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STUDY ON RISK FACTORS AND PERINATAL
OUTCOME IN MECONIUM STAINED LIQUOR IN IOG
Dissertation submitted to
THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY
In partial fulfilment for the award of the Degree of
M.S. (OBSTETRICS AND GYNAECOLOGY)
BRANCH II
MADRAS MEDICAL COLLEGE
CHENNAI
APRIL - 2018
BONAFIDE CERTIFICATE
This is to certify that dissertation titled “STUDY ON RISK
FACTORS AND PERINATAL OUTCOME IN MECONIUM
STAINED LIQUOR IN IOG” is the bonafide work done by DR.
DIVIA.A during her M.S., OG course at Madras medical college, Chennai.
Prof. Dr. PREMA ELIZABETH M.D, DGO.,
Professor,
Institute of obstetrics and gynaecology,
Madras medical college,
Chennai 5.
Dr SHANTHI GUNASINGH M.D, DGO.,
The Director,
Institute of obstetrics and gynaecology,
Madras medical college,
Chennai 5.
THE DEAN,
Madras medical college,
Chennai
DECLARATION
I solemnly declare that this dissertation “STUDY ON RISK
FACTORS AND PERINATAL OUTCOME IN MECONIUM
STAINED LIQUOR IN IOG” was prepared by me under the guidance
and supervision of Prof. Dr. Prema Elizabeth M.D, DGO., Professor,
Institute of Social Obstetrics and Gynaecology, Egmore Chennai.
This dissertation is submitted to The Tamil Nadu Dr. M.G.R.
Medical University, Chennai in partial fulfilment of the University
regulations for the award of the degree of M.S. (Obstetrics and
Gynaecology).
Place: Chennai
Date: Dr.A.DIVIA
ACKNOWLEDGEMENT
I would like to thank Prof. Dr. K. MURALIDHARAN M.S.,
M.Ch, Dean, Madras Medical College for having permitted me to do this
dissertation work.
It is my greatest pleasure to express my thanks to
Prof. Dr. SHANTHI SUNASINGH M.D., D.G.O., Director, Institute of
Obstetrics & Gynaecology, Egmore for her valuable guidance, interest and
encouragement in this study.
I take this opportunity to express my deep sense of gratitude and
humble regards to my beloved teacher and guide and professor
Dr. Prema Elizabeth M.D., D.G.O., for her timely guidance, suggestion
and constant inspiration which enabled me to complete this dissertation.
I thank all my Professors, Asst Professors and paramedical staff of
this Institute. I thank my family and friends for their inspiration and support
given to me.
I thank Mr. Padmanabhan Statistician who helped me for statistical
analysis.
CONTENTS
SN.NO TITLE PAGE
1 INTRODUCTION 1
2 AIM OF STUDY 4
3 REVIEW OF LITERATURE 6
4 MATERIAL AD METHODS 22
5 OBSERVATIONS 26
6 DISCUSSION 64
7 SUMMARY 76
8 CONCLUSION 81
9 BIBLIOGRAPHY 83
10 ANNEXURE
PROFORMA
INFORMED CONSENT FORM
MASTER CHART
1
INTRODUCTION
2
INTRODUCTION
Meconium staining of the amniotic fluid and abnormalities in the
fetal heart rate have long been recognised as sign of distress in process of
child birth.
J.Whitridge Williams (1903) observed that “characteristic sign of
impending asphyxia is the escape of meconium”.
Meconium passage is rare before 34 weeks of gestations and after
37 weeks its incidence increases steadily with increasing gestational age
about 10% at 36 weeks, 30% at 40 weeks and 50% at 42 weeks.
PATHOGENESIS
Under normal circumstances, passage of meconium is prevented by
lack of intestinal peristalsis because of low motilin levels,tonic
contraction of anal sphincter and terminal cap of viscous meconium.
Meconium is thought to be passed from the fetal gastro-intestinal
tract as a response to hypoxia, mesenteric vasoconstriction induced gut
hyperperistalsis, falling umbilical venous saturation, vagal stimulation
and normal physiological function of a mature fetus.
