Meconium-stained liquor and its impact on maternal and neonatal outcome

Background: Meconium stained amniotic fluid (MSAF) is predictor of adverse fetal outcomes. However, all fetuses with meconium passage do not have an adverse outcome and it is important to distinguish those who develop fetal distress promptly to prevent and intervene the sequalae accordingly. Hence this study was undertaken to study the grades of meconium stained liquor and its effect on intrapartum management and relation with maternal and neonatal outcome.Methods: A prospective observational study was conducted on term pregnancy patients. Firstly, the detailed case history and examination was performed. When membranes ruptured the colour of liquor was noted. Fetal monitoring by cardiotocography (CTG) was done continuously throughout labour. The mode of delivery, cord pH and base excess were noted. After the delivery Apgar score and weight of the baby, need for resuscitation, neonatal intensive care unit (NICU) admissions and neonatal complications were noted.Results: Of the 3117 deliveries conducted during the study period, 321 cases (10.29%) had meconium stained liquor out of whom, 183 women (57%) were with thin meconium and 138 (43%) had thick meconium. There was no risk factor identified in the majority of women. The CTG was reactive in most women with thin meconium (71.5%). There was a significantly higher incidence of pathological CTG’s in women with thick meconium (36.3%) (p value = 0.001). There was no significant difference in birth weight Apgar scores, cord pH, base excess in both the groups and rate of NICU admission.Conclusions: Maximum patients with thin meconium and reactive CTG included in our study delivered normally with good neonatal outcome. However presence of thick meconium in addition to other factors such as fetal heart rate alterations should be viewed seriously as it may pose a potential danger for the baby.

“I’ve got HIV and I want to have a baby”

Perinatal transmission is one of the important routes of HIV transmission that is preventable in the era of effective combination antiretroviral therapy (ART). This chapter presents the case of a known HIV-infected, ART-naïve pregnant woman who establishes antenatal and HIV care late, at 32 weeks’ gestational age. Her presentation raises concerns about the potential risk of HIV transmission to her baby given limited time to achieve HIV virologic suppression. The appropriate management is discussed, which includes first-encounter screening, management of opportunistic infections and sexually transmitted infections, risk behavior modification and counseling, ART initiation and treatment monitoring, intrapartum management, infant prophylaxis, and postpartum HIV care. The case presentation and discussion highlight the importance of comprehensive management of HIV infection in pregnant women to minimize the risk of mother-to-infant HIV transmission and optimize HIV control in the mothers.

Prenatal Diagnosis and Intrapartum Management of Congenital Ranula

A foetal sublingual cystic lesion was diagnosed by routine prenatal ultrasonography at 27 weeks of gestation. Foetal growth and amniotic fluid volume were normal. An ex utero intrapartum treatment (EXIT) procedure was performed, and the cyst was aspirated to allow breathing during planned Caesarean section. The cyst was totally excised when the newborn was 60 days old, and histopathological examination revealed a mucous cyst of the mouth floor.