Re: Van Bogaert LJ, Misra A. 2008. Neonatal outcome after caesarean birth for fetal distress and/or meconium staining in a South African rural setting. Journal of Obstetrics and Gynaecology 28:56–59

Dear Sir,

We read with interest the paper by Van Bogaert and Misra (2008) on neonatal outcome after caesarean birth for fetal distress, and make the following comments.

Meconium staining of the amniotic fluid is typically but arguable equated with fetal hypoxia. Intrauterine distress can cause passage of meconium into the amniotic fluid. If the meconium stained baby is not vigorous at birth, it will be necessary to intubate the trachea to clear before the baby takes its first breaths. If the meconium stained baby is vigorous, suctioning the trachea is not necessary.

The author mentioned in the discussion that meconium aspiration must be prevented by proper suction of the upper airway before delivery of the shoulders, followed by suction under vision of the oropharynx, endotracheal intubation to suction the lower respiratory tract and gastric aspiration to prevent the delayed meconium aspiration from regurgitation. Previously, we also used to practise the same, the intra-partum suctioning before the delivery of the shoulder to clear meconium from airway, before the baby took a breath. Recently, the multicentre, randomised controlled trial study by Vain et al. (2004) concluded that there were no differences in the incidence of MAS, need for mechanical ventilation and mortality between suction and no suction group. Intrapartum suctioning has potential risks such as apnoea, cardiac arrhythmias triggered by pharyngeal stimulation, worsening hypoxia, delay in resuscitation and damage to upper airway. Currently, the new guidelines are that the routine intra-partum oropharyngeal and nasopharyngeal suctioning is not recommended for prevention of MAS in infants born with MSAF (ACOG, Committee on Obstetric Practice 2007).