Factors Leading To Meconium Aspiration Syndrome in Term- and Post-term Neonates

Abstract

BackgroundMeconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age.MethodsA cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All neonates at ≥37 weeks of gestation with meconium-stained amniotic fluid (MSAF) detected during delivery were included in this study after obtaining informed consent from their parents. The demographic and factors related to MAS were recorded through predesigned proforma and analyzed using SPSS version 22. Mean and standard deviation were determined for quantitative variables whereas frequency and percentages were calculated for qualitative variables.ResultsOverall 136 neonates were included in the study. The mean gestational age was 38 ± 1.43 weeks. The major factors for MAS were detected as fetal distress (67.0%, n = 91), non-reassuring fetal heart rate (54.0%, n = 73), cesarean birth (48.0%, n = 65), intrauterine growth restriction (IUGR; 17.0%, n = 23), and post maturity (12.0%, n = 16).ConclusionWe conclude that the major factors for MAS are fetal distress, non-reassuring FHR tracing, cesarean birth, IUGR, and post maturity. Screening of such patients at an early stage may minimize morbidity and mortality related to MAS.

Maternal risk factors and meconium stained amniotic fluid

“…21 In present study, non-reassuring foetal heart rate was observed in 29 cases out of which 34% (n=8) neonates died and was statistically significant (p<0.05). Similar findings were reported by Chand et al 18 Fenton and Steer found a perinatal mortality of 21.4%, similar to present study, when foetal heart rate was 110 beats per minute or less in presence of meconium. 27 Resnick observed a perinatal mortality of 32% in presence of an abnormal foetal heart rate pattern when meconium was present which was consistent with our study.…”

“…In similar study by Chand et al 48% were LSCS and 52% were vaginal deliveries. 18 Similarly, Urvashi et al, Sankhyan et al, Narang et al, Sori et al and Afsar et al noted an increase in number of LSCS ranging from 45% to 71.66% in MSAF. 16,[19][20][21][22] Increase in incidence of LSCS in our study was seen which may be due to good foetal monitoring during delivery and resorting to LSCS at earliest sign of foetal distress.…”

“…Chand et al reported that 7% and 17% mothers with MSAF had diabetes mellitus and PIH respectively. 18 Hanoudi et al in Iraq observed that 5.2% mothers had DM, 12.2% had hypertension and 38.5% had UTI. 17 Their incidences were much higher than what we observed in our study.…”

Risk Factors for Incidence of Intrauterine Fetal Distress in Hospital of Pamekasan

“…Accordingto a study conducted by Saroop, outof a total of 136 deliveries with meconiumamnioticfluid, 91 cases (67%) of them experienced intrauterine fetal distress (Chand et al, 2019). Andaccordingtoresearchconductedby Peter, there were 1061 deliveries with amniotic membranes, 51% ofwhom were accompanied by intrauterine fetal distress (Peter &Beverley, 2006).…”

“…In a study by Yoder, infants with meconium amniotic fluid with moderate to thick thickness were substantially increased in terms of precipitating factors, one of which was through the symptoms indicated by the presence of fetal distress (irregular fetal heart pattern, fetal acidosis) in contrast to infants without meconium and newborn with light meconium stain (P <0.01). In a study by Berkus et al, The medium and thick meconium groups had a fundamentally higher hazard, as evidenced by an abnormal fetal heart rate and cord blood vessels with a pH below 7.20 (markers of intrauterine fetal distress) (Chand et al, 2019). In a study by Tolu et al said that meconium-stained amniotic fluid is associated with increased frequency of operative delivery, birth asphyxia, neonatal sepsis, and neonatal intensive care unit admissions compared to clear amniotic fluid (Tolu et al, 2020).…”