Term and postterm neonates are likely to pass meconium than
preterm neonates. passage of meconium into amniotic fluid may increase
3
the risk of intra amniotic infection. whatever the controversies, following
holds true:
1. Clear amniotic fluid is reassuring
2. Thick meconium is at high risk
3. Presence of abnormal fetal heart rate pattern in the presence of
MSAL, is a definite indication of fetal compromise.
4
AIM OF THE STUDY
5
AIM OF THE STUDY
To study the perinatal outcome of fetus and maternal in meconium
stained liquor.
6
REVIEW OF
LITERATURE
7
REVIEW OF LITERATURE
Historical prospective:
Meconium is a term derived from greek word mekonion a word for
poppy juice or opium like. Aristotle is credited with having drawn the
analogy between the presence of this substance in the amniotic fluid and
the sleepy newborn.
Laennec (1806), a physician in Paris was the failure of technique of
auscultation of adult heart and lungs.
Schwarts and von winckel (1858) stressed the importance of fetal
heart rate auscultation throughout labour. He thought the appearance of
meconium in labour meant impending fetal death.
In 1925, schulze conducted a study of 5500 birth in California and
concluded that passage of meconium during labour is in most of cases
independent of fetal asphyxia and the presence of old meconium in the
amniotic fluid was of no prognostic significance for the later development
of asphyxia. She has also observed that in cases associated with asphyxia,
there were always changes of fetal heart rate pattern during labour.
In 1958, Caldeyro Barcia, Bon, Hammacher reported their
observation on various fetal heart rate patterns associated with fetal
distress.
8
Fenton and Steer(1962) suggested the passage of meconium was
significant only if fetal heart rate was less than 110 beats per min
In 1966, Saling introduced amnioscopy for pregnancies more than
10 days past the expected date of confinement and suggested that finding
of meconium indicates impending danger and immediate amniotomy
and fetal blood sampling should be performed. He postulated that fetal
hypoxia precipitates fetal gut vasoconstriction which causes
hyperperistalsis and sphincter relaxation with passage of meconium.
Brandes et al, (1973) observed that fetal who have passed
meconium during labour are in state of temporary compensated fetal
distress and should be delivered within a reasonable time.
Miller et.at., (1975) found no difference in neonatal Apgar between
meconium and non-meconium group if fetal heart rate during the labour
had been normal. They concluded that presence of meconium in absence
of other signs was not a sign of fetal distress
Meis PJ; hall M(1978) observed thin meconium stained
amnioticfluid is not associated with any increased intrapartum or neonatal
morbidity or mortality in contrast to thick meconium stain fluid
Starks et al., (1980) found that thick meconium was associated
with lower fetal scalp ph than thin and absent meconium and concluded
9
that thick meconium usually indicates fetal hypoxia and acidosis
regardless of abnormal fetal heart rate patterns have similar outcome if
meconium is present in the amniotic fluid.
Krebs and co-workers (1980) concluded that bradycardia and
decelerations are significantly increases in patients with meconium.
Benacerraf et.al., (1984) reported that detection of thick meconium
by ultrasonography, but further studies showed that vernix can produce a
similar picture.
Grant et al., (1989) concluded that using a low minute APGAR
score as endpoint (APGAR <7) abnormal fetal heart rate has a high
negative predictive valve of 90% but a low positive predictive valve of
30%. Thismeans that normal trace indicates a fetus is not hypoxic but
abnormal trace is associated with large number of false positives.
Steer PJ,Eigbe F,LissauerTJ,Beard RW(1989) conducted a large
study on 1219 patients with meconium stained amniotic fluid monitored
by cardiotocography and sensitivity was 80%at any time for acidosis and
predictive valve was 32%.
Lately, studies on urinary meconium index(UMI) by
spectrophotometry have been reported.
10
The entry of meconium into the maternal circulation occur during
labour pain and may be excreted in mother’s urine. The entry take place
even in the absence of any clinical signs of rupture of membranes. Patient
who delivered babies with low Apgar had higher positive UMI of rising
type. (Chinese journal of obstetrics of gynaecology 1990).
In 1993 steer PJ and smith R studied the continuous monitoring of
meconium in liquor by optical sensor mounted to an intrauterine probe.
