Study of Maternal and Fetal Outcome in Parturients with Meconium Stained Amniotic Fluid at Term Gestation – Role of Intrapartum Amnio Infusion

Passage of meconium in utero is a dangerous sign for fetal outcome which influence the decision as well as the mode of delivery.Amnio infusion to dilute this meconium and prevent decelerations and hasten the progress of labour is a procedure which can be tried for improving maternal and fetal outcome. The aim of this study is to study the maternal and fetal outcome in parturients with MSAF and compare it with patients with clear amniotic fluid and to know the role of amnio infusion in improving the maternal and fetal outcome in patients with MSAF. This descriptive case control study was carried out in the department of Obstetrics and Gynaecology, Mamata general hospital, khammam, Andhra Pradesh, India from January 2011 to December 2012. A total of 50 women with meconium stained amniotic fluid( MSAF) were studied to identify maternal and fetal outcome and was compared with 50 women with clear amniotic fluid. Normal delivery was significantly higher (58%) in clear liquor group as compared to MSAF group (22%). Cesarean section was more common in MSAF group (66%) where as it was (38%) in the clear liquor group (p=0.005). Low Apgar scores of < 5 at one minute was seen in 48% of MSAF and only 6% in clear liquor group (p<0.2). But at 5 minutes low Apgar score persisted in same 48% of MSAF babies whereas it was seen in 12% of clear liquor group. Among the babies born with MSAF 34% were referred to higher center compared to 6% in clear liquor group . Four babies with thick MSAF and one baby with clear liquor had neonatal death (p=0.005). Amnio infusion was done in 25 patients with MSAF.20/25 of them had normal vaginal delivery with out undue prolongation of labour and all the babies were alive with good apgar at birth .It was failed procedure in 5 patients since the decelerations persisted(3/5 pts.) and labour did not progress(2/5 pts.) inspite of amnio infusion and were taken up for LSCS. There were no complications noted associated with the procedure. Mode of delivery and fetal outcome were adversely affected by the presence of thick meconium stained liquor as compared to clear liquor. Additional monitoring facilities e.g. cardiotocography (CTG) if available would reduce fetal distress and allow timely intervention in such cases. Amnio infusion can be an alternative option in countries like India to improve maternal and fetal outcome.