Question

Case Study 2

A 30-year-old P1G1 female, whose pregnancy had been uncomplicated, was admitted to the hospital for induction of labor at 41 weeks’ gestation. Induction was successful; artificial rupture of the membranes produced thick, meconium-stained amniotic fluid. An amnioinfu- sion was performed to relieve fetal heart decelerations. However, no change in the frequency of fetal heart rate decelerations was noted and a cesarean section was performed. A 3.6 kg female infant was delivered. The baby was limp at birth and was covered by yellow-green meconium. Little respiratory effort was noted and the infant’s respiratory rate was 20 breaths per minute. The heart rate was 90 beats per minute, the baby’s color was dusky, and she had poor peripheral perfusion. Positive pressure ventilation was given with 100% oxygen. Apgar scores were 3 at 1 minute and 6 at 5 minutes. The infant was intubated and suctioned for a significant amount of particulate me- conium. Heart rate and oxygen saturations improved, and the patient was mechanically ventilated and transferred to the NICU. Chest radiograph revealed the ETT tip was 2 cm from the carina, hyperinflation and perihilar opacities in the lung. The patient continued to receive supportive care with mechanical ventilation and then was weaned to CPAP +6 cm H2O day 3. She was extubated on day 4 and placed in an incubator with 25% oxygen. Her condition continued to improve with no additional complications, and she was discharged 2 weeks postpartum.

1. What supportive care options are there for patients who are in the severe MAS pathway?

Answer 1

Meconium aspiration syndrome (MAS)

It refers to breathing difficulties an infant have before,during or after the birth due to baby has passed meconium into the amniotic fluid during labor or delivery and then baby aspirate it to the lungs.

What supportive care options are there for patients who are in the severe MAS pathway?

Care for meconium aspiration syndrome (MAS)

1. An obstetrician must suction the Oro and nasopharynx before the delivery of shoulders
2. Cardiac examination
3. Echocardiography is necessary to rule out pulmonary hypertension of the newborn (PPHN)
4. Rooming in
5. Place baby in a radient warmer
6. Insertion of umbilical artery catheter
7. Minimize handling
8. Respiratory care and oxygen therapy
9. IV fluids
10. Use of protein rich diet and electrolyte , lipids

Pharmacologic Management

1. Sedatives
2. Neuromuscular blocking agents
3. Respiratory gases
4. Systematic vasoconstrictors