Demographic information of the mother and the newborn, hospitalization course, the need for mechanical ventilation, and complications and outcomes of disease were extracted and were analyzed using the SPSS software version There was a significant relationship between the need for mechanical ventilation, nonvigorous state at the birth, complications of disease and mortality rate. The mortality and morbidity rates can be reduced by improvement in perinatal care, prevention of post term delivery, timely caesarean and effective neonatal resuscitation at birth.
Meconium aspiration syndrome MAS occurs in 1. Meconium aspiration syndrome diagnosis is made based on symptoms such as meconium-stained amniotic fluid, respiratory distress after birth and aspiration radiological evidence. Newborn infants with severe congenital anomalies and cases with incomplete information were excluded from the study.
Then demographic information including age of mother, underlying diseases, parity the number of pregnancies , gestational age, birth weight, gender, mode of delivery, Apgar score at one and five minutes, neonatal resuscitation at birth, concentration of meconium-stained amniotic fluid thin or thick , and being vigorous or nonvigorous lack of respiratory effort, reduced muscle tone and heart rate less than beats per minute , were collected. Meconium aspiration syndrome was defined as an infant born through meconium-stained amniotic fluid, respiratory distress within 24 hours of birth, and radiological findings, which cannot be otherwise explained.
Radiological findings include patchy infiltration, hyperaeration, and sometimes air leak. Neonatal resuscitation at birth was conducted based on the neonatal resuscitation program NRP Guidelines by the American heart association AHA and American academy of pediatrics AAP , and in non-vigorous newborn infants, endotracheal tube suction was done. Length of stay at the NICU, requirement of mechanical ventilation, and clinical outcomes including recovery or death were recorded.
Cases and records of 63 newborn infants hospitalized during a period of 10 years were investigated in this study. Forty A significant relationship was observed between the need for mechanical ventilation, non-vigorous state at the time of birth and complications of disease with mortality rate. A comparison of some risk factors between living and dead infants diagnosed with neonatal meconium aspiration syndrome is presented in Table 1.
Despite scientific advances in developed countries, meconium aspiration syndrome is still a serious challenge faced by neonatologists due to morbidity and mortality of the disease. In our study, In other studies conducted by Anwar et al. The reduction of mortality, especially in developed countries has been due to increased prenatal care including prevention of post-term delivery 12 , surfactant treatment in newborn infants 13 , use of high frequency oscillatory ventilation HFOV 14 , inhaled nitric oxide NO 15 , and ECMO Due to the severity of the disease and its complications, the need for mechanical ventilation in newborn infants with meconium aspiration syndrome has been associated with very high mortality.
The need for mechanical ventilation in our study, and the studies of Anwar et al. Regarding other factors associated with the mortality rate in our study, there was no significant relationship between low Apgar score at birth five-minute Apgar score of less than seven , post term delivery, cesarean and mortality.
However, in the studies of Anwar et al. There was also a significant relationship between newborn infant depression nonvigorous infant at birth and mortality rate. Moreover, in our study, a significant relationship was seen between disease complications such as pneumothorax, infection, etc. A significant relationship was reported between pneumothorax and mortality in the studies of Dargaville et al. Furthermore, in different studies such as the studies of Anwar et al. Long-term hospitalization, the bustle of the unit or increased number of hospitalized infants, the shortage of personnel and mechanical ventilation are amongst the important reasons for infection, which lead to increased mortality Affiliation s.
Amniotic fluid is a clear and transparent liquid in which the fetus lives. It is principally made up of water Its volume increases from 20 ml at 7 weeks of gestation, to ml at 34 weeks and then drops to ml at 42 weeks. Its reabsorption is mainly by fetal swallowing and absorption through the amniotic membrane . Two main abnormalities of amniotic fluid are volume and colour changes. Colour abnormality could be blood or meconium stained MSAF .
birth | MidwifeThinking | Page 5
Meconium is the first stool of the fetus or neonate and its emission occurs between 24 and 48 hours of extra uterine life   . Certain pathological conditions can cause its emission before delivery, thus staining the amniotic fluid green. Although the exact cause of this MSAF is unclear, fetal distress, cord accidents and maternal hypertension have been identified as potential risk factors  . Intrauterine emission of meconium has both fetal and neonatal consequences as well as maternal risks .
