Re: About Cord Accidents and meconium inhalation....

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Babies do breathe in utero, they just don't get any oxygen that way. They breathe the amniotic fluid in and out, a process that helps to mature their lungs and exercise the breathing mechanism. The cord becomes entangled during the early part of pregnancy, when the baby can move in all directions. Just as a kitten will become entangled with a ball of yarn, the baby will become entangled with the cord. The cord does not need to be wrapped around the neck to be dangerous (any body part will do), as the damage is actually from the cord being pulled too tight, thus blocking blood flow through the cord. Since this bloodflow carries all of the baby's oxygen and nutrients, the effects are similar to strangling an adult by the neck.

>And what percentage of babies are born with the cord wrapped around some
>portion of the body? I am wondering why laboring women are not given
>ultrasounds upon hospital admission, to screen for the cord being
>wrapped, because there are so many other routine screening tests that
>seem to possibly affect only a small percentage of pregnancies.

Upwards of 40% of all babies are born with a nuchal cord, and only a tiny, tiny fraction have any compromise due to this condition. Those that do have some compromise are usually discovered by tracking the fetal heart tones. Since so many have the condition, and so few have a problem, and there are alternative ways to assess the situation, performing a C/S on millions to prevent relatively few injuries is simply not a reasonable option. U/S is not a reliable tool for diagnosing a nuchal cord in labor. Even with color flow Doppler, it can be very difficult to see.

>
>And what can be the causes of meconium to be present in the amniotic
>fluid? What factors put the baby more at risk of inhaling the meconium?
>Is it better to have the waters broken earlier in labor to try and
>prevent this? Can the baby still get meconium in the airways during
>birth even if the fluid is clear and drained early in labor?

Meconium is the material that comprises the baby's first bowel movement. A whole host of factors can induce that first BM, including but not limited to, postdates, fetal stress, and maternal medical conditions. Meconium is generally sterile, but if inhaled (and remember, the baby is breathing the fluid in and out), it can set up a chemical inflammation of the lungs known as chemical pneumonitis, which can lead to respiratory compromise. One option if meconium is discovered prior to delivery is to perform an amnioinfusion, I.E. circulating clean fluid around the baby in utero to dilute the meconium. This is only somewhat effective. C/S does not help either. If there is no meconium, there cannot be any meconium aspiration, but in the actual moment of delivery, many babies will have that first stool as they are actually being delivered. If some falls into the baby's mouth, then it can be aspirated. >
>Thanks to all who care to share opinion, experience, or medical facts.
>
>--
>Marshella (due 2/10/00 with first child, a boy)
>

--
William D. McIntosh, MD, FACOG
Clarksville, TN

This is for educational purposes only.  It is not intended
 to replace consultation and examination by your physician
 or other health care provider.

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• In reply to: Marshella: "About Cord Accidents and meconium inhalation...."