Risk Factors and Neonatal Outcome in Meconium-Stained Deliveries
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Abstract
Background: The occurrence of meconium-stained amniotic fluid (MSAF) during labor has been long considered the predictor of adverse fetal outcomes such as meconium aspiration syndrome and perinatal asphyxia, which lead to perinatal and neonatal morbidity and mortality.
Objective: To evaluate the risk factors and fetal outcome in Meconium Stained Amniotic Fluid (MSAF).
Patients and Methods: The study was conducted on all newborn babies with history of meconium stained amniotic fluid (MSAF) who were admitted to the department of neonatal intensive care (NICU) at Ali Omar Askar tertiary hospital during a period of one year from 1st January 2017 to 31st December 2017. Retrospectively maternal risk factors, mode of delivery, babies' vital signs pre-delivery, and post-delivery and details of NICU admission, were collected in a predesigned case sheet and data analysed using SPSS statistical software. There were 300 consecutive newborns admitted during the period of study with MSAF included in this study. 90% of the mothers had regular antenatal follow up.
Results: 35 Mothers (11.7%) had a premature rupture of membrane, 97 (32.3%) were diagnosed with UTI pre-delivery. 215 (71.7%) babies were delivered by normal vaginal delivery, 17 (5.7%) were delivered by elective cesarean section and 68 (22.7%) were delivered by emergency caesarian section. Abnormal CTG was reported in 37 babies (12.3%), 250 babies (83.3%) were full term babies, 19 were preterm (6.4%) and 31 babies (10.3%) were postdate delivery. After delivery, 11 babies (3.7%) had Apgar score less than 5 at 5 minutes, 2 (0.7%) had Apgar score less than 5 at 10 minutes. 13 babies (4.3%) needed resuscitations. As to the length of stay in NICU, 42.3% stayed for less than 1 day, 36.7% stayed for 1 to 3 days whereas 21% stayed for more than 3 days. 28 babies (9.3%) had abnormal chest x-rays and 25 babies (8.3%) with high leukocytosis. 12 babies (4%) were intubated and connected to mechanical ventilation, 31 babies (10.3%) were in respiratory distress and required oxygen supply and 1 baby (0.3%) had pneumothorax. 154 babies (51.3%) received antibiotic treatment; One baby died during admission to NICU (0.3%).
Conclusion: Meconium stained amniotic fluid is associated with an increased caesarean section rate, causes birth asphyxia, MAS and increases neonatal intensive care unit admissions. Coordination of care is needed between the obstetrician and neonatologist to prevent the complications related to MSAF. Based on our observation in this study we conclude that maternal factors (urinary tract infection, diabetes, hypertension and PROM) were important risk factor for MSAF and associated complications including meconium aspiration syndrome (MAS).
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