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Abstract of Study that Meconium Aspiration Syndrome not Caused by Meconium

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Regarding meconium:(abbreviated unless under " marks)

abstract written for MIDIRS BY HANNAH HULME June 1992 Volume2, Number2

This review has 123 references and addresses the widely-held assumption that:

  1. mec in fluids=fetal distress
  2. fetus inhales mec when asphyxia causes him to gasp
  3. mec asp sym (mas) is caused by mec in fetal lungs

1. mec staining occurs in 12% of all live births ..... passage is rare before 38 weeks ....30% of pregnancies over 42 weeks will be affected ... mec staining DOES NOT (articles emphasis not mine) necessarily indicate fetal distress

2. Inhalation of mec does not mean fetal asphyxia ... episodes of deep breathing are now accepted as normal fetal behavior .... If mec is in fluids, it will obviously pass into the lungs .... fetal tach can cause deep breathing in response to cord comp for example, but such behavior does not mean fetus is distressed ... mec inhalation is generally an antepartum event ... dramatic attempts to mechanically clear the baby's airways before first breath is taken are pointless.

3. mas arises as a result of intrauterine asphyxia .... smaller fluid volume ^ risk of asphyxia and therefore aspiration (#1 oligohydramnios indicates existing uteroplacental inadequacy, #2 danger of cord comp^, and #3 any mec in fluid is relatively concentrated, and therefore more readily inhaled in significant quantity ... prevention of mas should focus on identifying fetuses at risk ..i.e. oligohydramnios ... with amnioinfusion an appropriate(? mine) therapy.

Conclusion...."inhalation of meconium by an unasphyxiated infant produces only a "mild benign, self-limiting respiratory challenge". Observation may be all these babies require; aggressive suction therapy at birth is unnecessary and perhaps harmful".

"Meconium aspiration syndrome, on the other hand, is a multi-faceted disease, complicated by meconium but primarily caused by asphyxia. Distressed babies clearly require active resuscitation at birth and this generally necessitates airway clearance, although there is no convincing evidence that removal of meconium per se affects the course of the disease. Further study is required."

My procedure is to DeLee at the perineum if mec is present in fluids. I have seen no problems postnatally. Occasionally a too vigorous mom bursts the baby forth despite my attempts at stalling her pushing efforts, and still no ensuing problems. Only on one occasion where we had a meconium (light), rupture of membranes for 6 hours, oligohydramnios, downs baby was there pneumonia diagnosed at 24 hours postpartum (multiple, predisposing, underlying circumstances ??? I'd say yes!)

This Web page is referenced from another page containing related information about Meconium


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