Meconium aspiration syndrome: intrapartum and neonatal attributes

To identify the fetus and newborn at risk for meconium aspiration syndrome the perinatal characteristics of 238 infants delivered through meconium-stained amniotic fluid were prospectively examined. All infants with meconium-stained amniotic fluid were routinely suctioned with a DeLee apparatus before tracheal intubation and suctioning. The type and presence of meconium in the trachea, neonatal breathing before intubation, and Apgar scores were recorded in the delivery room. Intrapartum fetal monitoring data were collected for 80% (190/238) of the mothers and umbilical artery pH for 74% (177/238) of the newborns. Despite suctioning with a DeLee apparatus and endotracheal suctioning, meconium was present in the trachea in 87/238 (37%) and meconium aspiration syndrome developed in 22 (9.2%). A total of 73% of newborns who had meconium aspiration syndrome were delivered through thick meconium. Thick meconium, the presence of fetal tachycardia, and absence of intrapartum fetal cardiac accelerations identified the fetus at high risk for meconium aspiration syndrome. The presence of these monitoring findings and thick meconium should alert obstetricians to the possibility of a fetus that requires intervention. Low umbilical artery pH, Apgar scores less than 5, and meconium in the trachea further characterized the newborn at high risk for meconium aspiration syndrome. The combination of these findings may best identify the infant delivered through meconium-stained amniotic fluid who requires close observation for meconium aspiration syndrome.     

Fatal meconium aspiration syndrome occurring despite airway management considered appropriate

A combined obstetric-pediatric approach to tracheal toilet is said to prevent serious cases of the potentially fatal meconium aspiration syndrome. After delivery of the head a DeLee trap is used to suction the oropharynx and nasopharynx. Immediately following delivery, endotracheal suction is performed in an effort to remove any remaining meconium-stained amniotic fluid. Although routinely using this approach, we continue to have occasional cases of fatal meconium aspiration syndrome. Therefore, we reviewed the outcome of infants born through meconium-stained fluid. During a 5-year period, 1420 (15%) of 9299 live-born infants had meconium-stained fluid. Thirty (2.1%) of these 1420 developed meconium aspiration syndrome and 12 (40%) died; eight received a postmortem examination. Four had unequivocal evidence of meconium aspiration, two had large numbers of intra-alveolar squamous cells, and two had no evidence of aspiration. We conclude that aggressive airway management during and immediately after delivery does not always prevent fatal meconium aspiration syndrome.     

Meconium in the amniotic fluid and fetal acid-base status

Of 323 pregnancies with meconium-stained amniotic fluid at 36-42 weeks' gestation, 68 (21%) had a pH less than 7.20 in umbilical arterial blood, 21 (7%) had a pH less than 7.15, and only three newborns (0.9%) had true metabolic acidemia. At birth, of the 74 newborns with normal electronic fetal heart rate (FHR) tracings, eight (11%) had an umbilical arterial pH less than 7.20. There was a significantly higher frequency of acidemia (defined as pH less than 7.20) in newborns with both baseline and periodic FHR abnormalities. Although there was a significant difference (P less than .05) in the frequency of meconium found below the cords in these neonates with an umbilical artery pH less than 7.20 compared with those with values exceeding 7.20, there was no significant difference in the frequency of clinical meconium aspiration syndrome. We conclude that meconium-stained amniotic fluid correlates poorly with infant condition at birth as reflected by umbilical cord acid-base measurements.     

Meconium-stained amniotic fluid across gestation and neonatal acid-base status

OBJECTIVE: To estimate whether the acid-base status of neonates born to women with meconium-stained amniotic fluid varies across gestation. METHODS: We carried out a retrospective cohort study of all pregnancies that were complicated by meconium-stained amniotic fluid in 2004. Cases were identified from a perinatal pathology database that contained data on all pregnancies complicated by meconium-stained amniotic fluid. Data abstracted from the charts included gestational age at delivery, umbilical arterial pH, birth weight, and the presence or absence of labor. Cases were stratified according to gestational age at delivery. The distribution of meconium-stained amniotic fluid across gestation was computed. The mean umbilical arterial pH values (with 95% confidence intervals) across gestation were assessed by analysis of variance. RESULTS: The mean umbilical arterial pH in women with meconium-stained amniotic fluid did not differ across gestation. The overall incidence of meconium-stained amniotic fluid was 12.0% (766 of 6,403 deliveries). The rates of meconium-stained amniotic fluid increased from 1.2% at 32 weeks to 100% at 42 weeks. CONCLUSION: The rising incidence of meconium-stained amniotic fluid with gestational age is consistent with the hypothesis that fetal maturation is a major etiologic factor in meconium passage. Also, the lack of variation of mean umbilical arterial pH across gestation suggests that fetal acidemia is not increased when meconium passage occurs earlier in pregnancy rather than at later gestational ages.     

