Neonatal Outcomes in Meconium Stained Amniotic Fluid Delivery: A Rural Perspective SC16-SC19
Dr. Gajanan Venkatrao Surewad,
H. No. N001, N Block Quarter, Nimra Institute Medical Sciences, Jupudi, Vijayawada-521456, Andhra Pradesh, India.
Introduction: Presence of meconium in amniotic fluid is a potentially serious sign of foetal compromise and has demonstrated that the incidence of MSAF rises with gestational age. The incidences of admission to Neonatal Intensive Care Unit (NICU) with various neonatal disorders were higher in pregnancies complicated by MSAF.
Aim: To study clinical profile and outcomes in neonates born through MSAF at tertiary care hospital in rural area of Andhra Pradesh.
Materials and Methods: This cross-sectional, descriptive study included a total of 4462 infants who were admitted in the NICU of Nimra Institute of Medical Sciences and Hospital, Andhra Pradesh from December 2017 to January 2020. All pre-term, term and post-term infants, delivered normally or by caesarean section or instrumental delivery, with MSAF, were included in the study. A detailed ante-natal, natal and postnatal history was taken for the neonates to detect the aetiology of MSAF, type and duration of delivery and any complications Post delivery. All the clinical assessment and lab investigations, X-ray assessments were done for the subjects as and when required. The observations were noted along with the treatment given.
Results: Out of 4462 infants admitted in study period, 436(9.78%) had MSAF and 96 (22.01%) developed Meconium Aspiration Syndrome (MAS). MSAF infants born by Normal Vaginal Delivery (NVD) formed 220 (50.46%), Lower Segment Caesarean Section (LSCS) 176 (40.37%) and 40 (9.17%) instrumental delivery. MAS infants born by LSCS formed 38 (21.59%), NVD 52 (23.63%) and instrumental delivery 6 (15%). The mean gestational age was 38-40 weeks. MAS developed in 18 (50%) infants with gestational age >42 weeks, 12 (12%) between 40-42 weeks and 50 (23.36%) between 38-40 weeks (significant relationship, p-value 0.012). The mean birth weight was 2.599±441 kg. MAS developed more in infants of birth weight 2-2.499 kg and least were of birth weight between 1.5-1.999 kg. Male to female ratio was 1.27:1. Thick MSAF was seen in 160 (36.69%) and thin MSAF in 276 (63.31%) infants (p-value 0.001). In MAS infants, 82 had thick and 14 thin MSAF. Among MSAF alone infants (n=340), 142 (41.75%) were associated with birth asphyxia. Among MAS infants, incidence of birth asphyxia was 66 (68.75%). Thirty eight MAS infants developed complications. Pneumothorax was the most common complication. Overall, mortality was 160 (36.69%). MAS contributed to 22.5% of these deaths. A 60 (62.5%) MAS infants were discharged and 36 (37.5%) died.
Conclusion: MAS was most consistently associated with thick MSAF. Preventive measures like timely evaluation of high risk factors, preparedness for untoward intrapartum events and close monitoring of MSAF infants can be taken to minimise the mortality and morbidity rates, because it is a global problem especially in under-developed countries.