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.