Influence of postdatism and meconium on fetal erythropoietin.

OBJECTIVE: To determine whether fetal erythropoietin (Epo) concentrations are increased in pregnancies extending beyond 41 weeks' gestation and whether this is influenced by the presence of meconium-stained amniotic fluid. METHODS: Epo concentrations were measured in 116 fetal umbilical cord blood samples from otherwise uncomplicated pregnancies between 37 to 43 weeks' gestation during the period of October 1996 to October 1997. An enzyme-linked immunosorbent assay kit was used to measure Epo. Maternal demographics and birth outcomes including Apgar score, cord blood pH, and base deficit were obtained. Fetuses born between 41 and 43 weeks' gestation (post-term) were compared with matched controls born between 37 and 40 weeks' gestation (term). In addition, both post-term and term fetuses with meconium-stained amniotic fluid were compared with matched controls without meconium. RESULTS: Post-term fetuses without meconium had significantly higher Epo levels compared with term fetuses (mean +/- SEM: 50.6 +/- 6.5 versus 29.5 +/- 3.3 mIU/ml, p = 0.002). When matched for gestational age, fetuses with meconium-stained amniotic fluid had significantly greater Epo concentrations compared with controls without meconium (post-term, 80.7 versus 50.6 mIU/ml; term, 61.4 versus 29.5 mIU/ml; p < 0.05). However, no significant difference in Epo levels was found between post-term fetuses with meconium and term fetuses with meconium (80.7 +/- 15.7 mIU/ml versus 61.4 +/- 12.8 mIU/ml, respectively). Mean cord blood pH and base deficit values for all groups were within normal clinical range. CONCLUSION: Cord blood Epo concentrations were significantly increased in pregnancies extending beyond 41 weeks. Irrespective of gestational age, meconium-stained amniotic fluid was associated with a significant rise in Epo. High Epo levels in these pregnancies imply subacute or chronic fetal hypoxia. Close clinical monitoring of post-term fetuses and those with meconium-stained amniotic fluid is warranted.     

Efficacy of bulb versus DeLee suction at deliveries complicated by meconium stained amniotic fluid

A combined obstetric-pediatric approach to the management of deliveries complicated by meconium-stained amniotic fluid has been recommended to decrease the incidence of meconium aspiration syndrome. Although pharyngeal suction with a DeLee catheter is generally recommended, many obstetricians prefer to use a bulb syringe for suction at the perineum. A thorough review of the literature reveals no prospective studies in humans comparing the two techniques. In the present study, these two techniques of pharyngeal suction were prospectively compared at deliveries complicated by meconium-stained amniotic fluid. Of the total 2874 deliveries, 127 (4%) were complicated by moderate or thickly meconium-stained amniotic fluid, and 107 of these were included in the study. There were 53 infants in the DeLee-suctioned group and 54 in the bulb-suctioned group. Of the 107 studied infants, four (4%) developed meconium aspiration syndrome, three in the DeLee group and one in the bulb group. There was no significant difference in the amount of meconium found below the vocal cords, comparing pharyngeal DeLee suction to bulb suction (0.22 cc versus 0.24 cc; p = NS). In conclusion, the data fail to support a significant difference in efficacy between bulb and DeLee suction in clearing the naso- and oropharynx of the neonate of meconium in cephalic-presenting vaginal or cesarean delivery.     

Meconium in labour

Meconium staining of the amniotic fluid is a common occurrence during labour and although a large proportion of these pregnancies will have a normal neonatal outcome, its presence may be an indicator of fetal hypoxia and has been linked to the development of cerebral palsy, seizures and meconium aspiration syndrome. The management of the intrauterine passage of meconium has been controversial but appropriate intrapartum care with early detection and management of fetal hypoxia is important in minimizing the risk from meconium staining of the amniotic fluid. This review looks at the evidence for the potential mechanisms implicated in the passage of meconium; its intrapartum management and possible interventions available to reduce the risk of meconium aspiration. The neonatal complications and immediate delivery room management of the meconium-stained neonate are also discussed.     