SIGNIFICANCE OF AMNIOTIC FLUID MECONIUM
Meconium is a viscous green liquid that consist of GIT secretions,
bile, bile acids, mucus, pancreatic juice, cellular debris, amniotic fluid,
swallowed vernix caseosa, lanugo hair and squamous cells. It is rarely
seen in amniotic fluid until mid to late 3rd trimester. The incidence of
meconium staining of the amniotic fluid is approximately 10% of all
pregnancies. In 35% of these meconium is aspirated into the fetal lung
and 10-40% of the asphyxiated babies who aspirate die neonatally.
FORMATION OF MECONIUM:
The gastrointestinal tract originates from both endoderm and
splanchnic mesoderm by day 14 after fertilization and is lined by
undifferentiated cuboidal cells by day 18 (Arey, 1974; Grand et al.,).
Intestinal villi appear by 7 weeks and active absorption of glucose and
11
amino acids occurs at 10 weeks and 12 weeks respectively. By 12 weeks
gestation, development of Meissners and Auerbachs plexus within the
intestinal wall coincides with onset of peristalsis of the small intestine
and colon.
Meconium appears in the fetal intestine at approximately 70-85
days gestation (Smith, 1976). High concentration of intestinal enzymes
are present in amniotic fluid early in gestation followed by a decline that
could be related to increased anal sphincter tone (Potier et al., 1978 and
Mulivor et al., 1979).
Composition of meconium
Colour : dark green
Physical properties : thick, viscous and odourless
Dry weight : 28%
Protein : no demonstrable amount
Carbohydrate : 80%
Lipid : minimal
Blood group substances : Present
Nitrogen : high
pH : 5.5 to 7
12
electrolyte : Na, K, Ca, Mg, Cu, Zn
Water : 72-80%
Meconium also contain bile acids and salts, enzymes, amniotic
fluids, swallowed vernix caseosa, lanugo hair and squamous cells. Large
concentration of bile pigments excreted by the biliary tract from the
fourth month onward give meconium its green colour. The foetus lacks
intestinal bacteria, which accounts for many of the differences in
composition between meconium and adult stool.
Theories of meconium passage:
Maturation theory:
Because meconium seldom is observed preterm (Scott et al., 2001),
its preterm in amniotic fluid could reflect gastrointestinal maturity in late
gestation (Matthews and Warshaw, 1979). The hormone control of fetal
meconium passage is maturation dependent. Motilin, an intestinal peptide
responsible for bowel peristalsis and defecation is high in the umbilical
cord of term infants who have passed meconium compared to preterm
with clear liquor.
The neural control of meconium passage is also dependent on
gestational age because maturation and myelination of gastrointestinal
tract progresses throughout gestation. Immaturity of intrinsic and
13
extrinsic innervation of the bowel would impair the ability of premature
fetus to pass meconium into the amniotic fluid. At autopsy, preterm
neonates have more unmyelinated nerve trunks and fewer ganglion cells
in distal colon compared with term neonates.
Transit time through fetal small intestine decreases as gestation
advances. Furthermore, as the fetus matures, the intestinal tract become
more responsive to sympathomimetic agents.
Parasympathetic stimuli initiate meconium passage after
maturation of fetal intestinal tract after 34 weeks. The incidence of
meconium passage during labour increases with the gestational age and
reaches approximately 30% at 40 weeks and 50% at 42 weeks.
Theory of fetal distress:
The relationship of fetal hypoxia and intestinal peristalsis has been
a consideration for many years. Walker (1954), demonstrated that
meconium was released more frequently when the oxygen saturation of
the umbilical vein was below 30% and that heavy meconium is associated
with lower oxygen saturation more often than light meconium.
Hon (1963) suggested that meconium is passed in response to
parasympathetic stimulation during cord compression, but Krebs and
14
Associates (1980) found no difference in the frequency of variable
decelerations regardless of whether meconium was present.
Umbilical cord erythropoietin concentrations are elevated in human
pregnancies complicated by meconium stained amniotic fluid, suggesting
an association between chronic hypoxia and meconium passage (Richey
et al., Jazayeri et al., 2000). Manning and co-workers 1990 reported that
amniotic fluid was present more than twice as often if the last biophysical
profile score was abnormal (6 or less).
Fetal compromise usually of an acute or subacute nature leads to
passage of meconium. There is various degree of meconium staining
from diluted old meconium which is brownish yellow to thick green “pea
soup” meconium. Typically, thick undiluted meconium seen in breech
presentation is for obvious mechanical reason. Meconium passage in
preterm infants can occur if it became infected with organism which
cause a fetal enteritis (Listeria monocytogenes, urea plasma urealyticum,
rotavirus).
