks of gestation.
 INCIDENCE
• Meconium-stained amniotic fluid is a
common obstetric situation, occurring
in 12–22% of women in labour.*
• < 5 % in preterm.
• Up to 20% in term.
• > 20 % in post term.

* ACOG Committee opinion, number 346, October 2016

CAUSES: MATERNAL
• Placental insufficiency
• Maternal hypertension
• Pre-eclampsia
• Oligohydramnios
• Maternal drug abuse (tobacco,
cocaine)
CAUSES: FOETAL
• Response to acute hypoxic
events
• Relaxation of anal sphincter
• Increasing the production of
motilin, which promotes
peristalsis.
CONSISTENCY OF MECONIUM
Thin meconium:
• Yellow to light green and is watery
( Hagemanet al, 1988 ).
• 10% to 40% of the cases of
meconium passage.
• Passed as a maturational event in
most cases.
• Infants are more likely to be healthy
at birth.
• 10% to 20% of cases of MAS occur with thin
meconium.
CONSISTENCY OF MECONIUM
Thick or particulate meconium:
• Is pasty or granular ( Meis et al, 1978 ).
• The risk of perinatal death is increased (5-7times).
• Early in labour generally reflects:
a. Oligohydramnios
b. Risk factor for neonatal morbidity and mortality
MECONIUM ASPIRATION SYNDROME
• Presence of meconium below vocal cord is
known as meconium aspiration.
• Meconium aspiration syndrome (MAS) is
defined as a respiratory distress that
develops shortly after birth, with
radiographic evidence of aspiration
pneumonitis and presence of meconium
stained amniotic fluid.
• Meconium aspiration syndrome occurs in
up to 10% of infants who have been
exposed to meconium-stained amniotic
fluid.
PATHOLOGY OF MECONIUM ASPIRATION SYNDROME
FETAL HYPERCARBIA AND ACIDAEMIA

STIMULATES FOETAL RESPIRATION, CAUSING GASPING

ASPIRATION OF MECONIUM INTO THE ALVEOLI

MECHANICAL BLOCKAGE OF THE AIRWAY

CHEMICAL IRRITANT CAUSING
PNEUMONITIS
MANAGEMENT
• ANTEPARTUM
• INTRAPARTUM
• POSTPARTUM
ANTENATAL MANAGEMENT
• Prevention of post mature (>41 or 42 weeks
gestation) delivery.
• Anticipation of MSAF in high risk cases, like
1. Pre eclampsia
2. Chronic hypertension
3. Oligohydramnios
4. IUGR
5. Maternal Fever
6. PROM
INTRAPARTUM MANAGEMENT
• Foetal heart monitoring
• Improve foetal oxygenation and
uteroplacental blood flow.
• Take steps to diminish uterine
activity.
• Relieve umbilical cord
compression.
FOETAL HEART MONITORING
• Intermittent Auscultation
• Continuous Electronic Foetal Monitoring
• MONICA: WIFI enabled Wireless foetal
heart rate monitor
INTERMITTENT AUSCULTATION
• Every 15 to 30 minutes in active phase of first
stage of labour; every 5 minutes in second
stage of labour with pushing.
• Differentiate maternal pulse from foetal
pulse.
• Palpate for uterine contraction during period
of FHR auscultation to determine relationship.
• Count FHR between contractions for ≥ 60
seconds to determine average baseline rate.
 ELECTRONIC FOETAL MONITORING
• Electronic Foetal Monitoring is a method of
choice for foetal monitoring in high risk
pregnancies, like
 Preeclampsia
 Type 1 diabetes
 Preterm birth
 IUGR
 MSAF

* ACOG 2013
 IMPROVE FOETAL OXYGENATION
• Moving the mother to the lateral
position.
• Intravenous hydration—500 to 1000 mL
of lactated Ringer solution given over 20
minutes.
• Administer supplemental oxygen at 10
L/min.

Simpson KR, James DC. Efficacy of intrauterine resuscitation techniques in improving fetal oxygen status during labor.
Obstet Gynecol. 2005 Jun;105(6):1362-8
RELIEVE UMBILICAL CORD COMPRESSION
• Changing maternal position.
• Tocolysis.
• A physician may slip his/her
finger through the cord and
unwrap it if it’s wrapped around
the infant’s neck.
POSTPARTUM MANAGEMENT
Meconium stained liquor

No sign of depression Do not vigorously stimulate the baby , if

No resuscitation required
Observe for 2 hours
born with respiratory depression
Dry and assess airway, breathing and heart rate.
Inspect airway direct vision, if meconium seen,
aspirate with a large bore sucker.

Baby has meconium below the cords or continuing depressed vital signs

Intubation and direct tracheal suction.

Suction should be discontinued and inflation breaths delivered after 1 minute
 CONCLUSION

• Meconium stained amniotic fluid is common complication, seen in

1 out of every 5 pregnancies.
• Golden rule for management of MSAF is Foetal Heart Monitoring.
• An alert and vigilant Obstetrician can reduce foetal mortality and
morbidity.
• NST should be used in all high pregnancies.
• Neonatologists should be alerted in every case of MSAF in labour,
under vision suctioning should be done to prevent MAS.