Meconium aspiration is defined as the presence of meconium below the vocal cords in a newborn. Meconium aspiration may lead to the development of Meconium Aspiration Syndrome (MAS) which develops shortly after birth. Meconium aspiration may produce conditions ranging from transient respiratory distress to severe respiratory difficulty causing the death of the newborn in up to 10% of cases.
Meconium is the material found in the intestine of a newborn. Meconium first appears in the gut at approximately 10 weeks of gestation. Rarely is meconium passed from the fetus into the amniotic fluid before 34 weeks of gestation because a mature gastrointestinal tract is required for a fetus to pass meconium into the amniotic cavity.
Meconium has been classified in accordance with its consistency into thin meconium and thick or particulate meconium. Although thin meconium can be present in up to 40% of cases, the appearance of thick meconium has the most clinical significance. The risk of perinatal death is increased 5 to 7 times when thick meconium is present at the onset of labor. This finding is generally associated with oligohydramnios (low volume of amniotic fluid). The presence of meconium prior to the onset of labor denotes an event that is unrelated to the stress of labor. Meconium detected during labor after clear fluid was detected indicates an acute event associated with the process of labor.
Factors that are associated with the appearance of fetal distress and promote the passage of meconium in utero include the following:
Chorioamnionitis (maternal infection)
Fetal gasping secondary to fetal hypoxia
There is strong evidence that meconium passage in-utero is influenced by the following factors:
Physiologic maturational event
Response to acute hypoxic event (even in the absence of labor)
Response to chronic intrauterine hypoxia
Diagnosis of the underlying conditions that promote meconium passage in- utero and appropriate treatment which may include early operative delivery have been recommended. Although no single intervention can prevent the appearance of meconium aspiration syndrome, a decline in incidence and severity of complications have been associated with:
Early determination of meconium passage by amniotomy
Antepartum fetal monitoring
Continuous electronic fetal monitoring in labor
Amnioinfusion during labor
Suctioning of pharynx and trachea at birth
Physiotherapy and Saline lavage
Infants who suffer an acute hypoxic event just before or after the onset of labor are more likely to pass thick meconium and suffer meconium aspiration syndrome. Similarly, infants who suffer from chronic hypoxia promote the passage of meconium and fetal gasping. Prompt intervention may prevent or reduce the severity of meconium aspiration syndrome. Infants with meconium aspiration syndrome may benefit from the administration of surfactant in conjunction with other therapeutic approaches.
If your child was born and suffered meconium aspiration syndrome, allow Dr. Borten and our Boston area medical malpractice attorneys at Gorovitz & Borten to review your medical records. We can help you assert your rights and get the compensation you deserve.
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