DOCSLIB.ORG

Prevalence of Meconium Stained Amniotic Fluid and Its Associated

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Prevalence of Meconium Stained Amniotic Fluid and Its Associated Addisu et al. BMC Pregnancy and Childbirth (2018) 18:429 https://doi.org/10.1186/s12884-018-2056-y RESEARCHARTICLE Open Access Prevalence of meconium stained amniotic fluid and its associated factors among women who gave birth at term in Felege Hiwot comprehensive specialized referral hospital, North West Ethiopia: a facility based cross-sectional study Dagne Addisu1* , Azezu Asres2, Getnet Gedefaw3 and Simegnew Asmer2 Abstract Background: Meconium stained amniotic fluid is one of the risk factors to increase the rate of perinatal morbidity and mortality both in developed and developing countries. Duetoamultitudeoffactorsassociated with socioeconomic and quality of service, the ill effect of meconium stained amniotic fluid is even worse in developing countries. But very little information is known about the situation in Ethiopia, particularly the study area to design appropriate prevention strategies. Hence, this study aimed to determine the prevalence of meconium-stained amniotic fluid and its associated factorsamongwomenwhogavebirthatterminFelege Hiwot Referral Hospital, North West Ethiopia. Methods: Institutional based cross-sectional study was conducted at Felege Hiwot Referral Hospital from March 02–May 27, 2018. A total of 495 mothers were included in the study. The study participants were selected by systematic random sampling technique. A combination of chart review and interview were used to collect the data. Data entry and analysis were made by using Epi-data version 3.1 and SPSS versions 23 respectively. Both descriptive & analytical statistics were computed. Statistical significance was considered at P < 0.05 and the strength of association was assessed by using adjusted odds ratio. Result: The prevalence of meconium stained amniotic fluid was found to be 17.8%. Women whose age greater than 30 years [AOR =5.63, 95%CI =3.35–9.44], duration of labor greater than 24 h [AOR = 7.1, 95%Cl =1.67–29.68], induced labor [AOR = 2.60, 95% CI =1.39–4.87], preeclampsia [AOR = 3.45, 95%CI =1.26–9.37] and obstructed labor [AOR =5.9, 95%CI =1. 29–29.68] were found to be associated with meconium stained amniotic fluid. Conclusions: The prevalence of meconium stained amniotic fluid was similar as compared to the international standard. Preeclampsia, maternal age, obstructed labor, induced labor and longer duration of labor were factors associated with an increased risk for meconium-stained amniotic fluid. Thus, early detection and timely intervention are mandatory to decrease prolonged and obstructed labor. Keywords: Meconium, Amniotic fluid, Meconium stained amniotic fluid, Meconium aspiration syndrome, Felege Hiwot * Correspondence: [email protected] 1Department of midwifery, College of medicine and health science, Debre Tabor University, Debre Tabor, Ethiopia Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Addisu et al. BMC Pregnancy and Childbirth (2018) 18:429 Page 2 of 7 Background information Meconium aspiration syndrome occurs all over the The occurrence of meconium-stained amniotic fluid world about 5–10.5% of neonates with MSAF; which (MSAF) during labor has been long considered the accounts around 12% of neonatal mortality (as much as predictor of adverse fetal outcomes such as meconium 40% case fatality rate for the neonate and around 2% of aspiration syndrome and perinatal asphyxia, which leads perinatal mortality). Furthermore, the rates of severe to perinatal and neonatal morbidity and mortality [1, 2]. mental retardation and cerebral palsy are significantly Meconium is a germ-free, thick, black-green, odorless greater among infants born with MSAF [13, 14]. material which is first recognized in the fetal intestine Meconium stained amniotic fluid significantly increase around 12 weeks of gestation and stores in the fetal the rate of maternal complications such as meconium- colon throughout gestation [3, 4]. laden amniotic fluid embolism, intrapartum chorioamnioni- Passage of meconium in the newborn infants is a devel- tis, Puerperal endometiritis, wound infection, increased risk opmentally