1. Meconium Aspiration Syndrome

2. :Meconium
Meconium is the first intestinal discharge of the newborn. Intrauterine stress may cause in utero passage of meconium. Meconium is composed of amniotic fluid, mucus, lanugos, bile, and cells that have been shed from the skin and the intestinal tract. Consistency of Meconium is thick, greenish black, and sticky.

3. Meconium aspiration syndrome (MAS):
Aspiration of amniotic fluid that containing meconium, present in their lungs ,which can occur before, during, or immediately after birth.

4. Risk Factors for Meconium Passage in utero:
Post term pregnancy.
Preeclampsia ,eclampsia.
GDM.
Abnormal fetal heart rate.
IUGR.
Chorioamnionitis.
Maternal heavy smoking.
Placental insufficiency .
Oligohydramnios.

5. Causes of Meconium Aspiration:
Fetal distress.
 Thick meconium mixes into the amniotic fluid.
As the baby takes the first breaths at delivery, meconium particles enter the airway and can be aspirated (inhaled) deep into the lungs.

6. Meconium Aspiration Syndrome Pathophysiology:
Airway obstruction of large and small airways.
Effects of in utero hypoxemia and acidosis.
Inflammation and edema.
The plugged airways may cause air to be trapped and leak into the tissues in and around the lungs. Infection can also occur causing pneumonia .
Difficulty breathing and poor gas exchange in the lungs.

7. Signs of Meconium Aspiration:
Fetal tachycardia
Absence of fetal accelerations upon CTG in utero
Infant's skin stained greenish (occurs if meconium passed a long period before delivery).
Umbilicus and nails of the newborn will be greenish rather then white or yellowish.

8. Bluish skin color in the infant (cyanosis)
Rapid breathing (tachypnea)
Labored breathing (the infant needs to work hard to breathe).
Absence of breathing (apnea).
Low Apgar score.

9. :Investigation or Test
blood gas analysis showing low blood pH (acidosis, an acidic condition of the blood pH =5.5 to 7.0), decreased pO2 and increased pC02 .
a chest X-ray showing patchy or streaky areas on lungs .

10. Treatment for meconium aspiration
If MAS occurs, newborn will need immediate treatment to remove the meconium from the upper airway. After delivery, The doctor will immediately suction the nose, mouth, and throat. Then, a tube will be placed in the newborn’s windpipe (trachea) endotracheal tube (ET) to suction the fluid containing meconium from the windpipe. The suctioning will continue until no meconium is seen in the material removed.

11. After emergency treatment has been provided, your newborn may be placed in a special care unit to observe their breathing. Additional treatment may be needed to avoid complications of MAS. Five common treatments include:
Antibiotics.
ventilator, a breathing machine, to help your infant breathe.
extracorporeal membrane oxygenation (ECMO).
oxygen therapy.
the use of a radiant warmer to help the baby maintain body temperature.

12. Prevention:
Early identification of meconium aspiration is essential to preventing severe aspiration problems. A technique called amnioinfusion is sometimes used during labor with meconium-stained amniotic fluid. This procedure uses a small tube inserted into the uterus through the vagina. Sterile fluid is then infused through the tube to help dilute the thick meconium.