Journal of South Asian Federation of Obstetrics and Gynaecology

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VOLUME 11 , ISSUE 2 ( March-April, 2019 ) > List of Articles


Meconium-stained Amniotic Fluid Revisited: A Holistic Perspective

Rajesh Panicker, Lei Lei Win, Jaipal Moopil

Keywords : Aspiration, Chill factor, Meconium, Perinatal mortality, Perinatal outcome, Pregnancy, Prevention

Citation Information : Panicker R, Win LL, Moopil J. Meconium-stained Amniotic Fluid Revisited: A Holistic Perspective. J South Asian Feder Obs Gynae 2019; 11 (2):131-133.

DOI: 10.5005/jp-journals-10006-1658

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Since historical times, the presence of meconium in the amniotic fluid has been worrisome for midwives and accoucheurs alike. Its association with a neonate who does not cry has often been a chill factor in delivery suites. Having said that, all cases of meconium-stained amniotic fluid (MSAF) do not necessarily result in low APGAR scores. 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. The main pathology associated with MSAF is the aspiration of meconium during intrauterine gasping or during the first few breaths. This causes meconium aspiration syndrome (MAS) which has serious consequences on neonatal outcome. MAS is a common cause of severe respiratory distress in term neonates, with an associated highly variable morbidity and mortality. The pathophysiology of MAS is multifactorial and includes acute airway obstruction, surfactant dysfunction or inactivation, chemical pneumonitis, and persistent pulmonary hypertension of a newborn. Concepts regarding meconium and the management of MSAF to prevent MAS have changed in the last two decades or so. Guidelines published by the American Academy of Pediatrics/American Heart Association have changed the immediate neonatal management following delivery in the presence of MSAF. Initially, amnioinfusion was considered an important tool in the management of MSAF. However, evidence to support this view has not been forthcoming and current guidelines recommend amnioinfusion only in controlled and research settings. The future thrust should be aimed at early detection of MSAF and prevention of MAS. Needless to say, the obstetrician and the neonatologist need to work in consonance for achieving a better neonatal outcome in the presence of MSAF.

  1. Vain NE, Batton DG. “Meconium “Aspiration”. Semin Fetal Neonatal Med 2017;22(4):214–219. DOI: 10.1016/j.siny.2017.04.002.
  2. Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome: an update. Pediatr Clin North Am 1998;45(3):511–529. DOI: 10.1016/S0031-3955(05)70025-0.
  3. Ostrea EM, Jr, Naqvi M. The influence of gestational age on the ability of the fetus to pass meconium in utero: clinical implications. Acta Obstet Gynecol Scand 1982;61(3):275–277. DOI: 10.3109/00016348209156571.
  4. Balchin I, Whittaker JC, et al. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011;117(4):828–835. DOI: 10.1097/AOG.0b013e3182117a26.
  5. Van Ierland Y, De Beaufort AJ. “Why Does Meconium Cause Meconium Aspiration Syndrome? Current Concepts of MAS Pathophysiology”. Early Hum Dev 2009;85:617–620. DOI: 10.1016/j.earlhumdev.2009.09.009.
  6. Dargaville PA, Copnell B, et al. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006;117(5):1712–1721. DOI: 10.1542/peds.2005-2215.
  7. Pramanik AK, Rengaswamy N, et al. Neonatal respiratory distress: a practical approach to its diagnosis and management. Pediatr Clin North Am 2015;62(2):453–469. DOI: 10.1016/j.pcl.2014.11.008.
  8. Unsworth J. Meconium in labour. Obstet Gynaecol Reprod Med 2010;20(10):289–294. DOI: 10.1016/j.ogrm.2010.06.005.
  9. Jiménez E, Marín ML, et al. Is meconium from healthy newborns actually sterile? Res Micro 2008;159(3):187–193. DOI: 10.1016/j.resmic.2007.12.007.
  10. Snyder A, Rood KM, et al. Meconium-Stained Amniotic Fluid is Associated with an Increased Risk of Post-Cesarean Surgical Site Infection. Obstet Gynecol May 2017;129(5):1S. DOI: 10.1080/14767058.2019.1637408.
  11. Lakshmanan J, Ahanya SN, et al. Elevated plasma corticotrophin release factor levels and in utero meconium passage. Pediatr Res 2007;61:176. DOI: 10.1203/pdr.0b013e31802d8a81.
  12. Rossi EM, Philipson EH, et al. Meconium aspiration syndrome: intrapartum and neonatal attributes. Am J Obstet Gynecol 1989;161:1106–1110. DOI: 10.1016/0002-9378(89)90643-1.
  13. Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome. Unresolved issues. Pediatr Clin North Am 1993;40:955–981. DOI: 10.1016/S0031-3955(16)38618-7.
  14. Rodríguez Fernández V, Ramón Y Cajal CNL, et al. Intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid. Eur J Obstet Gynecol Reprod Biol 2018 Sep;228:65–70. DOI: 10.1016/j.ejogrb.2018.03.035.
  15. American Heart Association: Part 13: Neonatal Resuscitation. Web-based Integrated 2010 and 2015 American Heart Association Guidelines for Neonatal Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. AHA website. Updated 2015.
  16. Newton O, English M. Newborn resuscitation: defining best practice for low-income settings: transactions of Royal Society of Tropical Medicine and Hygene. Oct 2006;100(10-4):899–908. DOI: 10.1016/j.trstmh.2006.02.012.
  17. Karamustafaoglu Balci B, Goynumer G. Incidence of echogenic amniotic fluid at term pregnancy and its association with meconium. Arch Gynecol Obstet 2018;297:915. DOI: s00404-018-4679-7.
  18. Swarnam K, Soraisham AS, et al. Advances in the management of meconium aspiration syndrome. Int J Pediatr 2012;2012:359571. DOI: 10.1155/2012/359571.
  19. Bhat R, Vidyasagar D. Delivery room management of meconium-stained infant. Clin Perinatol 2012;39(4):817–831. DOI: 10.1016/j.clp.2012.09.004.
  20. Goldsmith JP. Continuous positive airway pressure and conventional mechanical ventilation in the treatment of meconium aspiration syndrome. J Perinatol 2008;28(Suppl 3):S49–S55. DOI: 10.1038/jp.2008.156.
  21. Beligere N, Rao R. Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review. J Perinatol 2008 Dec;28(Suppl 3):S93–S101. DOI: 10.1038/jp.2008.154.
  22. Divon MY, Haglund B, et al. Fetal and neonatal mortality in the postterm pregnancy: the impact of gestational age and fetal growth restriction. Am J Obstet Gynecol 1998;178:726. DOI: 10.1016/S0002-9378(98)70482-X.
  23. Doody Michael C. Assignee. Prenatal detection of meconium stained amniotic fluid. US pat. US5172693. 1992 Dec 22.
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