programmed incident; normally occurring of operative delivery and its complication [12, 15]. within the first 24 to 48 h after birth. However, the fetus The perinatal morbidity and mortality related to MSAF may pass meconium in the amniotic fluid during pregnancy can be decreased if major risk factors are recognized early due to different reasons. Meconium-stained amniotic fluid and closely monitoring of the labor and careful decisions is uncommon before 37 weeks of gestation and the occur- are made about the timing and mode of delivery [7]. rence of a meconium-stained amniotic fluid increases with Even though the magnitude and associated factors of increasing gestational age [1, 5]. meconium stained amniotic fluid were well studied in the Meconium stained liquor (MSL) is the passage of developed countries, there is a paucity of locally generated meconium by a fetus in utero during the antenatal evidence on the magnitude and associated factors of MSAF period or in labour. According to Royal College of to design appropriate prevention strategies in the study Obstetricians and Gynecologists (RCOG) intrapartum area. Therefore, this study was aimed to determine the care guideline, meconium stained amniotic fluid is prevalence of meconium stained amniotic fluid and its classified as significant MSL and non-significant MSL. associated factors among women who gave birth at term in Non- significant MSL is defined as a thin yellow or Felege Hiwot comprehensive Specialized Referral Hospital. greenish tinged fluid; containing non-particulate meco- nium whereas significant MSL is explained as dark green Methods or black amniotic fluid that is thick and tenacious and Study settings and design consists lumps of meconium [6]. Hospital based cross-sectional study was conducted at Meconium stained amniotic fluid contains masses of felege Hiwot Comprehensive Specialized Referral Hos- debris, desquamated cells from the intestine and skin, pital Obstetrics and Gynecology department, Obstetrics gastrointestinal mucin, lanugo hair, fatty material from ward from March 02–May 27, 2018 GC. This hospital is the vernix caseosa and intestinal secretions [4]. the only specialized hospital in Bahir Dar town and The exact etiology of meconium stained amniotic fluid located in the Amhara region, Bahir Dar special zone, is not clear. However, previous studies suggested that Bahir Dar City. It is located approximately 565 kms obstetric factors such as (prolonged labour, post-term North West of Addis Ababa. pregnancy, low-birth weight babies, oligohydramnios, Felege Hiwot Comprehensive Specialized Referral intrauterine growth retardation and hypertensive disor- Hospital is one of the top ten governmental hospitals in ders of pregnancy),medical factors (cholestasis of preg- Ethiopia. This Hospital is having around 400 beds & 9 nancy and anemia) and socio-demographic and operating tables, serving over 7 million people within its behavioral risk factors (higher maternal age, maternal catchment area. The labor ward gives services to around drug abuse especially tobacco and cocaine use) are the 612 deliveries per month. The Department of Obstetrics major contributory factors for the passage of meconium and Gynecology has a labor ward with seven beds in first into the amniotic fluid [7, 8]. stage room, two delivery couches in the second stage Evidence showed that the incidence of meconium stained room, four beds in the recovery unit and sixty nine beds liquor is increasing as the gestational age increases. From 7 in the maternity ward along with two operating rooms. to 22% of term pregnancy were complicated by meconium The ward is staffed with five obstetrics and gynecology stained liquor worldwide [9, 10]. specialists, thirty three midwives, seventeen clinical Meconium-stained amniotic fluid has adverse long nurses, thirty five residents of different years (levels) of and short-term fetal outcomes; especially it increased study and a varying number of interns. rates of neonatal resuscitation, respiratory distress, lower Apgar score, neonatal nursery admissions, meco- Characteristics of participants nium aspiration syndrome, neonatal sepsis and All women who gave birth at term in Felege Hiwot Re- pulmonary disease [2, 11, 12]. ferral hospital were the source population. This study Addisu et al. BMC Pregnancy and Childbirth (2018) 18:429 Page 3 of 7 included all women who gave birth at term throughout medical and behavioral information were collected the day and night during the data collection period. through interview of the mother and by reviewing her Those mothers who presented with breech presentation medical records. and intrauterine fetal death before the onset of labor were excluded from the study. Socio-demographic, obstetric, medical and behavioral variables Sample size determination Socio-demographic, obstetric, medical and other factors
