![]() ![]() The main pathology associated with MSAF is the aspiration of meconium during intrauterine gasping or during the first few breaths. Since the process of labor and delivery are stressful to the fetus, it is possible that this stress could result in biochemical events that result in the passage of meconium during the normal course of labor. 8 Apart from these associations, very little is known about in utero passage of meconium. Meconium passage has also been associated with maternal drug abuse, use of vaginal misoprostol for induction of labor, chorioamnionitis, and maternal diabetes. 6, 7 Though MSAF has been considered as a marker for fetal hypoxia, this association between fetal distress and in utero passage of meconium has not been conclusively substantiated. MSAF continues to be a chill factor in delivery suites primarily because of the association with fetal hypoxia and poor APGAR scores which is why the attending staff scurry around for help at the time of delivery. It is usually released within the first 48 hours after birth. 5 Meconium is the first intestinal discharge following delivery and it is believed that it accumulates within the fetal gastrointestinal tract throughout the third trimester of pregnancy. Meconium is a dark-green substance which contains gastrointestinal secretions, amniotic fluid, bile acids, bile pigments, blood, mucus, cholesterol, pancreatic secretions, lanugo, vernix caseosa, and cellular debris. ![]() 2, 3 MSAF is more common among women of African and Asian ethnicity. 1 MSAF is seen in 8–20% of all deliveries and may increase to 23–52% after 42 weeks of gestation which has been attributed to the gastrointestinal maturation. Keywords: Aspiration, Chill factor, Meconium, Perinatal mortality, Perinatal outcome, Pregnancy, Prevention.Īristotle was believed to have observed the tranquilizing effect of meconium on the newborn which probably explains the etymology of meconium from the Greek mēkōnion meaning the juice of the opium poppy. Needless to say, the obstetrician and the neonatologist need to work in consonance for achieving a better neonatal outcome in the presence of MSAF. The future thrust should be aimed at early detection of MSAF and prevention of MAS. However, evidence to support this view has not been forthcoming and current guidelines recommend amnioinfusion only in controlled and research settings. Initially, amnioinfusion was considered an important tool in the management of MSAF. Guidelines published by the American Academy of Pediatrics/American Heart Association have changed the immediate neonatal management following delivery in the presence of MSAF. Concepts regarding meconium and the management of MSAF to prevent MAS have changed in the last two decades or so. The pathophysiology of MAS is multifactorial and includes acute airway obstruction, surfactant dysfunction or inactivation, chemical pneumonitis, and persistent pulmonary hypertension of a newborn. MAS is a common cause of severe respiratory distress in term neonates, with an associated highly variable morbidity and mortality. This causes meconium aspiration syndrome (MAS) which has serious consequences on neonatal outcome. ![]() In addition to in utero fetal hypoxia, meconium passage has also been associated with maternal drug abuse, use of vaginal misoprostol for induction of labor, chorioamnionitis, and maternal diabetes. Having said that, all cases of meconium-stained amniotic fluid (MSAF) do not necessarily result in low APGAR scores. Its association with a neonate who does not cry has often been a chill factor in delivery suites. Since historical times, the presence of meconium in the amniotic fluid has been worrisome for midwives and accoucheurs alike. Meconium-stained Amniotic Fluid Revisited: A Holistic Perspective. Rajesh Panicker 1, Lei Lei Win 2, Jaipal Moopil 3ġ,3Department of Obstetrics and Gynaecology, AIMST University, Bedong, Malaysia 2Department of Paediatrics, AIMST University, Bedong, MalaysiaĬorresponding Author: Rajesh Panicker, Department of Obstetrics and Gynaecology, AIMST University, Bedong, Malaysia, Phone: +60 1126146711, e-mail: to cite this article Panicker R, Win LL, et al. Meconium-stained Amniotic Fluid Revisited: A Holistic Perspective Journal of South Asian Federation of Obstetrics and Gynaecology Volume 11 | Issue 2 | Year 2019 ![]()
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