RE: [ozmidwifery] meconium stained liquor

[Sally Westbury]

Have a look at the collection of articles about suctioning on the perineum here No Benefit Seen With Suctioning During Birth of Meconium-Stained Neonates SAN FRANCISCO (Reuters Health) Feb 11, 2003 - Suctioning during delivery of infants who present with meconium staining apparently does not prevent meconium aspiration syndrome. These findings, presented at the meeting of the Society for Maternal-Fetal Medicine, contradict current practice guidelines. Lead study author Dr. Edgardo Szyld, of the Hospital Diego Paroissien in Buenos Aires, Argentina, believes that "we should consider revising the current recommendations" of suctioning these infants during delivery. A total of 2514 infants with meconium-stained amniotic fluid were randomized to oro- and nasopharynx suctioning or to no suctioning just before delivery of the shoulders. Of those infants suctioned, 3.5% developed meconium aspiration syndrome (MAS), as did 3.6% of those not suctioned. Five newborns died in the suctioned group, and three in the group not suctioned. No differences between the two groups were observed in the frequency of thick meconium, C-sections or need for resuscitation. A single study back in the 1970s was the foundation for the recommendation of suctioning when meconium staining is evident, Dr. Szyld said. Recommendations to suction, set forth by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) makes the practice "widespread--and it's done around the world." However, he said, the current study shows that suctioning before the shoulders are delivered does not prevent meconium aspiration or its complications. "The data presented by Dr. Szyld's team provides convincing evidence that suctioning probably does not" alter outcomes, Dr. Laura E. Riley, chair of ACOG's Committee on Obstetric Practice, told Reuters Health. "Because suctioning has been beaten into clinicians for so many years, I'm not sure the current findings are really going to change clinical practice," Dr. Riley said. "Still, I think the findings may provide some reassurance to clinicians that when meconium aspiration syndrome occurs it probably didn't have anything to do with how adequately the infant was suctioned." While Dr. Riley believes that the researchers succeeded in showing that suctioning is probably unnecessary, she said they didn't address "whether suctioning may actually have harmful effects, such as causing facial trauma." Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, Weiss K, Schutzman D, Cleary GM, Filipov P, Kurlat I, Caballero CL, Abassi S, Sprague D, Oltorf C, Padula M Pediatrics 2000 Jan;105(1 Pt 1):1-7 Conclusions. Compared with expectant management, intubation and suctioning of the apparently vigorous meconium-stained infant does not result in a decreased incidence of MAS or other respiratory disorders. Complications of intubation are infrequent and short-lived. Medscape Summary Article - "With the possible exception of infants who develop respiratory problems in the first few minutes of life, we would recommend expectant management of the apparently vigorous meconium-stained neonate," Dr. Wiswell said in an interview with Reuters Health. "I anticipate that this position will be incorporated in the recommendations of the Neonatal Resuscitation Program due out later this year," Dr. Wiswell added, "and would expect this approach to supplant intratracheal suctioning within several months." About the Neonatal Resuscitation Program (NRP 2000)  from the American Academy of Pediatrics International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 - Of particular note is the change in guidelines for meconium - " Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. "  and "There is evidence that tracheal suctioning of the vigorous infant with meconium-stained fluid does not improve outcome and may cause complications"   -----Original Message----- From: owner-[EMAIL PROTECTED] [mailto:owner-[EMAIL PROTECTED]] On Behalf Of linda kamchevski Sent: Thursday, 2 October 2003 2:13 PM To: [EMAIL PROTECTED] Subject: [ozmidwifery] meconium stained liquor   I was just reading on another list that suctioning on perineum for mec liquor is a practice that is old new now and not being used all over.  At my unit we suction on perineum all mec liqour.   wot are others doing.   Linda     All the best…. Try to work according to the evidence based practise and see just how superstitious the hospital are.   Love Sally Westbury Midwifery Practitioner