Meconium in labour

Meconium staining of the amniotic fluid is a common occurrence during labour and although a large proportion of these pregnancies will have a normal neonatal outcome, its presence may be an indicator of fetal hypoxia and has been linked to the development of cerebral palsy, seizures and meconium aspiration syndrome. The management of the intrauterine passage of meconium has been controversial but appropriate intrapartum care with early detection and management of fetal hypoxia is important in minimizing the risk from meconium staining of the amniotic fluid. This review looks at the evidence for the potential mechanisms implicated in the passage of meconium, its intrapartum management and possible interventions available to reduce the risk of meconium aspiration. The neonatal complications and immediate delivery room management of the meconium-stained neonate are also discussed.     

Studies on meconium-like substances in the urine of mother and neonate during perinatal period

It is well known that the entry of amniotic fluid into the mother's circulation may result in the occurrence of amniotic embolism, and aspiration of meconium by the neonate may cause meconium aspiration syndrome. To study meconium-like substances detected in the urine of mother and neonate during the perinatal period, the authors carefully assayed the Urinary Meconial Index (UMI) in subjects including 100 pregnant women, 171 parturient women, 171 neonates and 68 samples of amniotic fluid. Through the UMI assay, the frequency of the appearance of high UMI, the mode of delivery at high UMI and its effect upon both mother and neonate were studied and the following findings obtained. The entry of meconium into the mother's circulation occurs during labor pains and may be excreted into the mother's urine (6.4%). Labor pains enhance the entry of meconium into the mother's circulation and the entry takes place even in the absence of any clinical signs of rupture of the membranes (p less than 0.01). The entry of meconium into both mother and neonate occurs at a higher rate in dystocia and in cases with meconium-stained amniotic fluid (p less than 0.05). Even in the absence of marked symptoms such as those in meconium aspiration syndrome, the aspiration of meconium affects postnatal course of the newborn (positive CRP, early appearance of bilirubinemia: p less than 0.05).     

ACOG Committee Opinion Number 346, October 2006: amnioninfusion does not prevent meconium aspiration syndrome

Amnioinfusion has been advocated as a technique to reduce the incidence of meconium aspiration and to improve neonatal outcome. However, a large proportion of women with meconium-stained amniotic fluid have infants who have taken in meconium within the trachea or bronchioles before meconium passage has been noted and before amnioinfusion can be performed by the obstetrician; meconium passage may predate labor. Based on current literature, routine prophylactic amnioinfusion for the dilution of amnioinfusion for meconium-stained amniotic fluid should be done only in the setting of additional clinical trials. However, amnioinfusion remains a reasonable approach in the treatment of repetitive variable decelerations, regardless of amniotic fluid meconium status.     

Meconium Does Not Guarantee Fetal Lung Maturity

Objective: In utero passage of meconium may represent a response to hypoxic stress or a normal maturational event. When found during the third trimester, one may be tempted to use its presence as prima facie evidence of fetal lung maturity. The purpose of our study was to determine the frequency of meconium-stained fluid in the third trimester and the incidence of biochemical and physiologic lung immaturity in these fetuses.

Methods: Amniotic fluid specimens obtained at our institution from 1991 through 1993 (n = 2,377) were analyzed for maturity and visually inspected for meconium. Perinatal outcome was obtained for intramural deliveries occurring within 3 days of amniotic fluid collection (n = 905). Gestational age was defined as the best obstetric estimate based on menstrual dates, clinical examination, and ultrasound results.

Results: Meconium staining was present in 2.7% (n = 64) of specimens. Although meconium-stained specimens were more likely to have mature lecithin-sphingomyelin (L:S) ratios (OR 2.1, 95% confidence interval [CI] = 1.2–3.6) and phosphatidylglycerol (PG) concentrations (OR 3.8, CI 2.2–6.7), 17.2% were immature for both L:S and PG (n = 11, CI = 9.9–28.2%). When analysis was limited to fetuses delivering intramurally within 3 days of amniotic fluid collection, respiratory distress syndrome occurred in 3.0% (CI = 0.5–15%) with meconium-stained fluid.

Conclusions: The presence of meconium in amniotic fluid does not guarantee lung maturity. The same consideration of the risks of prematurity must be given to the fetus with meconium-stained fluid as given to the fetus with clear fluid.     

Meconium aspiration syndrome in term neonates with normal acid-base status at delivery: Is it different?

