Meconium & Meconium Aspiration Syndrome

The existence of meconium during labour can be a significant sign of fetal distress during labour and delivery. Meconium Aspiration Syndrome (MAS) can be a significant complication during labour and delivery and can lead to long term, or permanent injury.

Some basic medicine

 Before we get into the discussion of meconium and meconium aspiration syndrome it may be useful to have a short discussion of some basic medical principles.

The first basic principle is that every human cell requires oxygen and nutrients, such as glucose, to survive. Of course, some cells require more oxygen and nutrients than others. The cells of the fetal and newborn brain have a high demand for oxygen and glucose. If either the oxygen or the glucose levels fall below a critical level the cell dies. A brain injury can thus be thought of as the death of a significant number of brain cells.

How does your baby get oxygen in utero?

It might also be useful to discuss how cells of the fetal brain are supplied with the necessary oxygen and nutrients. Before your baby is born, your baby (the medical term is fetus) does not breathe in the traditional sense.  Your baby’s lungs do not supply oxygen to the fetal blood.

Rather, the process can be thought to start with your (the mother’s) lungs. Your lungs supply oxygen to your blood. This blood moves from your lungs to your heart, and then is pumped throughout your body, including to your placenta.

The placenta exchanges oxygen and nutrients from the maternal blood to the fetal blood and carbon dioxide and waste products from the fetal blood to the maternal blood. The oxygenated fetal blood flows through the umbilical cord to your baby.

The significance of this is that your baby does not rely on his or her lungs to oxygenate the blood and accordingly the presence of meconium in the amniotic fluid does not have a direct negative effect on your baby. That changes at birth when your baby’s lungs are required to function efficiently to ensure proper oxygenation of your baby’s blood.

What is meconium?

Meconium is a medical term for the first bowel movement of a fetus or baby. It is a green tar like substance. In up to 25% of deliveries the fetus will pass meconium before birth.

Meconium mixes with the amniotic fluid and may go into the throat and lungs of the fetus. This is significant for two reasons:

 

  • Sign of fetal distress: First, it is generally recognized that a fetus that is not appropriately compensating for the stress of labour might, as a consequence, pass meconium. Thus, the fact your baby has passed meconium prior to delivery is a warning sign that your baby may have been subjected to possible fetal distress.

 

  • Meconium Aspiration Syndrome:  The other significant factor is that meconium in the throat and lungs of the newborn could prevent the newborn from breathing properly and may also prevent the effective functioning of the lungs to be able to oxygenate the baby’s blood. This is referred to as Meconium Aspiration Syndrome (MAS) and while potentially serious, the symptoms are usually transient in an otherwise healthy baby.

However, babies with asphyxia tend to be more vulnerable. If it is known that your baby passed meconium during labour it is essential to have a physician present at the delivery who can suction your baby’s throat both above and below the vocal cords, if necessary. It is essential to suction as much of the meconium as possible immediately after birth to minimize the risk of meconium aspiration syndrome.

What are the legal issues?

From a legal point of view, several questions arise:

a) Was there evidence that the fetus was not tolerating labour which, in turn, should have resulted in the delivery of the baby prior to the baby passing meconium?

b) Did the healthcare providers recognize that the passing of meconium by a fetus is a sign of fetal distress and did they react appropriately?

c) Did the healthcare providers ensure that there was a physician present at the delivery who was tasked with the suctioning of the baby’s throat above and below the vocal cords?

d) Was the suctioning of the meconium properly performed?

If you suspect your baby may have suffered an injury during labour or delivery, your birth injury lawyer will investigate all these issues to determine if there is evidence to establish whether meconium played a role in your baby’s injury.


Autism Caused by Hypoxic Ischemic Encephalopathy (HIE)

Autism spectrum disorder is a neurodevelopmental disorder characterized by social deficits (social communication and social interaction) and restricted repetitive patterns of behavior, interests and activities. Intellectual disability and seizures are also common in children with autism spectrum disorder. Autism spectrum disorder encompasses a number of disorders that were previously referred to as autistic disorder/autism, childhood […]

Read More

Behavioral Problems

One of the issues to consider in the context of a child with behavioral issues is whether those issues may be due to a brain injury acquired during labour and delivery. Sometimes the behavioral issues meet the autism diagnostic criteria. However, not all children with behavioral issues meet that criteria and it is the task […]

Read More

Brachial Plexus Injuries

A brachial plexus injury is an injury to the nerves in the neck of the baby. This injury can occur when the baby’s shoulder gets stuck on the mother’s pubic bone during the course of delivery. This is often referred to as shoulder dystocia. Shoulder dystocia is an obstetrical emergency. The baby is at a […]

Read More

Cerebral Palsy

Sadly, a common type of birth injury claim is one involving neurologic injury to a newborn caused by the failure of the obstetrical team (doctors, nurses, midwives) to intervene or expedite delivery in the face of fetal distress. If the baby is incapable of tolerating the intrauterine environment for whatever reason, an urgent delivery by […]