Thick meconium stained amniotic fluid is associated with increased
peripartum infection rates. Some reports have suggested an increased risk
of meconium passage in association with cholestasis of pregnancy.
15
AETIOLOGY OF MECONIUM PASSAGE
Fetal hormones neutral control cord compression
hypoxia
fetal gut spontaneous vagal activation
vasoconstriction gastrointestinal motility
hyperperistalsis &
sphincter relaxation
MECONIUM PASSAGE
16
MECONIUM ASPIRATION SYNDROME
Meconium aspiration is defined as the presence of meconium
below the vocal cords. The incidence of MSAF in all births was in the
1990s estimated to be within a wide range from 7 to 22% as reviewed by
Katz and Bowes, but the incidence of MSAF in 2000-2007 in 132,884
(37-43 weeks gestational age) was 8%, the incidence of MAS was 0.2%
and the incidence of severe MAS with a need for respiratory support was
0.067%.
PATHOPHYSIOLOGY
Meconium-stained amniotic fluid may be aspirated before or
during labour and delivery. The pathophysiology of MAS is due to a
combination of primary surfactant deficiency and surfactant inactivation
because of plasma proteins leaking into the airways from areas of
epithelial disruption and injury.
The leading three causes of MAS are
1. Due to physiologic maturational event.
2. A response to acute hypoxic events and
3. A response to chronic intrauterine hypoxia
17
If an infant inhale this mixture before, during, or after birth, it may
be sucked deep into the lungs. Three main problems occur if this
happens:
the material may block the airways
efficiency of gas exchange in the lungs is lowered
the meconium-tainted fluid is irritating, inflaming airways
(pneumonitis) and possibly leading to chemical pneumonia.
These can lead to significant morbidity and mortality if severe
enough.
DIAGNOSIS
High risk infants may be identified by fetal tachycardia,
bradycardia or absence of fetal accelerations upon CTG in utero, at birth
the infant may look cachexic and show signs of yellowish meconium
staining on skin, nail and the umbillical cord, these infants usually
progress onto Infant Respiratory distress syndrome within 4 hours.
Meconium aspiration syndrome (MAS) has been defined by
clinical criteria:
(1) Respiratory distress (tachypnoea, retractions or grunting) in a
neonate born through meconium-stained amniotic fluid (MSAF)
18
(2) A need for supplemental oxygen to maintain oxygen saturation of
haemoglobin (SaO2) at 92% or more
(3) Oxygen requirements starting during the first 2 h of life and lasting
for at least 12 h and
(4) Absence of congenital malformations of the airway, lung or heart.
CXR shows patchy infiltrates, coarse streaking of both lungs,
increased AP diameter and flattening of the diaphragm (due to
hyperinflation).
COMPLICATIONS
Airway obstruction
Complete obstruction of the airways by meconium results in
atelectasis. Partial obstruction causes air trapping and hyperdistention of
the alveoli, commonly termed the ball-valve effect. Hyperdistention of
the alveoli occurs from airway expansion during inhalation and airway
collapse around inspissated meconium in the airway, causing increased
resistance during exhalation. The gas that is trapped (hyperinflating the
lung) may rupture into the pleura (pneumothorax), mediastinum
(pneumomediastinum), or pericardium (pneumopericardium).
19
Surfactant dysfunction
Meconium deactivates surfactant and may also inhibit surfactant
synthesis. Several constituents of meconium, especially the free fatty
acids (e.g., palmitic, stearic, oleic), have a higher minimal surface tension
than surfactant and strip it from the alveolar surface, resulting in diffuse
atelectasis.
Chemical pneumonitis
Enzymes, bile salts, and free fatty acids in meconium irritate the
airways and parenchyma, causing a release of cytokines (including
tumour necrosis factor (TNF-α, interleukin (IL)-1β, IL-6, IL-8, IL-13),
which initiate a diffuse pneumonitis that may begin within a few hours of
aspiration.
These pulmonary effects can produce a gross ventilation-perfusion
(V/Q) mismatch.
