Meconium Stained Amniotic Fluid (Nursing)

by Jacquelyn McMillian-Bohler, PhD, CNM

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    00:01 Our very last complication we'll talk about is meconium stained amniotic fluid.

    00:06 This occurs when the fetus actually passes that first stool before they deliver.

    00:12 The reason why this is a problem is because if you've ever seen meconium, it's thick, and sticky, and tarry.

    00:20 And imagine if that sticky tarry substance gets into the respiratory tract, and you try to take a breath.

    00:28 The alveoli get stuck together, they don't open, we don't have good oxygenation, and that is not good for breathing.

    00:36 So thinking about what the risk factors might be, sometimes, this just happens that we have meconium, and it's released by the fetus for reasons that we can never explain.

    00:48 Other times, we may have it in response to a breech presentation.

    00:52 So this makes sense.

    00:53 If you think about the fact that the bottom is coming first, and the meconium is in the bottom, and the bottom gets a lot of squeeze action going, then you might find that well, poop happens, right? And so as it is excreted, it begins to float in the amniotic fluid.

    01:08 So another risk factor is being post dates.

    01:12 So the longer the fetus is in utero, the more likely they are to release meconium.

    01:18 So if we get to our due date, and then we get past our due date, and we get further past our due date, we can almost anticipate that we're going to have meconium fluid.

    01:28 It's just the way it goes.

    01:30 Also, when we have issues of decreased oxygenation.

    01:34 So think about hypoxia, when someone has an hypoxic event, they tend to over time, lose consciousness, they may have relaxation of muscles, one of those muscles being the anal sphincter, and meconium will begin to leak out.

    01:48 So if we have a situation where the fetus is exposed to hypoxia over and over again, because of some kind of distress, then we may find that meconium comes out and we see it in the amniotic fluid.

    02:01 So what does it look like? Well, it can look yellow, it can look green, it can look yellowy green, just doesn't look very good.

    02:11 So we can see that on the Chuck's pad, we can see it perhaps if the client comes in with water that's already broken, we might see it on the Maxi pad that they're wearing.

    02:21 These are all possibilities.

    02:23 Actually, when the baby comes out, sometimes you can see it all over them.

    02:26 And they're kind of a yellow or green mixed in with all of that vernix, and all those other things.

    02:32 So what do we do? First thing is we want to call the NICU.

    02:36 If we have those services, it's important to let them know, because remember what I said, if that meconium gets into the respiratory tract, we could have an issue with breathing.

    02:46 So we want a team there that can help support the fetus or now the baby, once they're out.

    02:51 We want to talk to the parents, because the protocol for the facility might be that the baby has to immediately be assessed rather than going straight to the chest for kangaroo care.

    03:01 And if that's the policy of the facility, we want to make sure we let the parents know that so they're not any surprises.

    03:09 Now one of the things we used to do not actually that long ago is we thought, well, the meconium is thick.

    03:16 So if we diluted a little bit with fluid, then if it does get into the respiratory tract, then it'll make it easier.

    03:22 Well, we figured out through study that that's not really true.

    03:26 So we don't do amnioinfusion anymore for a meconium fluid.

    About the Lecture

    The lecture Meconium Stained Amniotic Fluid (Nursing) by Jacquelyn McMillian-Bohler, PhD, CNM is from the course Complications in Labor (Nursing).

    Included Quiz Questions

    1. A client that is at 41 weeks gestation
    2. A client that is 38 weeks gestation
    3. A fetus that is in the normal passage position
    4. A fetus whose lungs have not produced surfactant
    1. Assess for discoloration of amnionic fluid
    2. Examine the baby immediately after birth for respiratory distress
    3. Notify NICU after confirmation from assessments
    4. Administer an amnioinfusion
    5. Prepare for immediate cesarean birth

    Author of lecture Meconium Stained Amniotic Fluid (Nursing)

     Jacquelyn McMillian-Bohler, PhD, CNM

    Jacquelyn McMillian-Bohler, PhD, CNM

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