Load more

Recommended publications
  • The Effects of Maternal Chorioamnionitis on the Neonate
    Neonatal Nursing Education Brief: The Effects of Maternal Chorioamnionitis on the Neonate https://www.seattlechildrens.org/healthcare- professionals/education/continuing-medical-nursing-education/neonatal- nursing-education-briefs/ Maternal chorioamnionitis is a common condition that can have negative effects on the neonate. The use of broad spectrum antibiotics in labor can reduce the risks, but infants exposed to chorioamnionitis continue to require treatment. The neonatal sepsis risk calculator can guide treatment. NICU, chorioamnionitis, early onset neonatal sepsis, sepsis risk calculator The Effects of Maternal Chorioamnionitis on the Neonate Purpose and Goal: CNEP # 2090 • Understand the effects of chorioamnionitis on the neonate. • Learn about a new approach for treating infants at risk. None of the planners, faculty or content specialists has any conflict of interest or will be presenting any off-label product use. This presentation has no commercial support or sponsorship, nor is it co-sponsored. Requirements for successful completion: • Successfully complete the post-test • Complete the evaluation form Date • December 2018 – December 2020 Learning Objectives • Describe the pathogenesis of maternal chorioamnionitis. • Describe the outcomes for neonates exposed to chorioamnionitis. • Identify 2 approaches for the treatment of early onset sepsis. Introduction • Chorioamnionitis is a common complication • It affects up to 10% of all pregnancies • It is an infection of the amniotic fluid and placenta • It is characterized by inflammation
    [Show full text]
  • Meconium Aspiration Syndrome – the Core Concept of Pathophysiology During Resuscitation
    Invited Review Neonatal Med 2017 May;24(2):53-61 https://doi.org/10.5385/nm.2017.24.2.53 pISSN 2287-9412 . eISSN 2287-9803 Meconium Aspiration Syndrome – The Core Concept of Pathophysiology during Resuscitation Tsu F. Yeh, M.D. *† Department of Pediatrics*, Maternal Child Health Research Center, Taipei Medical University, Taipei, Taiwan Children’s Hospital†, China Medical University, Taichung, Taiwan ABSTRACT Received: 17 August 2016 Revised: 10 May 2017 Aspiration of meconium produces a syndrome (Meconium Aspiration Syndrome Accepted: 10 May 2017 MAS) characterized by hypoxia, hypercapnia, and acidosis. Perinatal hypoxia, acute Correspondence to: Tsu F. Yeh airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulm­ Maternal Child Health Research onary hypertension, and surfactant inactivation all play a role in the pathogenesis of Center, College of Medicine, Taipei MAS. Most aspiration of meconium probably occurs before birth. Following aspira­ Medical University, Taipei 110, tion, meconium may migrate to the peripheral airway, usually take about 2 hours as Taiwan demonstrated in animal experiment, leading to airway obstruction and subsequent Tel: +886­2­2736­1661 ext.7213 lung inflammation and pulmonary hypertension. The presence of meconium in the E­mail: [email protected] endotracheal aspirate automatically establishes the diagnosis of MAS. Clinical diag­ nosis can be made in any infant born with meconium staining of amniotic fluid who develops respiratory distress at or shortly after birth and has positive radiographic findings. Prevention of intrauterine hypoxia, early cleaning (suctioning) of the airway, and prevention and treatment of pulmonary hypertension are essential in the mana­ gement of MAS. Recent studies suggest that avoidance of post­term delivery may reduce the risk of intrauterine hypoxia and the incidence of MAS.