Persistent pulmonary hypertension of the new-born
Infants with meconium aspiration syndrome (MAS) have
primary or secondary Persistent pulmonary hypertension in new born
because of chronic in utero stress and thickening of the pulmonary
vessels. PPHN further contributes to the hypoxemia caused by meconium
aspiration syndrome.
20
Finally, although meconium is sterile, its presence in the air
passages can predispose the infant to pulmonary infection.
PROGNOSIS
In mild cases, respiratory distress usually subsides in 2-4 days,
although tachypnoea can persist for longer. Rarely, more prolonged
respiratory damage can occur which can persist for many years. This is
more likely if ventilation has been required. Residual lung problems are
rare but include symptomatic cough, wheezing, and persistent
hyperinflation for up to five to ten years. The ultimate prognosis depends
on the extent of CNS injury from asphyxia and the presence of associated
problems such as pulmonary hypertension.Cerebral hypoxia may lead to
long-term neurological damage.
APGAR SCORING
Apgar is a method to analyse the new born quickly by using
5 simple criteria scaling from 0 to 2 for each. Skin colour, pulse rate,
respiratory effort, activity, reflexes summing up together 0 to 10.
21
0 1 2
Skin colour Blue or pale all
over Acrocyanosis Pink,no cyanosis
Pulse rate Absent <100 beats >100 beats
Respiratory
effort No effort Irregular,gasping Regular,strong
Activity No flexion Some flexion Full flexion
reflexes No response to
stimulation grimace Cry
Apgar is usually done at 1 and 5 min of birth,can be repeated, if the
score is or remains persistently low.
Apgar >7 is normal,6 to 4 is low, less than 3 is critically low.
Low 1 min Apgar requires medical attention, but does signifies
long term neurological complications. But low Apgar at 15min, 30 min
may indicate complication.
22
MATERIAL
AND
METHODS
23
MATERIAL AND METHODS
This prospective study was conducted in Institute of obstetrics and
gynaecology, Egmore, Chennai for a period of 10 month in 2016 and
2017.
Women entering the labour ward for spontaneous progression of
labour who encountered meconium stained liquor draining were analysed
for associated risk factors and monitored for progression of labour, intra
partum cardiotocography, mode of delivery, fetal outcome and maternal
outcome.
STUDY DESIGN
Prospective study
INCLUSION CRITERIA
Singleton pregnancy
Cephalic presentation
Gestational age >37 weeks
Primi or multigravida
With medical risk factors
Meconium stained liquor
24
EXCLUSION CRITERIA
Multiple gestation
Gestation age <37 weeks
Fetal Congenital anomaly
Malpresentation
Study protocol
Patients in labour with meconium stained liquor were selected
following the inclusion and exclusion criteria.
Detailed history wastaken and analysed for risk factors of
meconium, colour of meconium was graded following artificial rupture or
spontaneous rupture of membrane.
Labour was monitored for intra partum fetal heart rate
abnormalities by cardiotocography, stage and progression of labour,
mode of delivery.
After delivery fetal well being assessed by Apgar scoring. New
born is examined for cord around the neck, features of IUGR, congenital
anomalies and post maturity, meconium staining of tissues.
Perinatal outcome is evaluated based on duration of NICU
admission and development of complications such as meconium
25
aspiration syndrome, asphyxia, respiratory distress, sepsis, persistent
pulmonary hypertension of new born.
New-born were followed up to discharge. Mothers were followed
for subinvolution of uterus,wound resuturing, sepsis till discharge
26
OBSERVATION
AND
RESULTS
27
OBSERVATION AND RESULTS
200 hundred women admitted for labour natural in institute of
obstetrics and gynaecology for a period of 10 months were observed
according to inclusion criteria listed in material and methods and studied.
Age group vs neonatal complications
The age of the patients in this study ranged from 19 yrs to 38 yrs.
Age distribution and the neonatal complications in meconium stained
liquor with respect to age is
Neonatal complications
Total NO YES
Age group
20-25
Count 20 65 85
% within Age group 23.5% 76.5% 100.0%
% within Neonatal
complications 55.6% 39.6% 42.5%
% of Total 10.0% 32.5% 42.5%
26-30
Count 8 67 75
% within Age group 10.7% 89.3% 100.0%
% within Neonatal
complications 22.2% 40.9% 37.5%
% of Total 4.0% 33.5% 37.5%
31-35
Count 8 32 40
% within Age group 20.0% 80.0% 100.0%
% within Neonatal
complications 22.2% 19.5% 20.0%
% of Total 4.0% 16.0% 20.0%
Total
Count 36 164 200
% within Age group 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
28
Most of women come under 20 to 25yrs and 25 to 30yrs age group.
