more meconium???

[babyktchr]

Just wondering...since ACOG as put out the no elective induction before 39 week ruling, has anyone else seen an increase in meconium? We see a lot more 41 weekers now, and we have had a run of meconium babies and not the demure lightly stained mec fluid, but mod to thick particulate stuff and the babies are SICK. Was just curious if anyone else is coming across this. Wonder if this is going to be followed by the powers.

Thanks!!

[LLLovely, BSN, RN]

Not waiting here. Admitted a chronic HTN tonight at 36+6, at midnight the pit started for induction. She does not have pre-E, baby is fine, her pressures have been primarily borderline, but we're going to have a late preterm baby this morning. She is on labetalol only. To me, we could have added nifedipine to see if her pressures came down and given the baby more time, but I don't make the calls.

I would have to check, but my recollection from the NRP update is that meconium is really not a big concern anymore. Amnioinfusion for mec is no longer considered a treatment because it doesn't improve outcomes. Most mec babies are fine. I think it's interesting that the OP is seeing babies with mec who are very sick. I wonder what else is going on with them?

[mommy2boysaz]

I would have to check, but my recollection from the NRP update is that meconium is really not a big concern anymore. Amnioinfusion for mec is no longer considered a treatment because it doesn't improve outcomes. Most mec babies are fine. I think it's interesting that the OP is seeing babies with mec who are very sick. I wonder what else is going on with them?

I agree with you. I wonder how often these patients with "sick" babies are receiving vag exams during labor? How long is their water ruptured? Are any of these babies also GBS +? None of that is related to mec stained fluid. Interesting...

[babyktchr, BSN, RN]

The "sick" babies that I am referring to are mec aspiration pneumonia babies. In this specific facility I have just noticed a high incidence of thick nasty meconium and these babies having mec aspiration pnemonia.... not GBS or other related infections that cause sepsis. I would've mentioned that if that were the case.

When I wrote this originally, we had gone thru two weeks where almost every baby had meconium, and not the demure thin kind, but horrible pea soup kind. We sent 4 kids to the NICU with respiratory issues, then requiring vents for pneumonia related to aspiration. Thankfully that has resolved since then.

[lovemyjoblandd]

This brings me to wonder, food for though persay, was the mec a result of postdates (40+1 not really postdates but you get the point) OR a result of the induction. I'm going with induction and the stress it puts on mom and baby.

[Fyreflie]

When we moved to 41+3 for induction as per SOGC guidelines in Canada we saw waaaaay less inductions, more spontaneous and successful labours, a small increase in mec maybe but definitely no more complications. My last two hospitals wouldn't even suction for mec if baby was vigorous as per our guidelines--those babies stayed skin to skin at delivery.