APGAR scores and perinatal outcome in neonates born with meconium stained amniotic fluid
Manoj Kumar Ram, Bankey Bihari Singh
Background and Objectives: Meconium-stained stained amniotic fluid (MSAF) is the result of passage of meconium in utero by the fetus antenatally or during labor process. However, MSAF is considered an alarming sign of fetal compromise and its occurrence is associated with a poor perinatal outcome. There is growing evidence that indicates its association with increased incidences of meconium aspiration syndrome, operative delivery, respiratory distress, neonatal sepsis, need for resuscitation, neonatal intensive care admission, and low Apgar score. The present study was undertaken to determine the maternal factors and neonatal outcome of pregnancies complicated by meconium stained amniotic fluid. Methodology: We conducted this prospective case control study over 1 year from January 2017 to December 2017 at NICU of a tertiary care level Medical College in Bihar including neonates of gestational age >35 weeks born with MSAF and with no congenital anomalies. Maternal factors, APGAR score and short term outcome of neonates were compared in MSAF group and control group. Immediate perinatal outcome was also compared between neonates born with thin and thick meconium. Results: During the study period, we enrolled 152 neonates born with MSAF. Mean birth weight of neonates with MSAF was 3.28 kg ± 0.42 Kg. LBW was seen in 12 (7.9%) of these neonates. 94 (61.8%) were born by assisted or unassisted vaginal delivery while 58 (38.2%) were born by cesarean section. Mean Gestational age was 39.8 ± 1.7 in MSAF group and 38.7 ± 1.67 in control group. Primigravida mothers were more likely to give birth to neonates with MSAF. MSAF was found to be a risk factor for operative delivery. Both the 1 min APGAR score (6.1 ± 0.82 vs 8.2 ± 0.43, p <0.01) as well as 5 minute APGAR score (6.9 ± 0.95 vs 8.79± 0.31, p <0.01) were significantly lower in MSAF group as compared to controls. Neonates born with thick MSAF were more likely to be suffering from adverse immediate neonatal outcome as compared to neonates born with thin MSAF. Overall, neonates born with MSAF had a significant higher incidence of respiratory support, days of ventilator support, days of hospital stay and complications like EONS, HIE as well as mortality as compared to controls. Conclusion: Occurrence of MSAF is a worrisome phenomenon as this condition is a significant contributor to neonatal morbidity and mortality. Of particular concern is its association with an increased risk of operative delivery, perinatal asphyxia, requirement of extensive resuscitative efforts, neonatal sepsis, NICU admissions and respiratory support.