Grading Meconium

  1. Hello all you great OB nurses!

    I come to you with a question I hope you can answer for me.

    I've been out of nursing for 3 years and recently got a job in a NICU in my new state. I did NICU before I stopped nursing for a while.

    Anyway, I went with my preceptor to a pea-soup vaginal meconium delivery last night. Thankfully the mother had been able for amnioinfusion to be done so the meconium was thin by the time the baby was born. The child did very well, thankfully.

    My question is this: The OB nurse came to us to have us answer some questions about the delivery for her paperwork. Then she asked us, "Do you know what grade this delivery would be considered as... 1+, 2+, 3+ or 4+?" In my experience, meconium has been called thin, thick, or pea soup and is based usually on the appearance at delivery after amnioinfusion has been done. Do any of you know how to designate the 1+...4+ meconium grades or have any information about where I can learn more about this? My preceptor didn't have a clue either. I'm wondering if this is something that has been developed during the past 3 years while I was out of the loop so to speak...

    Thank you very much in advance for any light you can shine on this for me!!

  2. Visit Tiki_Torch profile page

    About Tiki_Torch

    Joined: Jul '03; Posts: 218; Likes: 12


  3. by   Jolie
    I've never heard of a grading system either. My NRP is not current, however, and I wonder if this scale is something relatively new in that program. I'm curious to read what others have to say.
  4. by   ragingmomster
    Just a link that came up when I googled...

    Just in case it is difficult to connect..."MSAF was graded as 2 if there was a reasonable amount of liquor with a heavy suspension of meconium. Grade 3 was when the meconium was undiluted and resembled spinach soup."

    Hope this helps
  5. by   Tiki_Torch
    Thank you JOLIE and RAGINGMOMSTER for your replies!

    You found some good research ther RagingMomster surfing the net! I looked around too but you really have a knack for finding things!

    The best I can tell, grading meconium is an older and rather subjective thing... I'm thinking, after reading the article RagingMomster found, that the grades may be something like this:

    1+ stained amniotic fluid

    2+ stained amniotic fluid with small amount of particulate matter

    3+ stained amniotic fluid with particulate matter resembling "spinach soup"

    4+ stained amniotic fluid with particulate matter resembling "pea soup"

    This article uses the term "spinach soup" which I've never heard of before. I've often heard the term "pea soup" and seen it written in medical and nursing texts when speaking of meconium staining. When thinking of soups, I imagine spinach soup to have parts of liquid and parts of spinach pieces; I imagine pea soup to be so thick that the liquid and solids blend together as if put through a blender.

    Oh my goodness this is soooooo gross! I'm making my own stomach queezy!!!:roll

    If anyone else agrees with my thoughts of what these grading designations are, or thinks I'm more off base than on, I'd appreciate hearing from you.

    By the way, this new hospital I'm working at is very behind-the-times in many ways; I wouldn't be a bit surprised if this meconium grading system is some ancient and obsolete way of describing meconium. It would be par for the course at this backwards place.

    Thanks again!
  6. by   SmilingBluEyes
    Woah.....we do not grade it; we objectively describe amniotic fluid...a nurse's note I write might read:

    " AROM 1930 per Dr. S--- copious dark green colored, malodorous amniotic fluid with thick particulate meconium noted.".

    what good does grading do when it's not universal? I have never heard of such a system at all. Really, I have found when in doubt, using objective, CLEAR descriptions in your narrative notes will not steer you wrong.
  7. by   Tiki_Torch
    Thank you SmilingBlueEyes, I completely agree with you!!!


    As I said in an earlier post, I feel this hospital is incredibly backwards in soooo many areas... grading meconium is obviously one of them!!!!! When trying to figure out what the grades might mean, I was referring to the article that RagingMomster found. Some of the sickest meconium aspiration syndrome babies I've cared for had aspirated thin meconium rather than the thick. We just never know how each baby will do. ANY type of meconium can be horrible to deal with.

    For future reference to anyone wondering about grading meconium, I believe we can all agree that it is an obsolete and non-recommended way to describe meconium.

    Thanks to all who have responded.
  8. by   SmilingBluEyes
    another thought:

    why bother grading it, when if it's at all particulate, you would just treat anyhow. where we are if it's there is ANY particulate matter at all, we do amnioinfusion unless otherwise contraindicated. and that, plus, using FHM as a tool to see how baby is doing, should be enough, without complicating the issue with a cumbersome numbering system that so many do not use.
  9. by   BETSRN
    We just do thin, thick, pea soup, particulate. Most of our babies do well regardless of the consistance of the mec. I ahve never heard of the other system.