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1 hour old infant passing copious bloody meconium

Last post 07-09-2010 4:52 PM by joycnm. 3 replies.
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  • 07-08-2010 10:42 AM

    1 hour old infant passing copious bloody meconium

    Hello all,

    I attended a birth of a G 10 P6 this week.  Uneventful prenatal care.  Mom opted for no US, and there were no indications to obtain one.  Labor onset with SROM, with what was described as "pink fluid."  I went to assess, and indeed, the fluid was pink.  Could have been bloody AF, or cervical change show; it was difficult to assess.  I listened carefully to FHT's, and re-assessed for placental sounds over suprapubic area.  No placental sounds, and baby was fabulous at 130-140's and reactive, even with UC's.  Labor progressed normally, and fairly quickly (as one would expect with higher parity), and mom gave birth kneeling, to a 9 lb 8 oz girl over an intact perineum.  As the shoulders were delivering, approx 100 cc clot slithered out.  Ah-ha....probable marginal sinus abruption.

    Baby was perfect, apgars 9-10, nursing within 15 minutes of birth.  Passed first meconium plug at 18 minutes of age.  Now....it gets odd.  Baby started passing copious amounts of bloody meconium.  And over the next hour, the stools got thinner, less meconium and more blood.  Placenta birthed at 40 minutes, approx 300 cc clot and trailing membranes that were easily teased out.  No obvious signs of abruption on placenta.  At 90 minutes of age, after baby passed approx 250 cc of fresh, bloody meconium, we transported.  Baby was nursing intermittently during that time, vitals were perfect.  But I could not assess where blood loss was coming from.  I guessed that this was an older abruption, and baby swallowed AF, and passed this in stools.  But....the blood was very fresh-looking, red, no clots.  I dosed baby with 1 drop of oral Vit K before transport (am not permitted to give IM vit K). 

    Arrived at Children's Hosp in my area, parents were received as well as I can expect for my political climate.  Took two hours to get an abdominal x-ray, and another hour to get a CBC, which clotted.  Repeat CBC revealed perfectly normal panel; in fact, 1 point elevated HGB.  An Apt test was discussed, but never done, because it had been over 20 years since there had been an indication for one at this facility (grrr).  They observed baby for 18 hours, then discharged with normal meconium stools finally passing, and a repeat normal x-ray and CBC.  Baby stayed perfectly normal, nursing and stable vitals throughout. 

    My questions....could swallowing blood-tinged AF REALLY have caused that much bloody meconium?  Wouldn't the blood have had an older, brown, coffee-ground appearance?  Wouldn't baby have been more likely to be vomiting blood, because it is such a gastric irritant?  Any thoughts on what else I might have assessed/done in this situation?

    All opinions are welcomed and appreciated...thanks :)

     

     

     

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  • 07-08-2010 7:32 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: 1 hour old infant passing copious bloody meconium

    Momandmidwife,

    Very, very interesting this story.  I too would assume swallowing bloody AF would result in vomiting and  not passing through to the intestines in any quantity because they are mec filled and if it had it would be brown colored not red..  That would leave me to speculate about an internal disorder or bleed and I would transport as well.  Why would they not do an Apt. test???  Clear need to discern maternal from fetal blood in this case!!  How are the newborn screening results?

    IMO, you did well and really no other option existed here.  Good job!

     

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 07-09-2010 9:09 AM In reply to

    Re: 1 hour old infant passing copious bloody meconium

     Thanks for the reply, April.  I would have expected brown, coffee-ground appearing blood, too from "digested" blood.  The Apt was brought up by me, the neonatologist, and the peds team.  The MDs had a wistful tone as they described new lab regulations that prohibited them from doing the test on the unit, as was done in years gone by.  I am unclear as to why one could not have been done within the lab, though.  Makes me want to buy a dropperful of the sodium hydroxide to stash in my kit!

    Baby looked great on day 3, normal appearing, mild yellowing that mom describes as "less than her other babies on Day 3."  Milk is in, and normal stools are present.  Baby is alert, nursing frequently, voiding well.  I sent the NB screening on that visit, and results will not be in  until next week at the earliest. 

    I appreciate the reply, and would welcome other thoughts as well...

     

  • 07-09-2010 4:52 PM In reply to

    Re: 1 hour old infant passing copious bloody meconium

     Hi,

    I wouldn't have questioned myself about transporting that baby.  All that bloody stool would've scared me.  As far as the question about digested blood causing blackened/browned stools makes sense.  But, I vaguely remember caring for a woman who was breastfeeding with cracked nipples that bled when she nursed in the first couple of days.  When I did my exam on the third day and checked the baby's diaper, it had bloody stool in it!  The woman said she thought it was from her bleeding nipples and I told her I didn't think that would make red blood mixed with the  stools.  As long as everything else was normal, I was okay with waiting.  When I came back for the one-week visit, her nipples were healed and the bloody stools were gone.  I think blood must digest differently in the first few days.  Joyce

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