    [Show full text]
  • Long-Term Outcome After Neonatal Meconium Obstruction
    Long-term Outcome After Neonatal Meconium Obstruction Julie R. Fuchs, MD, and Jacob C. Langer, MD ABSTRACT. Objective. It is unclear whether children meconium ileus and those undergoing resection or enter- with cystic fibrosis (CF) who present with neonatal ostomy. Patients with meconium obstruction who do not meconium ileus have a different long-term outcome from have CF have an excellent long-term prognosis. This those presenting later in childhood with pulmonary com- information will be useful in counseling the families of plications or failure to thrive. We examined a cohort of infants presenting with neonatal meconium obstruction. patients with meconium ileus, and compared their long- Pediatrics 1998;101(4). URL: http://www.pediatrics.org/ term outcome with children who had CF without meco- cgi/content/full/101/4/e7; cystic fibrosis, meconium ileus, nium ileus and neonates who had meconium obstruction meconium plug syndrome. without CF (meconium plug syndrome). Study Design. Comparative study using retrospective and follow-up interview data. ABBREVIATION. CF, cystic fibrosis. Patients. Group 1 consisted of 35 surviving CF pa- tients who presented with meconium ileus between 1966 econium obstruction in the neonate is a and 1992. Two control groups were also studied: 35 age- spectrum of disease that includes meco- and sex-matched CF patients without meconium ileus 1 (group 2), and 12 infants presenting with meconium plug Mnium ileus and meconium plug syndrome. syndrome during the same time period (group 3). Meconium ileus is characterized by extremely viscid, Outcome Measures. Pulmonary, gastrointestinal, nu- protein-rich inspissated meconium causing terminal tritional, and functional status were reviewed, and sur- ileal obstruction, and accounts for approximately gical complications were recorded.
    [Show full text]
  • PROBLEMS of the NEONATAL PERIOD
    PROBLEMS of the NEONATAL PERIOD Susan Fisher-Owens, MD, MPH, FAAP Associate Clinical Professor of Clinical Pediatrics Associate Clinical Professor of Preventive and Restorative Dental Sciences University of California, San Francisco Zuckerberg San Francisco General Hospital UCSF Family Medicine Board Review: Improving Clinical Care Across the Lifespan San Francisco March 6, 2017 Disclosures “I have nothing to disclose” (financially) …except appreciation to Colin Partridge, MD, MPH for help with slides 2 Common Neonatal Problems Hypoglycemia Respiratory conditions Infections Polycythemia Bilirubin metabolism/neonatal jaundice Bowel obstruction Birth injuries Rashes Murmurs Feeding difficulties 3 Abbreviations CCAM—congenital cystic adenomatoid malformation CF—cystic fibrosis CMV—cytomegalovirus DFA-- Direct Fluorescent Antibody DOL—days of life ECMO—extracorporeal membrane oxygenation (“bypass”) HFOV– high-flow oxygen ventilation iNO—inhaled nitrous oxide PDA—patent ductus arteriosus4 Hypoglycemia Definition Based on lab Can check a finger stick, but confirm with central level 5 Hypoglycemia Causes Inadequate glycogenolysis cold stress, asphyxia Inadequate glycogen stores prematurity, postdates, intrauterine growth restriction (IUGR), small for gestational age (SGA) Increased glucose consumption asphyxia, sepsis Hyperinsulinism Infant of Diabetic Mother (IDM) 6 Hypoglycemia Treatment Early feeding when possible (breastfeeding, formula, oral glucose) Depending on severity of hypoglycemia and clinical findings,
    [Show full text]
  • Subset of Alphabetical Index to Diseases and Nature of Injury for Use with Perinatal Conditions (P00-P96)
    Subset of alphabetical index to diseases and nature of injury for use with perinatal conditions (P00-P96) SUBSET OF ALPHABETICAL INDEX TO DISEASES AND NATURE OF INJURY FOR USE WITH PERINATAL CONDITIONS (P00-P96) Conditions arising in the perinatal period Conditions arising—continued - abnormal, abnormality—continued Note - Conditions arising in the perinatal - - fetus, fetal period, even though death or morbidity - - - causing disproportion occurs later, should, as far as possible, be - - - - affecting fetus or newborn P03.1 coded to chapter XVI, which takes - - forces of labor precedence over chapters containing codes - - - affecting fetus or newborn P03.6 for diseases by their anatomical site. - - labor NEC - - - affecting fetus or newborn P03.6 These exclude: - - membranes (fetal) Congenital malformations, deformations - - - affecting fetus or newborn P02.9 and chromosomal abnormalities - - - specified type NEC, affecting fetus or (Q00-Q99) newborn P02.8 Endocrine, nutritional and metabolic - - organs or tissues of maternal pelvis diseases (E00-E99) - - - in pregnancy or childbirth Injury, poisoning and certain other - - - - affecting fetus or newborn P03.8 consequences of external causes (S00-T99) - - - - causing obstructed labor Neoplasms (C00-D48) - - - - - affecting fetus or newborn P03.1 Tetanus neonatorum (A33) - - parturition - - - affecting fetus or newborn P03.9 - ablatio, ablation - - presentation (fetus) (see also Presentation, - - placentae (see also Abruptio placentae) fetal, abnormal) - - - affecting fetus or newborn
    [Show full text]
  • Meconium Aspiration Syndrome: a Narrative Review
    children Review Meconium Aspiration Syndrome: A Narrative Review Chiara Monfredini 1, Francesco Cavallin 2 , Paolo Ernesto Villani 1, Giuseppe Paterlini 1 , Benedetta Allais 1 and Daniele Trevisanuto 3,* 1 Neonatal Intensive Care Unit, Department of Mother and Child Health, Fondazione Poliambulanza, 25124 Brescia, Italy; [email protected] (C.M.); [email protected] (P.E.V.); [email protected] (G.P.); [email protected] (B.A.) 2 Independent Statistician, 36020 Solagna, Italy; [email protected] 3 Department of Woman and Child Health, University of Padova, 35128 Padova, Italy * Correspondence: [email protected] Abstract: Meconium aspiration syndrome is a clinical condition characterized by respiratory failure occurring in neonates born through meconium-stained amniotic fluid. Worldwide, the incidence has declined in developed countries thanks to improved obstetric practices and perinatal care while challenges persist in developing countries. Despite the improved survival rate over the last decades, long-term morbidity among survivors remains a major concern. Since the 1960s, relevant changes have occurred in the perinatal and postnatal management of such patients but the most appropriate approach is still a matter of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management and prognosis of infants with meconium aspiration syndrome. Keywords: infant newborn; meconium aspiration syndrome; meconium-stained amniotic fluid Citation: Monfredini, C.; Cavallin, F.; Villani, P.E.; Paterlini, G.; Allais, B.; Trevisanuto, D. Meconium Aspiration 1. Definition of Meconium Aspiration Syndrome Syndrome: A Narrative Review. Meconium aspiration syndrome (MAS) is a clinical condition characterized by respira- Children 2021, 8, 230. https:// tory failure occurring in neonates born through meconium-stained amniotic fluid whose doi.org/10.3390/children8030230 symptoms cannot be otherwise explained and with typical radiological characteristics [1].
    [Show full text]
  • Distocia Or Birthing Problems
    Birthing problems or dystocia Nothing is more stressful than assisting your animal in it’s birthing process at home. Fortunately, this is usually a beautiful exprerience. However if complications arise, which happens in about 5-6% of deliveries, it can become a nightmare. A birthing problem must always be considered an emergency! Usually the entire litter dies within 24h after the first signs of dystocia. Moreover, if nothing is done the female can start showing signs of generalized infection after about 48 to 72hrs. This requires critical care and places her at risk for death. So when should you consult your veterinarian? Is your pet really showing signs of a problematic delivery? Should we induce delivery, or should we let nature take it's course? We will try to answer these questions in the next few paragraphs. Stages of a normal delivery: 1. The pre-delivery stage: There is a decrease in normal body temperature of about 1 to 1.5 degrees (that is to say from 38.5 to 37.5- 37°C) 12 to 24h before delivery due to a decrease in blood progesterone levels. The female behaves normally, except for some that will have a decreased or absent appetite during this period. For a few females this stage, that usually lasts about 12 to 24h, can last up to 48hrs. 2. The delivery Stage 1. The female cannot find a comfortable position, she pants a lot and walks constantly, but does not have any contractions. This is the stage when you can sometimes note the ‘’water breaking’’ or the presence of black, green, brown or red discharge coming from the vulva.
