Thick meconium in the amnionic luid is particularly worrisome. The viscosity probably signiies the lack of liquid and thus oligohydramnios. Aspiration of thick meconium may cause severe pulmonary dysfunction and neonatal death (Chap. 33, p. 620). Because of this, amnioinfusion during labor has been proposed as a way of diluting meconium to lower the incidence of aspiration s) ndrome (Wenstrom, 1989). As discussed in Chapter 24 (p. 475), the benefits of amnioinfusion remain controversial. In a large randomized trial by Fraser and colleagues (2005), amnioinfusion did not reduce the risk of meconium aspiration syndrome or perinatal death. According to the American College of Obstetricians and Gynecologists (2016a), amnioinfusion does not prevent meconium aspiration, however, it remains a reasonable treatment approach for repetitive variable decelerations.
he likelihood of a successful vaginal delivery is reduced appreciably for the nullipara who is in early labor with thick, meconium-stained amnionic fluid. Therefore, if the woman is remote from delivery, strong consideration should be given to prompt cesarean delivery, especially when cephalopelvic disproportion is suspected or either hypotonic or hypertonic dysfunctional labor is evident. Some practitioners choose to avoid oxytocin use in these cases.
Until recently, it was taught-including at Parkland Hospital -that aspiration of meconium could be minimized but not eliminated by suctioning the pharynx as soon as the head was delivered. According to the American Heart Association guidelines, this in no longer recommended (Wyckof, 2015). The merican College of Obstetricians and Gynecologists (2017a) does not recommend routine intrapartum suctioning. Alternatively, if the depressed newborn has meconium-stained fluid, then intubation is carried out.
Alexander JM, McIntire DO, Leveno KJ: Forty weeks and beyond: pregnancy outcomes by week of gestation. Obstet Gynecol 96:291, 2000a lexander JM, McIntire DO, Leveno KJ: Postterm pregnancy: does induction increase cesarean rates? J Soc Gynecol Invest 7:79A, 2000b lexander JM, McIntire DO, Leveno KJ: Postterm pregnancy: is cervical "ripening" being used in the right patients? J Soc Gynecol Invest 7:247 A, 2000c Alexander JM, McIntire DO, Leveno KJ: Prolonged pregnancy: induction of labor and cesarean births. Obstet Gynecol 97:9t11t, 2001
Alexander JM, McIntire DO, Leveno KJ: he efect of fetal growth restriction on neonatal outcome in postterm pregnancy. Abstract No. 463. Am J Obstet Gynecol 182:S148, 2000d
Alfirevic Z, Luckas M, Walkinshaw SA, et al: A randomized comparison between amniotic fluid index and maximum pool depth in the monitoring of postterm pregnancy. Br J Obstet Gynaecol 104:207, 1997
American College of Obstetricians and Gynecologists: Amnioinfusion does not prevent meconium aspiration syndrome. Committee Opinion No. 346, October 2006, Reairmed 2016a
American College of Obstetricians and Gynecologists Qoint with the Society for Maternal-Fetal Medicine): Deinition of term pregnancy. Committee Opinion No. 579, November 20t13, Reairmed 20t16b
American College of Obstetricians and Gynecologists: Fetal macrosomia. Practice Bulletin No. 173, November 20t16c