TO STUDY THE ASSOCIATION OF PERINATAL OUTCOME WITH MECONIUM STAINED LIQUOR IN TERM PREGNANCY IN A BUSY PERIPHERAL TERTIARY CARE HOSPITAL

Abstract

Passage of meconium still remains an enigma to the obstetrician and equally worries the paediatrician. The presence of meconium in amniotic fluid is still believed to be a serious sign of intra –uterine fetal compromise which is associated with an increase in perinatal morbidity. Clear amniotic fluid on the other hand is regarded as a good sign of clinical reassurance to both the obstetrician as well as the pediatrician. The exact etiology of meconium stained amniotic fluid is unclear. In our study the mean gestational age of the meconium stained liquor group was 39.6 (+ 1.4) weeks and of the clear liquor group was 38.8 (+ 1.3) weeks. In our study , 32% of the cases in the meconium stained group had gestational age between 40 – 42 weeks in comparison to only 13% patients in the control group. Our study concluded that meconium stained amniotic fluid was more prevalent in primigravidas (59%).No significant co-relation was found between age and meconium stained amniotic fluid. There is a greater incidence of meconium stained amniotic fluid in the unbooked population. As per our study, 35% of the patients in the meconium stained group were unbooked compared to 11% of the population in the control group. Overall, 77% of the population was booked and 33 % were unbooked. In our study , 47% of the patients had thin meconium , 20 % had moderate and 33% of the patients had thick meconium. As per present study, there was a greater incidence of fetal heart rate abnormalities in the form of abnormal CTG in meconium stained group in comparison to the clear group. In the group with meconium stained liquor, 30% of the patients had fetal heart rate abnormalities whereas only 12% of the patients in the clear liquor group had fetal heart rate abnormalities. Meconium stained liquor is associated with increased rate of operative deliveries as per our study. In our study , we found that 46% of the patient in the MSAF group underwent caesarean section whereas in the clear liquor group , 25% of the patients underwent caesarean section. In the MSAF group 49% patients had vaginal delivery and 5% had instrumental delivery. From the present study , we concluded that the percentage of babies with Apgar score <7 at 1 minute in the meconium stained group was more compared to the clear liquor group. In our study 27% of the babies in the MSAF group had low Apgar scores compared to only 11% of the babies in the clear liquor group.73% of the babies in the MSAF group had Apgar score >7. No significant co-relation was noted between Apgar score at 5 minutes and meconium staining of liquor. 9% of the babies in the meconium stained group had Apgar score <7 at 5 minutes compared to 6% of controls. Majority(46%) of the babies had birth weight between 2.5 – 3.0 kg whereas a significant percentage of babies had birth weight below 2.5 kg (21%). Meconium stained amniotic fluid is associated with a greater number of SNCU admissions. In our study, 20% of the babies in the meconium stained group were admitted to the nursery in comparison to only 9% nursery admissions in the clear liquor group. In this study it was seen that meconium aspiration syndrome was prevalent in the thickly stained group than in thinly stained group. 80% of the babies having meconium aspiration were in the thick meconium group. Early neonatal death did not seem to be significantly associated with meconium stained amniotic fluid , as per our study. 3 out of 100 babies born in the meconium stained group died whereas there was no death in the clear group.