OBJECTIVE: Our aim was to compare the clinical characteristics of meconium aspiration syndrome in cases with pH > or =7.20 and in those with pH <7.20. STUDY DESIGN: Medical records of diagnostic codes from the International Classification of Diseases, Ninth Revision, were used to identify neonates with severe meconium aspiration syndrome who had been delivered at our institution from 1994 through 1998. Severe meconium aspiration syndrome was defined as a mechanical ventilator requirement of >48 hours. Clinical data including neonatal outcomes of cases of meconium aspiration syndrome associated with umbilical pH > or =7.20 at delivery were compared with data on outcomes of cases with pH <7.20. RESULTS: During this 4-year study period, 4985 singleton term neonates were delivered through meconium-stained amniotic fluid. Forty-eight cases met all study criteria, and pH values at delivery were as follows: pH > or =7.20, n = 29, and pH <7.20, n = 19. There were no differences between groups in the incidence of clinical chorioamnionitis, in the presence of meconium below the vocal cords, or in birth weight. Neonates with meconium aspiration syndrome and umbilical pH > or =7.20 at delivery developed seizures as often as those with pH <7.20 (20.1% vs 21.1%; P = 1.0). CONCLUSION: Normal acid-base status at delivery is present in many cases of severe meconium aspiration syndrome, which suggests that either a preexisting injury or a nonhypoxic mechanism is often involved.     

应用胎粪吸引管气管内吸引防治胎粪吸入综合征的临床效果分析

目的 评价气管内吸引防治胎粪吸入综合征(meconium aspiration syndrome,MAS)的有效性,探讨新生儿活力与胎粪吸入的关系. 方法 2004年1月至2006年12月我院分娩胎粪Ⅲ度污染新生儿(简称粪染儿)495例,随机分为观察组249例,生后常规气管插管、应用胎粪吸引管抽吸胎粪;对照组246例,生后插管、气管内冲洗.观察两组MAS发生率、并发症及预后. 结果 观察组与对照组MAS发生率分别为7.6%和11.4%(x2=2.45,P＞0.05);观察组重型MAS发生率明显低于对照组[0.8%(2/249)和4.5%(11/246),x2=6.51,P＜0.05];观察组机械通气率为0.4%,对照组为2.8%(x2=3.12,P＞0.05);观察组病死率为0,对照组病死率1.2%(3/246).观察组1 min Apgar评分9～10分有活力新生儿气管抽出胎粪中位数为0.86 ml,明显少于≤8分无活力新生儿的1.65 ml(z=1.44,P＜0.05);观察组有活力粪染儿中17.8%(38/214)气管内可抽到胎粪,其中26.3%(10/38)可抽出大量胎粪.结论 (1)粪染儿生后早期进行气管内吸引不能减少MAS发生率,但可减轻临床症状,防止并发症,降低病死率.(2)有活力新生儿亦可发生胎粪吸入,应积极处理.     

Risk of meconium-stained amniotic fluid in different ethnic groups.

BACKGROUND: Recent studies indicate that the risk of meconium-stained amniotic fluid (MSAF) varies in different ethnic groups. This study prospectively examined the ethnic variation of MSAF and meconium aspiration syndrome, adjusting for gravidity, gestational age (GA), and birth weight. METHOD: The study population consisted of 6901 consecutive live births and included 31 different nationalities, seven main ethnic (race) groups, gravidity between 1 and 19, GA between 22 and 44 weeks, and birth weights between 350 and 6292 gm. RESULTS: The overall incidence of MSAF was 19% (13% thin, 6% thick). The prevalence of meconium aspiration syndrome was 5% in thick MSAF and none in thin MSAF. The incidence of MSAF differs significantly by ethnicity (14% to 30%), gravidity (17% to 23%), GA (6% to 46%), and birth weight (11% to 28%). Multivariate logistic regression analysis using the same variable showed that being black African, post-term, with a gravidity of > or = 7 and a birth weight of > or = 4000 gm significantly increased the chance for MSAF but not meconium aspiration syndrome. After controlling for these clinical variables, the black African infants had a higher percentage of MSAF at all GAs compared with the other ethnic groups. CONCLUSION: This study showed that the risk of MSAF varied by ethnicity and increased with higher gravidity, a GA of > 42 weeks, and a birth weight of > or = 4000 gm The higher incidence of MSAF without an increase in meconium aspiration syndrome in some ethnic groups may indicate advancing maturity of the gastrointestinal system in black ethnic groups compared with others of the same GA.     