    [Show full text]
  • Clinical Chorioamnionitis at Term: New Insights Into the Etiology, Microbiology, and the Fetal, Maternal and Amniotic Cavity Inflammatory Responses
    SEMMELWEIS 200 SEMMELWEIS 200 Roberto Romero1-4, Nardhy Gomez-Lopez1,5,6, Juan Pedro Kusanovic1,7, Percy Pacora1,5, Bogdan Panaitescu1,5, Offer Erez1,5, Bo H. Yoon1,8 Clinical chorioamnionitis at term: New insights into the etiology, microbiology, and the fetal, maternal and amniotic cavity inflammatory responses Roberto Romero, M.D., D.Med.Sci. 1 Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U S Department of Health and Human Services, Bethesda, Maryland, and Detroit, Michigan, USA 2 Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA 3 Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, Michigan, USA 4 Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA 5 Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA 6 Department of Immunology, Microbiology and Biochemistry, Wayne State University School of Medicine, Detroit, Michigan, USA 7 Division of Obstetrics and Gynecology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile 8 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea 2018. JÚNIUS NŐGYÓGYÁSZATI ÉS SZÜLÉSZETI TOVÁBBKÉPZŐ SZEMLE 103 SEMMELWEIS 200 Abstract Clinical chorioamnionitis is the most common infection related diagnosis made in labor and delivery units worldwide. It is traditionally believed to be due to microbial invasion of the amniotic cavity, which elicits a maternal inflammatory response characterized by maternal fever, uterine tenderness, maternal tachycardia and leukocytosis. The condition is often -as sociated with fetal tachycardia and a foul smelling amniotic fluid.
    [Show full text]
  • The Gastrointestinal Tract and Intraabdominal Organs
    The Gastrointestinal Tract and Intraabdominal Organs Normal Anatomy of the Meconium Peritonitis/ 243 Gastrointestinal Tract and the Hirschsprung's Disease/ 245 Anterior Abdominal Wall/ 233 Splenomegaly/ 246 Esophageal Atresia with and without Hepatomegaly/ 249 Tracheoesophageal Fistula/ 234 Choledochal Cyst/ 251 Duodenal Atresia/ 236 Mesenteric, Omental, and Bowel Obstruction/ 239 Retroperitoneal Cysts/ 253 Normal Anatomy of the Gastrointestinal Tract and the Anterior Abdominal Wall The stomach forms at about 4 weeks after conception are characterized by vigorous and fleeting movements by the development of a spindle-shaped dilatation of with a duration of less than 3 seconds. Later in the foregut caudal to the esophagus. The stomach gestation, peristaltic waves are more vigorous, descends into the abdomen at about 6 to 7 weeks after ubiquitous, and of longer duration. A small bowel conception, and by 11 weeks the muscles in its wall loop of more than 7 mm in internal diameter should are developed. Visualization with ultrasound is raise the index of suspicion for bowel obstruction.4 possible as early as the 9th week of menstrual age. Generally, segments of small bowel measure less than Different parts of the gastric anatomy (greater 15 mm in length. Meconium formation begins at 16 to curvature, fundus, body, and pylorus) can be seen by 20 weeks of menstrual age. Sonographically, the 14th week. Peristalsis is rarely visible before the meconium appears hypoechogenic in comparison to 16th week. Table 7-7 (see p. 254) displays data on the bowel wall. The large bowel appears as a large fetal stomach dimensions. Observations of this organ tubular structure in the periphery of the fetal abdomen.
    [Show full text]
  • Meconium Aspiration Syndrome
    MECONIUM ASPIRATION SYNDROME Background 1. Definition: meconium aspiration refers to fetal aspiration of meconium stained amniotic fluid (MSAF) during the antepartum or intrapartum period. Meconium aspiration syndrome (MAS) refers to newborn respiratory distress secondary to the presence of meconium in the tracheobronchial airways. 2. General: o MAS is distinct from aspiration of other substances such as blood and amniotic fluid (which may produce similar respiratory symptoms) Pathophysiology 1. Pathology of Disease o Meconium is made of amniotic fluid, lanugo, skin cells, and vernix swallowed by the fetus, combined with biliary acids, proteins, and cells of the gastrointestinal tract1 o Passage of meconium is normally inhibited but may occur as a result of: . Increased motilin at term, leading to expulsion of the meconium plug . Vagal stimulation, possibly associated with fetal distress or states such as hypoxia or acidosis which relax the anal sphincter. o MAS causes significant respiratory distress immediately-to-shortly after delivery. Mild or moderate MAS usually results from aspiration of MSAF at birth in a vigorous infant . Severe MAS is most likely caused by chronic in-utero insult or placental insufficiency2 o Meconium aspiration takes place in utero in most cases,3 caused by: . Decreased alveolar ventilation related to lung injury, ventilation- perfusion mismatch and air-trapping. Pneumothorax or pneumomediastinum in 15-30% of cases . Persistent pulmonary hypertension (PPHN) in severe MAS(increased pulmonary vascular resistance with right-to-left shunting) . Fetal acidemia4 . Chemical pneumonitis . Surfactant inactivation caused by meconium’s disruption of surface tension 2. Incidence, Prevalence o 10-15% of deliveries involve meconium-stained amniotic fluid5 o 5-12% of infants delivered through meconium-stained fluid develop meconium aspiration syndrome6 o 25,000 to 35,000 cases of MAS per year in US7 3.
