Meconium is the odorless, bile stained contents of the fetal bowel intestine that are passed before childbirth. Meconium develops in the fetal bowel between the 10th and 16th weeks of gestation.
Meconium is a risk factor not for the fetus, but for the newborn. What it does indicate is that you better take special care when that baby is born to make certain there is not aspiration of meconium. This means the baby takes a breath and inhales meconium into its airways.
There are two main issues with meconium that lead to birth injury medical malpractice lawsuits: (1) meconium aspiration syndrome (MAS) and, (2) failure to appreciate the increased risk to the baby that comes with meconium exposure.
Meconium Aspiration Syndrome
Meconium is involved in about 7% to 20% of live births. About 10% of the time when meconium is present in the amniotic fluid, meconium gets into the baby's lungs causing meconium aspiration syndrome. More technically, MAS is meconium below the vocal cords in the baby's tracheal bronchial tree. It is lung failure due to having meconium in the chest, airway, and lungs.
So when a newborn breathes in too much meconium that is in the amniotic fluid, it enters the infant's lungs. Meconium can toxic and can also obstruct the child's airway or overinflate the lungs. So, brutally for the baby, this is both a chemical and an obstruction of breathing problem for the newborn. The result can be immediate or slightly delayed respiratory distress. Lack of oxygen for a newborn can lead to damage to all of the baby's vital organs, including the brain. The most common injury that you see in birth injury cases involving meconium is hypoxic-ischemic encephalopathy.
If there is meconium in amniotic fluid (MSAF) before delivery, the obstetrician should consider the possibility of aspiration (MAS) and monitor the baby closely. Obstetricians and midwives can be found liable for not intervening in the fetal distress and preventing the meconium aspiration. Early identification and intervention of meconium aspiration are essential in preventing severe aspiration problems.
A baby that is born vigorous at birth with spontaneous respiration is very unlikely to every aspirate meconium. But meconium fluid, particularly thick, dark liquid, is a harbinger of possible coming fetal distress even without. Meconium is a marker for anemia, sepsis, or a fetal neurological injury.
Too many OBs and pediatricians fail to put up their antenna after finding meconium in the amniotic fluid because often meconium does not come with complications. With the stakes as high as they are with the neonate and newborn's brain, increased risk has to be met with increased diligence.Meconium aspiration sneaks up on doctors because two of the leading causes of concern -- low Apgar scores or high or low cord blood gasses -- are not always helpful in determining the status of the fetus when meconium is involved because they reflect the condition of the baby at delivery. So the health care providers are lured into a false sense of security if they are not diligent.
The obstetrical risk factors for meconium exposure are a fetus that is over 40 weeks in gestational age of the fetus and an abnormal fetal heart rate during the labor.
A distressed baby is a big risk factor. Late decelerations in the heart rate are of particular concern as are decreased fetal movement, hemorrhage on the part of the mother, or low Apgar scores.
Other factors that increase the risk of MAS include high blood pressure and diabetes in the pregnant mother.Defense of Meconium Birth Injury Cases
The background of the defense is that meconium in amniotic fluid occurs in 11% to 22% at birth. So the defense lawyers try to set the stage that meconium is not the cause for alarms to be set off
The doctors' primary argument in these cases is that the meconium could be aspirated in utero long before the birthing process. The fetus can aspirate thick meconium before childbirth which would mean that the damage from the meconium exposure may not be preventable.
Indeed, meconium aspiration syndrome does not automatically mean that there was medical malpractice in the diagnosis and treatment of meconium exposure. But this argument in specific cases often ignores that if the fetus was suffering from hypoxia or other complication, the fetal heart rate would have some irregularities. If the fetus was doing just fine, it is most likely that meconium aspiration syndrome occurred following or during the last few hours of labor, just before and during childbirth. This is the period when an OB can see there is a problem and do something about it.
- Learn more about meconium aspiration lawsuits
- Example meconium exposure malpractice lawsuit
- About 90% of PPHN cases come from meconium aspiration
If your child has suffered a birth injury and you believe meconium exposure may have been the reason for the harm, call Ron Miller or Laura Zois today and let's talk about your options.
We have a track record of success in wrongful death and catastrophic injury cases. We can help you and your child get the compensation you need and deserve. Call Miller & Zois today and speak to our birth injury medical malpractice attorneys at 800-553-8082 or get an online case evaluation.
- Desai D, et. al: Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):1030-1035.
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Committee Opinion No. 689: Delivery of a newborn with meconium-stained amniotic fluid. Obstet Gyneol 2017;129: e33-e34.
- Swarmam K, et. al: Advance in the management of meconium aspiration syndrome. Int J Pediatr 2012:1-7 (induction for pregnancies at or beyond 41 weeks has led to a reduction in the incidence of MAS)
- Velaphi S, Vidyasagar D. Intrapartum and post-delivery management of infants born to mothers with meconium-stained amniotic fluid: evidence-based recommendations. Clinics in Perinatology. 2006; 33(1):29–42.