羊水粪染的羊水置换与新生儿预后

目的 对Ⅱ度以上羊水粪染的孕妇行羊水置换,旨在改善新生儿预后。方法 ３２例采用自行设计的三通管装置和置换液行羊水置换,作研究组,另３０例作对照组,进行对比分析。结果 新生儿窒息率、胎粪吸入综合征发生率、脐血及股动脉血血气分析,研究组与对照组对比有显著性差异（Ｐ〈０．０１）。产褥病率两组无明显差异（Ｐ〉０．０５）。两组各自脐静脉和股动脉血血气分析对比无显著性差异（Ｐ〉０．０５）。结论 羊水染行羊水和     

Meconium Staining and Its Effect on Hospital Care During the Neonatal Period

Objective: to characterize differences in outcome and course of newborn care between births with meconium-stained amniotic fluid and those with clear amniotic fluid.Design: prospective cohort study complemented by retrospective chart review.Setting: London Health Sciences Centre.Participants: all live singleton births delivered at LHSC between January 1 and December 31, 1996. Excluded were multiple births and elective Caesarean sections.Outcome Measures: degree of resuscitation performed on newborns, Apgar scores, paediatric consultations, transfers from newborn nursery to higher level of care, hospital revisit and readmission rates within 30 days of discharge.Results: there were a total of 126 births associated with thick meconium staining, 194 with thin meconium staining, and 52 with terminal meconium only. Resuscitation efforts were undertaken in 54.0 percent of thick meconium births, 32.5 percent of thin meconium births, 30.8 percent of terminal meconium births and 17.3 percent of births with clear amniotic fluid, a significant difference (p<0.001). One-minute Apgar scores less than 7 occurred in 23.0 percent of thick meconium births, 14.4 percent of thin meconium births 7.7 percent of terminal meconium births and 6.4 percent of births with clear amniotic fluid. Five-minute Apgar scores less than 8 were significantly more common (5.5%) in meconium-stained births of all types (thick, thin, and terminal) than in births with clear amniotic fluid (0.64%; p<0.001). Five percent of infants with meconium staining and 1.6 Percent of infants with clear amniotic fluid required paediatric critical care unit (PCCU) admission: a significant difference (p=0.016). Paediatric consultation rate after transfer from the delivery room was 18.3 percent for infants born with thick meconium, significantly more than the 10.0 percent for infants not born with thick meconium (p=0.014). There was no significant difference in frequency of subsequent visits to the emergency department or readmission rates in the first month after birth by infants who had any degree of meconium staining compared to those who had clear amniotic fluid.Conclusions: presence and degree of meconium-stained amniotic fluid prior to birth predicts an increased likelihood of resuscitative interventions and a possibility of increased intensity of care needed in the first few days of life.     

Does DeLee suction at the perineum prevent meconium aspiration syndrome?

OBJECTIVE: We attempted to determine the impact of "early" (before delivery of the chest) oronasopharyngeal DeLee suctioning at the perineum in the prevention of meconium aspiration syndrome and to confirm that meconium aspiration syndrome is a postnatal event. STUDY DESIGN: We compared infants with meconium-stained fluid who underwent "early" oronasopharyngeal DeLee suctioning with a similar group of infants whose airways were suctioned "late" (after chest delivery). Practicing obstetricians did not know the study was being conducted by the pediatric staff, and an independent observer documented whether obstetricians performed "early" or "late" oronasopharyngeal DeLee suctioning. Immediate postnatal tracheal suctioning was performed in both groups. The study was conducted in a private tertiary care center averaging 5800 deliveries annually. A consecutive sample of 438 infants with meconium-stained fluid was analyzed. Of these infants, 221 received "early" oronasopharyngeal DeLee suctioning, while 217 infants were suctioned "late". RESULTS: Of the 438 infants with meconium-stained fluid, meconium aspiration syndrome developed in 38 (9%). These infants had higher rates of fetal distress (i.e., abnormal fetal heart rates) and lower Apgar scores (< or = 6) than infants without meconium aspiration syndrome (58% vs 17% and 65% vs 13%, respectively; p < 0.001). Forty-five percent of the infants with meconium aspiration syndrome had renal failure during the first 20 hours of life. In spite of "early" oronasopharyngeal DeLee suctioning, 53% of the infants in this group had meconium below the vocal cords and meconium aspiration syndrome developed in 7%. The time of oronasopharyngeal DeLee suctioning did not affect the rate of meconium aspiration syndrome or the presence of meconium below the vocal cords. CONCLUSIONS: We concluded that "early" oronasopharyngeal DeLee suctioning at the perineum does not affect the rate of meconium aspiration syndrome. We speculate that meconium aspiration syndrome is predominantly an intrauterine event associated with fetal distress and that meconium in the airways is merely a "marker" of previous fetal hypoxia.     