Read More

Delayed Diagnosis of Heart Defects

Some babies are born with congenital heart defects, which are problems that occur with the baby’s heart while the baby is developing in utero. These can be structural (such as a problem with a valve or a blockage) or functional (such as problems with heart rhythm). In some instances, these conditions are not diagnosed until […]

Read More

Erb’s Palsy

Erb’s Palsy and Brachial Plexus Injuries Erb’s palsy, is a type of nerve injury that causes paralysis in the shoulder and arm. It is sometimes referred to as Brachial plexus palsy. There is a network of nerves, called the brachial plexus that runs from your neck, into your shoulders and arms. If your baby’s brachial […]

Read More

Failure to Diagnose or Treat Preeclampsia

Preeclampsia is a pregnancy induced condition characterized by high blood pressure which generally develops late in pregnancy (after week 20). An estimated 8-10% of pregnant women are diagnosed with preeclampsia during pregnancy.   If not properly diagnosed and treated, preeclampsia can lead to life threatening illness in both the mother and her unborn baby.  Below we […]

Read More

Fetal & Neonatal Stroke

For many years it was assumed that fetal or neonatal strokes were not preventable.  Recent studies, however, have shown that some strokes suffered in the fetal time period are due to preventable hypoxic ischemic episodes (an inadequate supply of oxygen to the brain) during labour. A brain injury can result directly from a hypoxic ischemic […]

Read More

Hypoglycemia

Brain cells require glucose to live and function.  A reduction in a newborn baby’s glucose (hypoglycemia) can, if significant enough, result in the brain cells dying and a resultant permanent brain injury. During pregnancy the baby receives the necessary glucose from mom.  When the baby is delivered, the glucose supply from mom stops and the […]

Read More

Hypoxic Ischemic Encephalopathy (HIE)

Oxygen Deprivation During Labour and Delivery The medical term is hypoxic ischemic encephalopathy (HIE). This simply means brain sickness from inadequate oxygenation to the brain. The fetus receives his or her necessary oxygen and nutrients from the mother through the umbilical cord. If this mechanism of delivery of oxygen and nutrients is compromised the fetus […]

Read More

Jaundice, Kernicterus & Hyperbilirubinemia

Kernicterus, a brain injury caused by excessive bilirubin is described by physicians as a “never event”.  It is referred to as a never event not because it never happens, but because it should never happen. Jaundice is very common, occurring in over 50% of births.  Jaundice occurs with excessive bilirubin, a byproduct of the breakdown […]

Read More

Meconium & Meconium Aspiration Syndrome

The existence of meconium during labour can be a significant sign of fetal distress during labour and delivery. Meconium Aspiration Syndrome (MAS) can be a significant complication during labour and delivery and can lead to long term, or permanent injury. Some basic medicine  Before we get into the discussion of meconium and meconium aspiration syndrome […]

Read More

Negligent Resuscitation of a Newborn

Despite the fact that there have been very clear guidelines published by the Canadian Pediatric Society under its neonatal resuscitation program there are still instances where newborns requiring resuscitation suffer a brain injury simply because these guidelines were not followed. The simple fact is that every person who chooses to deliver babies and every hospital […]

Read More

Newborn Infections

A newborn baby, particularly a small or preterm baby, is at risk of suffering a neurological injury if he or she becomes infected. The mother may be carrying Group B Strep bacteria, which can be passed on to the baby as the baby is delivered. As well, infection can occur during labour affecting the placenta […]

Read More

Periventricular Leukomalacia (PVL)

This brain injury is seen in some babies who are born prematurely. The more premature the baby the higher the risk of this injury occurring. The medical term refers to an injury to the white matter of the brain around the ventricles. The premature baby does not have a developed system for the supply of […]

Read More

Seizures

Seizures in the neonatal period are not uncommon, particularly with premature infants. While they can be caused by a number of different conditions, they signify abnormal electrical discharges in the newborn’s central nervous system. Seizures can be related to serious medical conditions and require urgent investigation, often by EEG (a test to identify abnormalities in […]

Read More

Trauma from Forceps & Vacuum

There is a risk of trauma with the use of vacuum or forceps. While the risk is small, injuries such as retinal hemorrhage and hematomas can result from the use of vacuums and forceps. As a general rule, it is not acceptable to use both forceps and vacuum to deliver a baby and the obstetrician […]

Read More

Twin to Twin Transfusion Syndrome

What is twin to twin transfusion syndrome and how can it place your babies at risk? Twin pregnancies can occur as either dizygotic (fraternal twins) or monozygotic (identical twins).  In the case of a dizygotic (fraternal) pregnancy the twins are the result of fertilization of two separate eggs.  In the case of monozygotic (identical) pregnancy […]

Read More

Whole Body Cooling

Within the last number of years there have been significant advances in the knowledge and use of head and whole body cooling to reduce the extent of brain injury associated with a hypoxic ischemic event (an inadequate supply of oxygen to the brain). Those healthcare professionals that practice obstetrics, and physicians who care for newborn […]

Read More