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Meconium stained liquor rarely causes a
problem. Thick or particulate meconium can cause MAS. Until there is clearer
research evidence I will be suctioning on the peri for thick mec. The issue is
that if the baby in utero has been asphyxiated and passes meconium and then
gasps, which he is likely to do if the asphyxia is severe. He may inhale mec at
that point and nothing we do at or post birth will retrieve that meconium.
The thorny issue is whether the baby passed the mec as a result
of pathological hypoxaemia or did he open his bowels because he
is mature and has a ready response to low oxygen levels however slight and
transient. Cord compression is common in all pregnancies and as the
baby nears term the liquor production decreases slowly making cord compression
more likely. A 42 weeker will pass mec very readily and a high % have MSL at the
onset of labour. A quick check with a CTG is required. No evidence of
hypoxaemia...fine, off with the monitor and on with the labour. Thanks for the
reference. ECPC addresses this topic but it is about due for a new edition.
Cheers
jenny
Jennifer Cameron FRCNA FACM
ProMid
Professional Midwifery Education Service
0419 528 717
----- Original Message -----
Sent: Saturday, February 19, 2005 12:25
PM
Subject: Re: [ozmidwifery] Castor
oil
Sorry for butting in, but just found this quickly in my saved file,
thought it might clarify current findings...
Tania
Oropharyngeal and nasopharyngeal suctioning of meconium-stained
neonates
before delivery of their shoulders: multicentre, randomised
controlled
rial . ARTICLE
The Lancet, Volume 364, Issue 9434, 14
August 2004, Pages 597-602
Nestor E Vain, Edgardo G Szyld, Luis M Prudent,
Thomas E Wiswell, Adriana M
Aguilar and Norma I
Vivas
Abstract
Background
Meconium aspiration syndrome (MAS)
is a life-threatening respiratory
disorder in infants born through
meconium-stained amniotic fluid (MSAF).
Although anecdotal data concerning
the efficacy of intrapartum oropharyngeal
and nasopharyngeal suctioning of
MSAF are conflicting, the procedure is
widely used. We aimed to assess the
effectiveness of intrapartum suctioning
for the prevention of
MAS.
Methods
We designed a randomised controlled trial in 11
hospitals in Argentina and
one in the USA. 2514 patients with MSAF of any
consistency, gestational age
at least 37 weeks, and cephalic presentation
were randomly assigned to
suctioning of the oropharynx and nasopharynx
(including the hypopharynx)
before delivery of the shoulders (n=1263), or
no suctioning before delivery
(n=1251). Postnatal delivery-room management
followed Neonatal Resuscitation
Program guidelines. The primary outcome was
incidence of MAS. Clinicians
diagnosing the syndrome and designating other
study outcomes were masked to
group assignment. An informed consent waiver
was used. Analysis was by
intention to treat.
Findings
18 infants
in the suction group and 15 in the no suction group did not meet
entry
criteria after random assignment. 87 in the suction group were
not
suctioned, and 26 in the no suction group were suctioned. No
significant
difference between treatment groups was seen in the incidence
of MAS (52
[4%] suction vs 47 [4%] no suction; relative risk 0�9, 95% CI
0�6-1�3), need
for mechanical ventilation for MAS (24 [2%] vs 18 [1%]; 0�8,
0�4-1�4),
mortality (9 [1%] vs 4 [0�3%]; 0�4, 0�1-1�5), or in the duration
of
ventilation, oxygen treatment, and hospital
care.
Interpretation
Routine intrapartum oropharyngeal and
nasopharyngeal suctioning of
term-gestation infants born through MSAF does
not prevent MAS. Consideration
should be given to revision of present
recommendations
----- Original Message -----
Sent: Saturday, February 19, 2005 1:08
PM
Subject: Re: [ozmidwifery] Castor
oil
I have been watching this discussion re mec
liquor and perineal suction. Anne, could you please give reference to your
research that does not support this practice?
thank you.
marcia
----- Original Message -----
Sent: Friday, February 18, 2005 9:50
AM
Subject: Re: [ozmidwifery] Castor
oil
Dear Katrina,
It seems that almost everyone does suction at
the peri with mec. liq. but the resarch does not support this routine
procedure.
Regards,
Anne Clarke
Brisbane
----- Original Message -----
Sent: Thursday, February 17, 2005
3:23 PM
Subject: Re: [ozmidwifery] Castor
oil
Hi Anne
Are these articles on Cochrane? I had a lady
the other day I was supporting and helping birth, and there was mec
liquor, thin, but wen to thick right at the end, and the midwife I was
working with suctioned at the peri, I had no idea it was not the thing
to do....
Thanks
Katrina
On 16/02/2005, at 3:13 PM, Anne
Clarke wrote:
Mec. liq. is not the
end of the world, especially if the mother is overdue and there is no
signs of fetal distress. Depending on your workplace the mother
needs to negotiate for intermittent electronic fetal monitoring
(if you have to do it at all) and no suction of the baby at birth as
the evidence does not support this procedure if done purely to
reduce mec. aspriation. If a baby is going to have mec.
aspiration suctioning of the oro-nasal pharynx is not going to help
and doesn't reduce the
risk.
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