The chi-square value is 4.062 and P value is 0.100, hence not
significant
AGE GROUP
29
DISTRIBUTION BASED ON PARITY
The percentage of primi and multigravida in the study group is
68% (136 women) and 32%(64 women)respectively. Out of that 82.4% of
new-born in primi,84.6%new-born in 2nd gravida and 33.3% new-born in
3rd gravida developed complications due to MSL.
Neonatal complications
Total NO YES
Parity
1
Count 24 112 136
% within primi 17.6% 82.4% 100.0%
% within Neonatal complications 66.7% 68.3% 68.0%
% of Total 12.0% 56.0% 68.0%
2
Count 8 44 52
% within 2nd gravida 15.4% 84.6% 100.0%
% within Neonatal complications 22.2% 26.8% 26.0%
% of Total 4.0% 22.0% 26.0%
3
Count 4 8 12
% within 3rd gravida 33.3% 66.7% 100.0%
% within Neonatal complications 11.1% 4.9% 6.0%
% of Total 2.0% 4.0% 6.0%
Total
Count 36 164 200
% within parity 18.0% 82.0% 100.0%
% within Neonatal complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
30
Chi square=2.164 P=0.339 Not significant.
Parity
31
POST DATED PREGNANCY
Out of 200 MSAL, 33 women were found to be post-dated. 87.9%
new born in post-dated group and 80.8% new born in non-post-dated
group developed complications postnatally.
Neonatal
complications Total
NO YES
Postdated
NO
Count 32 135 167
% within Postdated 19.2% 80.8% 100.0%
% within Neonatal
complications 88.9% 82.3% 83.5%
% of Total 16.0% 67.5% 83.5%
YES
Count 4 29 33
% within Postdated 12.1% 87.9% 100.0%
% within Neonatal
complications 11.1% 17.7% 16.5%
% of Total 2.0% 14.5% 16.5%
Total
Count 36 164 200
% within Postdated 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
32
P value=0.336, not significant,
POSTDATED
Anaemia in MSAL
Of 200 study group, 24.5% (49 women) were anaemic. In anaemic
group 91.8% (45 women) developed neonatal complication and78.8%
develop in neonatal period.
In this study reference haemoglobin has been taken as 10 grams,
women with haemoglobin less than 10 grams, were brought into anaemic
group
33
Chi square valve=4.255, P valve= 0. 039, hence it is statistically
significant.
Neonatal
complications Total
NO YES
Anaemia
NO
Count 32 119 151
% within anaemia 21.2% 78.8% 100.0%
% within Neonatal
complications 88.9% 72.6% 75.5%
% of Total 16.0% 59.5% 75.5%
YES
Count 4 45 49
% within anaemia 8.2% 91.8% 100.0%
% within Neonatal
complications 11.1% 27.4% 24.5%
% of Total 2.0% 22.5% 24.5%
Total
Count 36 164 200
% within anaemia 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
34
ANEMIA
Oligohydramnios in MSAL
45 women of 200 study group had oligohydramnios Amniotic fluid
index< 5.
35
Of oligohydramnios group, 64.4% developed complications and
87.1% in women with normal liquor. Neonatal complications arise more
in normal liquor status group.
Neonatal
complications Total
NO YES
Oligo
NO
Count 20 135 155
% within oligo 12.9% 87.1% 100.0%
% within Neonatal
complications 55.6% 82.3% 77.5%
% of Total 10.0% 67.5% 77.5%
YES
Count 16 29 45
% within oligo 35.6% 64.4% 100.0%
% within Neonatal
complications 44.4% 17.7% 22.5%
% of Total 8.0% 14.5% 22.5%
Total
Count 36 164 200
% within oligo 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
36
Its P value is 0, which is statistically significant, suggesting
oligohydramnios to be a significant risk factors for complication due to
meconium.
