No abstract

The first demonstrable meconium is found around the third month of the gestational age in the intestines of the fetus as black green color, odorless mass. Multiple conditions of intrauterine fetal distress is said to be causative reason for intrauterine passage of meconium in the amniotic fluid by the fetus. Aspiration of meconium stained amniotic fluid may lead to a gasping breathing pattern which induces hypoxia via airway obstruction, surfactant dysfunction, chemical pneumonitis, and pulmonary hypertension. The aim of the present study was to find the prevalence of various grades of meconium stained amniotic fluid as well as meconium aspiration syndrome according to gestational age and parity. The present study was a prospective observational study. It was conducted in the Obstetrics and Gynecology department of Tertiary Hospital & Medical Collage & Research Centre, Ahmedabad, Gujarat, India during May 2016 to May 2018 on 200 laboring mothers with meconium stained amniotic fluid who delivered or underwent cesarean section in the institute were included in the study. MSAF grade 1 cases were maximum 40/82(48.78%) in mothers having previous vaginal delivery. MSAF grade 2 cases were maximum 51/63(80.95%) in primigravid mothers. MSAF grade 3 cases were maximum 24/55(43.64%) in primigravid mothers. 3.96% of the primigravida patients were found to have MAS whereas 15.38% of the patients with previous vaginal delivery were having MAS. Maximum cases of grade 1 MSAF 64/82(78.05%), grade 2 MSAF 40/63(63.49%) as well as grade 3 MSAF 26/55(47.27%) were in mothers having gestational age between 37-40 weeks at the time of delivery of baby. 45.45% patients having gestational age less than 37 weeks, 4.62% of the patients having gestational age between 37-40 weeks, and 6.78% patients having gestational age greater than 40 weeks were having MAS.

Black-green colored odorless material known as meconium is physiologically passed by new born babies with in 48 hours of birth. Presence of meconium in the amniotic fluid could be a dangerous condition. It may expose the baby to multiple condition depending upon the amount of meconium entering in to the respiratory track of the baby. The knowledge of association of various maternal and fetal associated factors with meconium aspiration syndrome is of immense importance for appropriate clinical judgments and decisions. The aim of the present study was to study various maternal and fetal parameters associated with meconium stained amniotic fluid. The present study was a prospective observational study. It was conducted in the Obstetrics and Gynecology department of Tertiary Hospital & Medical Collage & Research Centre, Ahmedabad, Gujarat, India during May 2016 to May 2018 on 200 laboring mothers with meconium stained amniotic fluid who delivered or underwent cesarean section in the institute were included in the study. Majority of them were between 20–30 years of age (59%). The women between 31–35 years of age were 27%. Participants either <20 years or >35 years were 9% and 5% respectively. There were 82 patients who had grade I MSL, 63 patient who had grade II MSL whereas 55 patients who had grade III MSL. Out of 200, there were 196 women who were having associated risk factors like prolonged labour, PROM, hypertension, postdatism, GDM, IUGR and anaemia. MSL as well as MAS has been strongly associated with the parity of the mother. It was also observed that patients who’s age was greater than 35 yrs. All (100%) presented with grade 3 MSL. Fetus whose gestational age was greater than 40 weeks has fewer chances of co-morbidities. It was concluded in the present study that multiparity, higher maternal age, presence of Maternal Risk Factors, C-section, IUGR, oligo-hydraminos, post-datism, GDM, non-reactive CTG, prolonged labor and PROM had significant association with higher grades of meconium stained Liquor. It is strongly recommend that in such patients early and appropriate care along with constant monitoring can prove to be highly beneficial.

Background: The objective of the study was to evaluate role and safety of transabdominal trans-amniotic approach for Chorionic villus sampling (CVS) for prenatal diagnosis of genetic disorders.Methods: Retrospective analytical study carried out on data form couples coming for pre-natal diagnosis from January 2010 to February 2021. Patient related parameters like age, gestational age; procedure related parameters like amount of sample, number of attempts required; different genetic disorder diagnosed and complications by both the approaches of CVS were recorded and analyzed.Results: Total 2287 patients undergoing CVS with mean age of 27±3.3 years were included. Majority (1621;70.9%) had CVS procedure at gestational age of 12-14 weeks. On analyzing physician’s perception, 663 (29%) patients having complete posterior placenta could not be accessible with routine trans-abdominal CVS and opted for trans-amniotic approach. Amount of sample yield and number of attempts were not statistically significant (p>0.05) by both methods of CVS. Thalassemia major was found in 948 (41.45%) followed by thalassemia minor in 525 (22.96%) patients. No statistically significant difference was found for developing complications by both the methods (p>0.05). Most common complication was pain and discomfort which was relieved by simple analgesics. Out of total 17 (0.74%) abortions; 13 (0.80%) from routine transabdominal and 4 (0.60%) from trans-amniotic route CVS with no statistically significant difference among them (p>0.05). No case of post procedure infection was observed.Conclusions: In complete posterior placenta CVS procedures usually postponed by most physicians leading to delay in diagnosis of genetic disorders. The novel method transabdominal trans-amniotic approach for CVS is effective and safe in skilled hands and can help in early prenatal diagnosis of genetic disorders.