Importance of transcervical amnioinfusion for msaf in an institution withlimited resources

Introduction: Meconium stained amniotic fluid during labor management possesses a dilemma to the obstetrician in an under resourced set up. The passage of meconium in utero is associated with significant perinatal mortality and morbidity especially meconium aspiration syndrome. Amnioinfusion can reduce the incidence of perinatal morbidity and mortality in places with limited resources for peripartum surveillance. Methods: A prospective study of 50 women with thick / thin meconium stained amniotic fluid fulfilling the inclusion criteria, who underwent trans cervical amnioinfusion with normal saline . Periodic checking of underpads for clearing or thinning of meconium was noted. A maximum of 1800 ml of NS was instilled. The thinning of meconium, mode of delivery, APGAR score at 1 min and 5 min, meconium aspiration, MAS, NICU admissions were noted. Results: Out of 44 cases of thick meconium at the time of detection 13.64% became moderate, 54.55% became thin whereas 31.82% remained as such. 68.18% had vaginal delivery, 4.55% had forceps delivery and 27.27 % had LSCS for fetal distress. Apgar score at 1 min < 5 was seen in 34.09%, between 5-7 in 85.91% cases and Apgar score at 5 minute <5 in 6.82%, 5-7 in 50%, >7 in 43.18% cases of thick MSAF respectively. Meconium aspiration was seen 76%babies. NICU admission was 20%. X Ray abnormality was seen in 4.55% cases and MAS 2.27% cases. Conclusion: In institutions with limited peripartum surveillance, transcervicalamnioinfusion is effective in improving both maternal and neonatal outcome and preventing perinatal loss due to meconium aspiration syndrome.