She was in a daze when I told her that her baby had pooped inside her womb.
C, a 35 year old first-time mum, was at her 41 weeks of gestation. She was admitted for an induction of labour as her baby had passed the due date by one week. When I ruptured the water bag with an amnihook-- a long, thin plastic hook that resembles a crochet hook-- to get the labour going, out gushed a gooey and tenacious dark green amniotic fluid resembling the appearance of thick green pea soup. The foetal heart rate was also low at 110 beats per minutes with decelerations seen in between uterine contractions. As these were signs of foetal distress, an emergency caesarean section was carried out immediately.
The baby was flaccid at birth with a low Apgar score. Luckily, he became active and gave a good cry after resuscitation. He was sent to high dependency unit for monitoring immediately.
The greenish material in the amniotic fluid is the baby’s poop called meconium. It is formed as a result of the baby swallowing the amniotic fluid during pregnancy. It contains debris such as mucus, bile, and the baby's body hairs.
About one in ten babies defecates before he/she is born. It is not completely understood why he/she does this in the womb. It is usually associated with foetal distress. Studies have shown that the thicker and darker the poop, the worse the foetal outcome at delivery. It is believed that the lack of oxygen may cause foetal intestine to move more actively and the anus to relax, resulting in the release of the meconium into the amniotic fluid.
Meconium stained amniotic fluid is usually associated with
· Placental malfunction
· Hypertensive disease of pregnancy (pre-eclampsia)
· Diabetes
· Post-date pregnancy
· Intrauterine growth restriction (IUGR)
· Increased maternal age
Other than birth asphyxia, the baby may suffer from a potentially life-threatening condition when he takes his first breath and inhales the poop into his lungs. This may result in blockage of the airway, respiratory distress and pneumonia—a condition called meconium aspiration syndrome (MAS). Fortunately, this condition is not common.
C was very relieved when she was discharged. Her baby did not develop MAS and was discharged well after 3 days of close observation. "Doc, we are grateful for your decisive and rapid intervention. You saved my baby, ” she said with tears of joy welling in her eyes.