These guidelines include continuous surveillance and amnioinfusion in cases of thick MSAF. These have led to a significant reduction in caesarean section rates   . With an extensive literature search, there is lack of studies assessing maternal and neonatal outcomes in case of MSAF in Cameroon. Therefore, this study aimed at determining the fetal, neonatal and maternal complications associated with MSAF in order to improve its management.
The study was conducted over a 5 months period from December to April Uniform and standard operating protocols for the management of labour were in use in both study settings. We included all consecutive and consenting pregnant women presenting with singleton pregnancies at term, fetuses in cephalic presentation and ruptured fetal membranes and who gave their informed consent.
We excluded women with pre-term or post term pregnancies, breech and other mal-presentations, multiple gestations, those admitted for elective caesarean, women with unknown last menstrual period and those with intra-uterine fetal death on admission. Women were matched based on parity. Participants were followed up during labor using the WHO partograph , and 72 hours following delivery, checking for maternal, fetal and neonatal complications.
The variables studied were see appendix 1 ; 1 Maternal sociodemographic data: maternal age, marital status, level of education and occupation. Data was collected using a pretested questionnaire and analyzed using Epi-info version 3. A total of deliveries were registered during the study period.
Changes in the coagulation system of the mother and fetus: pregnancy, labour and puerperium
Among these there were cases of MSAF, hence, a prevalence of Of the cases of MSAF, 52 cases The average age of the pregnant women was There was no significant difference in ages between the two study groups Table 1. The majority of the women were spinsters Out of the cases analysed in this study, babies were male and female, giving a sex ratio of 1.
This ratio was similar in the different subgroups. The mean birth weight was The weights were similar in the two groups.
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Out of the cases with MSAF, In Most Nuchal cord and cord knots were respectively found in 21 9. Table 1. Socio-demographic characteristics of the study participants. Common indications of caesarean delivery were cephalo-pelvic disproportion and acute fetal distress. The meconium inhalation syndrome MIS was found in 5 2. Fetal heart rate abnormalities, neonatal infection and neonatal asphyxia were significantly higher in cases with MSAF.
All ten cases 4. Table 2. Obstetrical characteristics of the study participants.
Perinatal outcome in meconium stained amniotic fluid
Table 3. Characteristics of meconium stained amniotic fluid MSAF. Table 4.
Effect of MSAF on maternal morbidity. N-A: not applicable The relative risk could not be calculated because all the cases were in the exposed group. Table 5. Fetal and neonatal morbidity in cases of MSAF. The aim of this study was to determine the maternal and fetal outcomes in case of meconium stained amniotic fluid observed during labour of term singleton pregnancy in cephalic presentation.
We found that the prevalence of MSAF was MSAF was associated with a significant risk of caesarean delivery and prolonged labor. Detailed history was taken and analysed for risk factors of meconium, colour of meconium was graded following artificial rupture or spontaneous rupture of membrane. Labour was monitored for intra partum fetal heart rate abnormalities by cardiotocography, stage and progression of labour, mode of delivery.
After delivery fetal well being assessed by Apgar scoring. New born is examined for cord around the neck, features of IUGR, congenital anomalies and post maturity, meconium staining of tissues. Perinatal outcome is evaluated based on duration of NICU admission and development of complications such as meconium aspiration syndrome, asphyxia, respiratory distress, sepsis, persistent pulmonary hypertension of new born. This study group consist of patients in labour room with meconium stained amniotic fluid. The age of the patients in this study range from 19 to 38 years with a mean age of