OLIGO
37
IUGR IN MSAF
Out of 200 study women 29 fetal growth charts showed features of
IUGR. 86.2% of IUGR fetus and 81.3% of fetus without IUGR developed
complications due to MSAL.
In Women whose antenatal USG, suggesting growth profile in
decreased difference more than 3 weeks, on clinical examination
difference of 3 weeks were categorised as IUGR.
Neonatal
complications Total
NO YES
IUGR
NO
Count 32 139 171
% within IUGR 18.7% 81.3% 100.0%
% within Neonatal
complications 88.9% 84.8% 85.5%
% of Total 16.0% 69.5% 85.5%
YES
Count 4 25 29
% within IUGR 13.8% 86.2% 100.0%
% within Neonatal
complications 11.1% 15.2% 14.5%
% of Total 2.0% 12.5% 14.5%
Total
Count 36 164 200
% within IUGR 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
38
Chi square = 0.407 P value = 0.524 ,Statistically not significant.
IUGR
GDM IN MSAL
Out of 200 study people,28 women had GDM.women with GDM
developed fetal complications due to MSAL in 100% fetus
39
Neonatal
complications Total
NO YES
GDM
NO
Count 36 136 172
% within GDM 20.9% 79.1% 100.0%
% within Neonatal
complications 100.0% 82.9% 86.0%
% of Total 18.0% 68.0% 86.0%
YES
Count 0 28 28
% within GDM 0.0% 100.0% 100.0%
% within Neonatal
complications 0.0% 17.1% 14.0%
% of Total 0.0% 14.0% 14.0%
Total
Count 36 164 200
% within GDM 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
40
Chi square =7.147 P value = 0.008 is significant.
41
PREGNANCY INDUCED HYPERTENSION
Of 200 study women,24 people developed PIH during antenatal
period. Of them 66.7% developed complication due to meconium
postnatally and 84.7% women without PIH develop meconium
complication.
Neonatal complications
Total NO YES
PIH
NO
Count 28 148
% within PIH 15.9% 84.1% 100.0%
% within Neonatal
complications 77.8% 90.2% 88.0%
% of Total 14.0% 74.0% 88.0%
YES
Count 8 16 24
% within PIH 33.3% 66.7% 100.0%
% within Neonatal
complications 22.2% 9.8% 12.0%
% of Total 4.0% 8.0% 12.0%
Total
Count 36 164 200
% within PIH 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
42
Chi square = 4.344 P value = 0.037 is significant
PIH
43
PROM IN MSL
Out of 17 PROM, 81% new-born developed complications due to
MSL, this is same for new born with no history of PROM.
Neonatal
complications
Total NO YES
Prom>24hrs
NO
Count 32 147 179
%within prom
>24hrs 17.9% 82.1% 100.0%
% within Neonatal
complications 88.9% 89.6% 89.5%
% of Total 16.0% 73.5% 89.5%
YES
Count 4 17 21
% within prom >
24hrs 19.0% 81.0% 100.0%
% within Neonatal
complications 11.1% 10.4% 10.5%
% of Total 2.0% 8.5% 10.5%
Total
Count 36 164 200
% within prom >
24hrs 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
44
Chi square 0.17 P value is 0.895 not significant
PROM>24 hrs
45
Chronic respiratory disease in MSAL
Out 200 women, 33 women had history of chronic respiratory
disease, such as bronchial asthma, chronic bronchitis.
Neonatal
complications
Total NO YES
chr.res.dis
NO
Count 24 143 167
% within chr.res.dis 14.4% 85.6% 100.0%
% within Neonatal
complications 66.7% 87.2% 83.5%
% of Total 12.0% 71.5% 83.5%
YES
Count 12 21 33
% within chr.res.dis 36.4% 63.6% 100.0%
% within Neonatal
complications 33.3% 12.8% 16.5%
% of Total 6.0% 10.5% 16.5%
Total
Count 36 164 200
% within chr.res.dis 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
46
Its P value is 0.003, which is statistically significant.
