Meconium stained amniotic fluid: antenatal, intrapartum and neonatal attributes.

OBJECTIVES To find out the incidence, outcome as well as antenatal, intrapartum and neonatal attributes of meconium stained amniotic fluid (MSAF). DESIGN Prospective study. SETTING Neonatal Unit of Hospital. SUBJECTS 1426 live births occurring in 1500 consecutive deliveries, over one year period. INTERVENTIONS In all babies born through MSAF, thorough oropharyngeal suction as soon as the head was delivered followed by immediate intratracheal intubation and suctioning in infants depressed at birth. RESULTS 204 (14.3%) deliveries had MSAF of which thick meconium was present in 141. Hepatitis in mother, fetal distress during labor and intrauterine growth retardation were significant factors associated with MSAF. One fifth of babies born through MSAF suffered severe birth anoxia compared to 5.6% in non-MSAF group. The consistency of meconium had direct bearing on the neonatal outcome. Severe birth asphyxia (SBA) occurred in 27.0 and 6.3% of babies with thick and thin meconium staining, respectively. Meconium aspiration syndrome was observed in 9 babies of thick meconium group and 8 of these were depressed at birth. All deaths occurred in thick meconium group and were associated with SBA. CONCLUSIONS Selective approach can be adopted for babies with MSAF reserving intratracheal suctioning at birth for depressed neonate or evidence of fetal distress in utero. Rest of the neonates only need careful observation after thorough oronasopharyngeal suctioning.