Meconium aspiration syndrome: importance of the monitoring of labor.

OBJECTIVE

This study was conducted to identify the associated obstetric and neonatal factors in babies with meconium aspiration syndrome.

STUDY DESIGN

All babies diagnosed with meconium aspiration were included in the study. Maternal details, monitoring of labor, and mode of delivery were recorded. The neonatal details included Apgar scores, resuscitation, weight, gestational age, and the grading of the radiographs for severity of meconium aspiration syndrome. Outcome was determined as survival or death, the need for mechanical ventilation, and the severity of the radiographic changes.

RESULTS

Of the 55 patients entered into the study 8 babies (14.5%) died and 23 (42%) received mechanical ventilation. Fifty-four percent of the babies were born postterm. Univariate analysis revealed that the lack of monitoring of the labor was the most significant variable associated with moderate to severe radiographic changes (p = 0.008). Tracheal suction was significantly associated with more severe radiographic changes (p = 0.008). One (8.2%) of 12 babies with mild radiographic changes had an arterial pH < 7.2 (p = 0.032). Multivariate analysis showed that mortality and the need for mechanical ventilation were associated with monitoring of labor and with prolonged resuscitation. Moderate to severe changes on radiograms were associated with tracheal suction and with prolonged resuscitation. The obstetric complications in this study were those commonly seen in the local obstetric practice.

CONCLUSION

The monitoring of labor was the most significant factor in the reduction of meconium aspiration syndrome. The presence of more severe radiologic changes in those babies who had tracheal suction and a lower arterial pH supports the view that aspiration occurs in some babies before delivery. The number of babies delivered postterm suggests that avoidance of postmaturity is a further preventive factor in meconium aspiration syndrome.