    [Show full text]
  • Antibiotics for Neonates Born Through Meconium-Stained Amniotic Fluid (Review)
    Cochrane Database of Systematic Reviews Antibiotics for neonates born through meconium-stained amniotic fluid (Review) Kelly LE, Shivananda S, Murthy P, Srinivasjois R, Shah PS Kelly LE, Shivananda S, Murthy P, Srinivasjois R, Shah PS. Antibiotics for neonates born through meconium-stained amniotic fluid. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD006183. DOI: 10.1002/14651858.CD006183.pub2. www.cochranelibrary.com Antibiotics for neonates born through meconium-stained amniotic fluid (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 3 BACKGROUND .................................... 6 OBJECTIVES ..................................... 6 METHODS ...................................... 6 RESULTS....................................... 9 Figure1. ..................................... 10 Figure2. ..................................... 12 Figure3. ..................................... 13 Figure4. ..................................... 14 ADDITIONALSUMMARYOFFINDINGS . 16 DISCUSSION ..................................... 19 AUTHORS’CONCLUSIONS . 19 ACKNOWLEDGEMENTS . 19 REFERENCES ..................................... 20 CHARACTERISTICSOFSTUDIES . 22 DATAANDANALYSES. 29 Analysis 1.1. Comparison 1 Antibiotics versus control (no antibiotics) in symptomatic neonates, Outcome 1 Incidence of confirmedsepsisinfirst28days.
    [Show full text]
  • Biological Interrelationships Between the Ambrosia Beetle Xyleborus Dispar and Its Symbiotic Fungus Ambrosiella Hartigii
    AN ABSTRACT OF THE THESIS OF JOHN RICHARD JOSEPH FRENCH for the Ph. D. (Name of student) (Degree) in ENTOMOLOGY presented on oNo (Major) (Date) Title:BIOLOGICAL INTERRELATIONSHIPS BETWEENTHE AMBROSIA BEETLE XYLEBORUS DISPAR ANDITS SYMBIOTIC FUNGUS AMBROSIELLA HARTIGII Redacted for Privacy Abstract approved: William P. Nagel Biological interrelationships between the ambrosiabeetle Xyleborus dispar (F. ) (Coleoptera:Scolytidae) with itssymbiotic fungus, Ambrosiella hartigii Batra (FungiImperfecti) were inves- tigated in western Oregon. Postdiapause adults of X. dispar collected in Marchthrough June with rotary nets, and excised fromoverwintered and newly attacked host material, produced a single generationwhen the beetle was reared in vitro with A.hartigii.Diapause beetles excised from host materials in the fall failed to oviposit.This study is the first record of rearing a temperate zone scolytid invitro and on a fungus in the genus Ambrosiella. Such in vitro rearingallowed controlled studies of ecological, behavioral, developmentaland physiological aspects of this ectosymbiosis.Comparisons were made between wild and in vitro populations. Seasonal variations of thefungus within the femalebeetles mesonotal mycangium, andthe synchronization ofovariole develop- ment were demonstrated. Comparative concentrationsof solube proteins and freeamino acids suggested that thefungus in the mycangia wasbuilt up from free amino acids of theinsects.At the period of emergence,flight and attack of new hosts,the females were found tohave a concentra- tion of soluble proteins morethan double that found inthe beetles during the remainder of the year.Whereas, the free amino acids were the lowestvalues recorded duringthis period (March-October). Ovariole development andoviposition only occurred afterthe post - diapause female had fed onthe ambrosial form of A.hartigii.These beetles attacked a newhost with empty intestinal tracts.The relation- ship between the number of progenyand the volume of thegalleries was linear.
    [Show full text]