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 MAS pathway would this patient fall into?

Answer 1

IN MECONIUM ASPIRATION SYNDROME,WE CAN CATEGORISE PATIENTS INTO TWO GROUPS.

1)VIGOROUS BABY

PATIENTS IN THIS CATEGORY CRIES AFTER BIRTH,WITH HEART RATE OVER 100BPM,WITH GOOD TONE AND COLOUR,GOOD RESPIRATORY EFFORT.

2)NON VIGOROUS BABY

PATIENTS IN THIS CATEGORY ARE WITH NO/POOR RESPIORATORY EFFORT,HEART RATE LESS THAN 100,DECREASED TONE(AS EVIDENT FROM POOR APGAR SCORE)

AS PATINET IN THIS QUESTION COMES SHOWS ALL THE FEATURES OF SECOND CATEGORY,IT FALLS UNDER NONVIGOROUS BABY.