The calibration of the weighing scale was checked regularly before each measurement in order to avoid error, baby was placed on the weighing scale ensuring that entire body was on the scale, then weight was adjusted until the balance beam was centered, after that reading was documented and plotted on specific WHO growth charts (Fenton growth chart) percentiles were noted and categorized as low birth weight (LBW) if weight was less than 2.5kg, appropriate for gestational age (AGA) was more than 2.5kg. Weight was measured without clothes using standard weighing balance in kilogram (kg). In routine practice, birth anthropometries were measured by staff nurse in labor room or operation theatre by using standardized equipment (Laiqa by Italy). Gestational age (recorded as completed weeks) was calculated from maternal last menstrual period (LMP) to date of delivery and was categorized as preterm less than 37 weeks gestation and term 37 weeks or above. As this was retrospective study there was no need to take subject consent.Ī pre-designed proforma was filled by reviewing of clinical notes which entailed information about basic demographic information gestational age, birth weight, gender of baby, booking status of mother, maternal clinical characteristics, medical and obstetric complications during pregnancy, premature rupture of membrane (PROM), grades of meconium, mode of delivery, neonatal outcome (APGAR score, type of resuscitation, meconium aspiration syndrome and need for admission in nursery). The study was carried out after obtaining approval from the Aga Khan University Hospital ethical review committee. Patients with gestational age >37 weeks, cephalic presentation, who presented with meconium stained liquor after spontaneous or artificial rupture of membranes during labour were enrolled and their records were reviewed, while all neonates with congenital anomalies were excluded. AKHW-Garden is a secondary care and a private teaching hospital caters to a class of patients that belong to lower and middle class social strata. This retrospective study was conducted at the Level-II Nursery of Agha Khan Hospital for Women (AKHW) Garden, from January 2013 – December 2013. Aim of this study was to determine the maternal factors and neonatal outcome of pregnancy complicated by meconium stained amniotic fluid. ![]() Therefore identification of maternal factors may help to anticipate the need for neonatal resuscitation in delivery room which eventually helps to improve the perinatal outcome and reduce perinatal mortality and morbidity associated with MSAF. ![]() 5 MSAF is associated with higher rate of caesarean delivery, instrumental delivery, NICU admission rate, fetal distress, low birth weight and neonatal death. MSAF predisposes perinatal mortality even in women with very low risk for obstetric complications. 7 Meconium stained neonates are more prone to develop respiratory distress than neonates born with clear fluid. 6 Placental insufficiency, maternal hypertension, pre-eclampsia, oligohydramnios or maternal drug abuse (tobacco, cocaine) are predisposing factors of in utero passage of meconium. Vagal stimulation from umbilical cord compression causing fetal hypoxic stress, resulting in increased peristalsis and relaxation of anal sphincter leading to intrauterine passage of meconium. 4 Passage of meconium is not common before 34 weeks of gestation, beyond that period the incidence gradually increases. 3 One such attribute is MSAF, 27.3% of neonatal deaths had a history of or evidence of meconium passage during delivery. 2 Unfortunately Pakistan is number three among those ten countries who contribute two-thirds of the world’s neonatal deaths with an estimated neonatal mortality rate of live births. MAS contributes to neonatal death in up to 0.05% (i.e. ![]() Incidence of meconium stained amniotic fluid ranges from 7-22% 1 while meconium aspiration syndrome (MAS) occurs in approximately 5% of all cases of MSAF. ![]() Meconium stained amniotic fluid (MSAF) is an alarming sign of fetal compromise and associated with a poor perinatal outcome.
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