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 Asphyxia or other stress can cause passage of meconium before the fetus is born.  Thick. may be seen in the amniotic fluid after 34 weeks gestation.Aspiration of meconium (the neonate’s first feces) into the lungs.  Aspiration of meconium in utero can cause chemical pneumonitis.  Meconium aspiration syndrome occurs when the meconium stained amniotic fluid is aspirated by the fetus before or after delivery.  . sticky. and greenish black substance.  Typically occur with the first breath or while the neonate is in utero.

It does not tend to occur in extremely-lowbirthweight infants because the substance has not passed far enough in the bowel for it to be at the rectum in these infants. the appearance of the fluid at birth is green to greenish black from the staining.      Meconium is present in the fetal bowel as early as 10 weeks’ gestation. In both instances. . which releases meconium into the amniotic fluid. Meconium staining occurs in approximately 10% to 12% of all pregnancies. Babies born breech may expel meconium into the amniotic fluid from pressure in the buttocks. An infant with hypoxia in utero experiences a vagal reflex relaxation of the rectal sphincter.

2.A secondary infection of injured tissue may lead to pneumonia. and intrapulmonary and extrapulmonary shunting occur. .  Hypoxemia.  An infant may aspirate meconium either in utero or with the first breath after breath. carbon dioxide retention. Meconium can cause severe respiratory distress in three ways: 1. it causes inflammation of bronchioles because it is a foreign substance it can block small bronchioles by mechanical plugging it can cause a decrease in surfactant production through lung cell trauma. 3.

Right-to-left shunting commonly follows. and reflex gasping of amniotic fluid into the lungs. passage of meconium into the amniotic fluid. Chemical pneumonitis results. Hyperinflation. relaxation of the anal sphincter. again preventing adequate gas exchange. . Cardiac efficiency can be compromised from pulmonary hypertension.PATHOPHYSIOLOGY        Asphyxia in utero leads to increased fetal peristalsis. Meconium creates a ball-valve effect. and academia cause increased peripheral vascular resistance. trapping air in the alveolus and preventing adequate gas exchange. hypoxemia. causing the alveolar walls and interstitial tissues to thicken. Neonates with meconium aspiration syndrome (MAS) increase respiratory efforts to create greater negative intrathoractic pressures and improve air flow to the lungs.

CAUSES Commonly related to fetal distress during labor.  Advance gestational age (greater than 40 weeks)  Difficult delivery  Fetal distress  Intrauterine hypoxia  Maternal diabetes  Maternal hypertension  Poor intrauterine growth  .

7. 2. 6.COMPLICATIONS 1. 3. 4. Air leak Pulmonary interstitial emphysema Pulmonary hemorrhage Pulmonary hypertension Pneumonia Infection Thrombocytopenia Asphyxia . 5. 8.

3. 2. 4. mechanical obstruction by particles of meconium Chemical pneumonitis caused by irritation of the alveoli by meconium Signs of infection as meconium is a good medium of bacterial growth in the lungs Diagnostic tests:     Chest x-ray Complete blood count (CBC) C-reactive protein Blood cultures .SIGNS AND SYMPTOMS 1. Air trapping.

and respiratory distress.  Coarse crackles when auscultating the neonate’s lungs.  Signs of distress at delivery.  Dark greenish staining or streaking of the amniotic fluid noted on rupture of membranes. cyanosis. pallor.  Obvious presence of meconium in the amniotic fluid  Greenish staining of the neonate’s skin (if the meconium was passed long before delivery) or placenta. an Apgar score below 6. such as the neonate appearing limp.ASSESSMENT FINDINGS Fetal hypoxia as indicated by altered fetal activity and heart rate.  .

 Chest X-ray may show patches or streaks of meconium in the lungs. air trapping.  .TEST RESULTS Arterial blood gas analysis shows hypoxemia and decreased pH. or hyperinflation.

GIT bleeding and renal failure . Suctioning after head is delivered Oxygenation and ventilation Administer prescribed   Antibiotic therapy Bicarbonate for acidosis 4. 2.MANAGEMENT 1. 5. Monitoring of blood gases Watch out for seizures. 3.

TREATMENT Respiratory assistance via mechanical ventilation  Maintenance of a neutral thermal environment  Administration of surfactant and an antibiotic  Extracorporeal membrane oxygenation (in severe cases).  .

Immediately inspect any fluid passed with rupture of the membrane. including breath sounds and respiratory rate and character. as indicated. Assist with immediate endotracheal suctioning before the first breaths. Frequently assess the neonate’s vital signs. Provide the family with emotional support and guidance. Institute measures to maintain a neutral thermal environment. such as oxygen and respiratory support as ordered. . Administer treatment modalities. Monitor lung status closely.NURSING INTERVENTIONS         During labor. continuously monitor the fetus for signs and symptoms of distress.

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