Study on umbilical cord arterial blood pH & perinatal outcome in meconium-stained amniotic fluid

Abstract

Objective: To compare the umbilical artery pH between the neonates delivered with meconium-stained liquor and neonates delivered with clear liquor. To know the correlation between umbilical artery pH and perinatal outcome in neonates with meconium-stained liquor. Study design: A prospective case control study was conducted from Jan 2018 to June 2019 (18 months) on pregnant women who were admitted to the labor room for delivery. A total of 88 cases were taken, 44 with clear liquor, 44 with meconium-stained liquor. All had umbilical cord arterial blood gas analysis done. Details about the mode of delivery, condition of the baby, need for intensive care was assessed. Results: The umbilical cord blood pH was assessed for all 88 deliveries, among them 51% delivered Vaginally 43% LSCS 6% instrumental. We found that 32% grade 1 and 2 meconium-stained liquor were delivered vaginally and neonatal outcome was good. Only 10.9% of neonates with cord blood pH <7.2 (p=0.028) needed NICU admissions >72hrs who all had Grade 3Meconium. There was a positive correlation between cord blood pH and APGAR scores in clear liquor and found to be statistically significant whereas though there was a positive correlation between APGAR and cord blood pH in Meconium-stained babies but it was not statistically significant, as babies with Grade 1 and Grade 2 Meconium had good APGAR scores. Conclusion: The present study reveals that very few neonates with grade 1 and grade 2 meconium-stained liquor had fetal acidosis and poor neonatal outcome, only cases with grade 3 meconium had severely acidotic pH resulting in fetal acidosis and increased neonatal morbidity and mortality. Thereby concluding unnecessary Caesarean sections in such cases can be avoided/reduced and as grade 3 Meconium had very poor perinatal outcome, early intervention will improve perinatal outcome in these babies.