Association of abnormal first stage of labor duration and maternal and neonatal morbidity
Stephanie A. BlankenshipNandini RaghuramanAnjana DelhiCandice WoolfolkYong WangGeorge A. MaconesAlison G. Cahill
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Cervical dilation
Meconium aspiration syndrome
To the Editor.— The report by Wiswell et al in the May 1990 issue of Pediatrics1 provides valuable insight into meconium aspiration syndrome. However, I am concerned that there is a possible cause of meconium aspiration syndrome in the vigorous neonate which has not received enough emphasis, either in this or other reports. Namely, vigorours babies who develop meconium aspiration syndrome may be insidiously aspirating regurgitated meconium in the first few hours after leaving the delivery room.
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In Reply.— Doctors Bull et al, Denk, and Reynolds all bring out an important aspect of our investigation...meconium-stained newborns whose tracheae were not intubated and suctioned were significantly more likely subsequently to develop the meconium aspiration syndrome (MAS). I disagree with Dr Reynolds9 contention that intratracheal suctioning of newborns is uniformly unnecessary among neonates born through meconium. Although babies born through thin meconium are less likely to develop MAS, as many as 38% to 41%1,2 of neonates with the disorder are born through thin-consistency fluid.
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Meconium aspiration syndrome
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To the Editor.— The report by Wiswell et al in the May 1990 issue of Pediatrics1 provides valuable insight into meconium aspiration syndrome. However, I am concerned that there is a possible cause of meconium aspiration syndrome in the vigorous neonate which has not received enough emphasis, either in this or other reports. Namely, vigorours babies who develop meconium aspiration syndrome may be insidiously aspirating regurgitated meconium in the first few hours after leaving the delivery room.
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Background Neonates born through meconium stained amniotic fluid (MSAF) are associated with significant morbidity and mortality. Objective To study the incidence, associated factors and outcome of meconium stained amniotic fluid babies born in Dhulikhel hospital. Method Prospective, cross-sectional study conducted in Obstetric ward and Neonatal Intensive Care Unit (NICU) from 15 December 2015 to 15 December 2016. All the babies born through meconium stained amniotic fluid during the period were included. Result Incidence of meconium stained amniotic fluid was 6.5%(167/2581). Meconium aspiration syndrome (MAS) developed in 9(5.4%) among all meconium stained amniotic fluid cases. Primigravidity and postdatism were observed more in Meconium aspiration syndrome group than meconium stained amniotic fluid group (77.8% VS 73.4%; 33.3% VS 26.3%). Babies delivered by caesarian section were more in meconium stained amniotic fluid group than Meconium aspiration syndrome group (47.5% VS 33.3%). All the babies with meconium stained amniotic fluid improved except one baby with Meconium aspiration syndrome who expired. Neonatal sepsis was a significant co-morbidity in Meconium aspiration syndrome group (P value= 0.008). There was increased incidence of operative delivery in thick meconium stained amniotic fluid than thin meconium stained amniotic fluid (52.6% VS 38.9%). Similarly, Neonatal Intensive Care Unit admission and neonatal complications like Meconium aspiration syndrome, perinatal asphyxia and sepsis were more commonly observed in thick meconium stained amniotic fluid group than thin meconium stained amniotic fluid group. Conclusion The progression to meconium aspiration syndrome in babies with meconium stained amniotic fluid is not associated with any maternal and neonatal factors studied. MAS babies are 10 times more likely to require NICU admission and sepsis is a significant co-morbidity. Thick meconium stained amniotic fluid is worrisome. There is increased chance of operative delivery and neonatal complications if associated with thick meconium stained amniotic fluid.
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To the Editor.— In the article Intratracheal Suctioning, Systemic Infection, and the Meconium Aspiration Syndrome, Wiswell and Henley review their experience with meconium-stained babies from 1985 to 1989. Dr Wiswell compares two groups of neonates, those intubated and those not intubated. The rationale for not intubating neonates included (1) the lack of meconium in the hypopharynx, (2) the apparent vigor of the child, and (3) thin-consistency meconium. The literature agrees that the majority of meconium-stained neonates fall into such a category; however, Dr Wiswell finds only 19% of neonates in this category.
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To the Editor.— In the article "Intratracheal Suctioning, Systemic Infection, and the Meconium Aspiration Syndrome," Wiswell and Henley review their experience with meconium-stained babies from 1985 to 1989. Dr Wiswell compares two groups of neonates, those intubated and those not intubated. The rationale for not intubating neonates included (1) the lack of meconium in the hypopharynx, (2) the apparent vigor of the child, and (3) thin-consistency meconium. The literature agrees that the majority of meconium-stained neonates fall into such a category; however, Dr Wiswell finds only 19% of neonates in this category.
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Meconium aspiration syndrome (MAS) continues to be a major cause of morbidity and mortality in newborn infants. Recent studies on the pathophysiology of MAS showed that the meconium is more potent and toxic than we had previously appreciated. On the basis of animal experiences and a clinical pilot study, we propose that early tracheobronchial lavage with diluted surfactant is an effective and safe method for treatment of severe MAS.
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Overdistension of the lungs is a cause of ventilator-induced lung injury. In meconium aspiration syndrome, irregular overdistension of the lungs often occurs.We investigated whether surfactant replacement could restore the terminal airspaces in the lungs that had been distended after meconium aspiration.Meconium aspiration was induced by injecting meconium (50 mg x kg(-1)) into the airways of adult rats anesthetized with pentobarbital and ventilated with pressure-preset mode. The animals were further ventilated with or without surfactant replacement (100 mg x kg(-1)), and the sizes of the terminal airspaces were determined after fixing the lungs at an airway pressure of 10 cm H2O on deflation.Approximately 75 min after aspiration (early analysis point), alveolar ducts were widened and the mean ratio of the largest terminal airspace size class (> or =63,000 microm(2)) was 38.7% (n = 7), which was significantly higher than that of controls (6%, n = 7). Three hours after the early analysis point, the ratio increased to 50.2% (n = 7, p < 0.05), but surfactant replacement reversed the ratio to 18.8% (n = 7, p < 0.05).In rats with meconium aspiration, surfactant replacement restored the distended terminal airspaces of the lungs and kept the spaces from irregular overdistension.
Meconium aspiration syndrome
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To the Editor.— In the article "Intratracheal Suctioning, Systemic Infection, and the Meconium Aspiration Syndrome," Wiswell and Henley review their experience with meconium-stained babies from 1985 to 1989. Dr Wiswell compares two groups of neonates, those intubated and those not intubated. The rationale for not intubating neonates included (1) the lack of meconium in the hypopharynx, (2) the apparent vigor of the child, and (3) thin-consistency meconium. The literature agrees that the majority of meconium-stained neonates fall into such a category; however, Dr Wiswell finds only 19% of neonates in this category.
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