Use of maternal plasma level of zinc-coproporphyrin in the prediction of intrauterine passage of meconium: a pilot study

OBJECTIVE: To evaluate the usefulness of maternal plasma zinc-coproporphyrin (ZCP) level as a marker for intrauterine passage of meconium. METHODS: A pilot study consisting of 10 pregnancies with meconium-stained amniotic fluid and 10 pregnancies with clear amniotic fluid was used. The corresponding plasma and amniotic fluid levels of ZCP were measured using spectrofluorometry. ZCP levels in plasma and amniotic fluid were compared between the two groups and the relation between plasma and amniotic fluid ZCP levels in the clear and meconium-stained groups was assessed using Spearman rank-order correlation. RESULTS: Mean amniotic fluid ZCP was significantly higher in the meconium-stained amniotic fluid as compared to the clear amniotic fluid group. Although mean plasma ZCP levels were higher in the meconium-stained amniotic fluid group, this difference was not statistically significant. There was no significant correlation between plasma ZCP levels and amniotic fluid ZCP, but we could categorize patients according to plasma ZCP levels into four categories with different risks for having meconium-stained amniotic fluid. CONCLUSIONS: Plasma ZCP might be a promising test for prediction of intrauterine passage of meconium in high-risk patients if confirmed by larger studies. The implications of this prediction on management remain unknown.     

Risk factors for meconium aspiration syndrome in infants born through thick meconium.

OBJECTIVE: To determine risk factors for meconium aspiration syndrome (MAS). METHOD: A cohort study was conducted of 70 consecutive singleton pregnancies complicated with thick meconium-stained amniotic fluid delivered at > or = 37 weeks' gestation. Cases were randomized either for elective abdominal delivery or spontaneous vaginal delivery after 20 min of external fetal heart rate (FHR) monitoring. Risk estimation analysis for MAS was performed calculating relative risks (RR) and odds ratios (OR). RESULTS: The presence of meconium below the vocal cords (RR=7.3, 95% CI=2.6-20.3), non-reassuring FHR tracings (RR=3.0, 95% CI=1.2-7.5), Apgar score < or = 6 at 5 min (RR=3.8, 95% CI=1.7-8.4) and an umbilical cord plasma erythropoietin (UCPer) level > 50 mlU/ml (RR=5.0, 95% CI=2.1-12.0) were found to be significant risk factors for MAS. The presence of meconium below the vocal cords (OR=33.4, 95% CI=3.6-303.7) and non-reassuring FHR tracings (OR=12.2, 95% CI=1.3-111.7) remained as significant risk factors at the end of the multivariate analysis. CONCLUSION: Non-reassuring FHR tracings and the presence of meconium below vocal cords are associated with an increased risk for MAS in infants born through thick meconium.     

Role of Intrapartum Transcervical Amnioinfusion in Patients with Meconium-Stained Amniotic Fluid

Objectives

The study was undertaken to evaluate maternal, perinatal outcomes following transcervical intrapartum amnioinfusion in women with meconium-stained amniotic fluid.

Methods

A prospective comparative study was conducted on 100 women with meconium-stained amniotic fluid in labor. Group A: study group (50 cases) received amnioinfusion. Group B: control group (50 cases) did not receive amnioinfusion. FHR monitoring was done using cardiotocography.

Results

Significant relief from variable decelerations was seen in 68.18 % cases in the amnioinfusion group as compared to 7.1 % cases in the control group. 78 % cases who were given amnioinfusion had vaginal delivery as compared to 18 % cases in the control group. Fourteen percent cases in the study group had cesarean delivery as compared to 68 % cases in the control group. Meconium aspiration syndrome was seen in six percent neonates in the study group as compared to 20 % in the control group. Two neonates died in the control group due to meconium aspiration syndrome. There was no maternal mortality or major maternal complication.

Conclusions

Intrapartum transcervical amnioinfusion is valuable in patients with meconium-stained amniotic fluid.