What (not) to do before delivery? Prevention of fetal meconium release and its consequences

Abstract

Background: Meconium-stained amniotic fluid is a common occurrence which places the mother at risk of escalating obstetric interventions, and the baby at risk of meconium aspiration syndrome.

Methods: The Cochrane Library was searched for interventions related to care before delivery with useful evidence on the outcomes 'meconium-stained amniotic fluid' and 'meconium aspiration syndrome'.

Findings: Curtailment of post-term pregnancy reduces the occurrence of meconium-stained amniotic fluid, and meconium aspiration syndrome. Uterine stimulants, particularly misoprostol, are associated with occurrence of meconium-stained amniotic fluid. Amniotomy during labour may be a risk factor for meconium aspiration syndrome. There is little research evidence on the benefits or otherwise of obstetric interventions such as expedited delivery for meconium-stained liquor without other evidence of fetal distress. Amnioinfusion for meconium-stained amniotic fluid improves neonatal outcome only in settings with limited peripartum surveillance. There is insufficient evidence to support the use of amnioinfusion for meconium-stained liquor in settings with adequate peripartum surveillance.