Aims MSAF is common. The NICE guidelines of intrapartum care for healthy women and babies recommend different management strategies in the labour suite according to whether the meconium is significant (defined as dark green or black amniotic fluid with thick or tenacious, or any MSAF containing lumps of meconium) or non-significant. Our aim was to determine if outcomes differed according to grade of meconium.

Methods A prospective study was conducted over a seven-month period in 2016 of infants born through MSAF. Trainees attending such deliveries completed a proforma regarding whether the meconium was significant, the baby’s condition at birth and the labour ward management. Information was also collected regarding which babies were admitted to the neonatal unit and their outcomes.

Results Eighty infants born through MSAF with a median gestational age of 40 (range 36–42) weeks and birth weight of 3563 (2644–4390) grams were included. Infants born through significant meconium compared with those born through insignificant meconium were born at a later median gestational age (41, 38– 42 weeks vs 40, 36–42 weeks, p<0.001), more likely to be delivered by emergency caesarean section (50% vs 13.5%, p=0.002) and more likely to be floppy at birth (62% vs 8%, p<001). The need for inflation breaths at birth, CPAP and endotracheal intubation during resuscitation were commoner in infants born through significant MSAF (p<0.001). Sixteen of the 80 infants born through MSAF required admission to the NICU, all were delivered through significant meconium. Infants who were admitted to the NICU were born at a later gestational age (median 41 vs 40 weeks, p=0.015), had a greater need for inflation breaths (69% vs 20%, p<0.001), endotracheal intubation (75% vs 0%, p<0.001) and had lower Apgar scores at 1, 5 and 10 min (p<0.001).

Conclusion These results demonstrate that perinatal management needs to be directed at significant MSAF and attendance by paediatricians at non-significant MSAF may not be necessary?