CHRONIC RESPIRATORY DISEASE
47
HYPOTHYROID IN MSL
Out of 200 women, 14% (28 women) had hypothyroid. It does not
significantly influence the outcome of meconium in terms of
complications
Neonatal
complications
Total NO YES
Hypothyroid
NO
Count 32 140 172
% within hypothyroid 18.6% 81.4% 100.0%
% within Neonatal
complications 88.9% 85.4% 86.0%
% of Total 16.0% 70.0% 86.0%
YES
Count 4 24 28
% within hypothyroid 14.3% 85.7% 100.0%
% within Neonatal
complications 11.1% 14.6% 14.0%
% of Total 2.0% 12.0% 14.0%
Total
Count 36 164 200
% within hypothyroid 18.0% 82.0% 100.0%
% within Neonatal
complications 100.0% 100.0% 100.0%
% of Total 18.0% 82.0% 100.0%
48
Chi square is 0.304, P value is 0.581 it is not significant.
49
Prolonged labour
Prolonged labour is defined as failure to progress when the labour
lasts for more than 20 hrs in primi and 14hrs in multigravida. There are 2
main types latent phase more than 12hrs and active phase more than
8hrs.8 women out of200 had prolonged labour as per definition, of them 4
developed neonatal complications postnatally.
Neonatal
complications
Total NO YES
prolonged
labour
NO
Count 36 156 192
% with Neonatal
complications 18% 82%
YES
Count 4 4 8
% with Neonatal
complications 50% 50%
50% of neonates with prolonged labour went for neonatal
complications.
P value is 0.176, which is statistically not significant.
50
Colour of liquor
On grading colour of liquor and comparing with complication,73%
out of thin meconium stained liquor, 79% of moderate meconium stained
liquor and 100% thick meconium stained liquor developed complication
postnatally.
Neonatal
complications
Total NO YES
Colour of
liquor
THIN
Count 24 65 89
% within colour of
liquor 27.0% 73.0% 44.5%
MODERATE
Count 12 46 58
% within colour of
liquor 20.7% 79.3% 29%
THICK
Count 0 53 53
% within colour of
liquor 0.0% 100.0% 26.5%
51
Chi square is16.766 and P value is 0.00 which is significant.
.
52
MODE OF DELIVERY IN MSAL
In this study, majority of the patients (60.5%) were delivered by
caesarean section, 2.5 % delivered by instrumental delivery and 27%
delivered by labour natural
Percentage of LSCS in thin MSL is 54%, moderate MSL is 70%,
thick MSL is 60%.
Common indications for caesarean section in study group is MSAF
in early labour (48.5%), next common being fetal distress (41.5%).
Its P value is 0.127, statistically not significant.
LN/CS
Total NORMAL FORCEPS CS
Colour of
liquor
THIN
Count 41 5 48 89
% 46.06% 5.6% 53.93%
MODERATE
Count 17 2 41 58
% 29.3% 3.4% 70.7%
THICK
Count 21 2 32 53
% 39.6% 3.7% 60,4%
53
Distribution based on indication for LSCS
MSAF in early labour 97 48.5%
Fetal distress 83 41.5%
Arrest of descent 6 3%
Arrest of dilatation 10 5%
Non- progression of labour 4 2%
Common indications for caesarean section in study group is MSAF
in early labour, next common being fetal distress.
54
CARDIOTOCOGRAPHY
89 women in study group had non- reassuring CTG,of which 81
neonates(91%) developed neonatal complications and 72 women (80.9%)
went for LSCS
LN/CS
Total NORMAL CS
CTG
NORMAL
Count 62 49 111
% of Total 55.9% 44.1%
ABNORMAL
Count 17 72 89
% of Total 19.1% 80.9%
55
Chi square is 27.9 and P value is 0.00 which is statistically significant.
56
CTG and neonatal complications
89 women in study group had non- reassuring CTG, of which
81 neonates (91%) developed neonatal complications and 72 women
(80.9%) went for LSCS.
This explains CTG makes an important role in decision making in
MSAL.
P value in comparing reassuring and non-reassuring CTG in terms
of neonatal complications and LSCS are 0.00 and 0.03 (statistically
significant).
Neonatal
complications
Total NO YES
CTG
NORMAL
Count 28 83 111
% of Total 25.3% 74.7% 55.5%
ABNORMAL
Count 8 81 89
% of Total 9% 91% 44.5%
57
Chi square value is 8.82 and P value is 0.003, which is statistically
significant.
58
Parity and LSCS
The incidence of LSCS was almost equal in primi, 2nd gravida and
multigravida, explains that parity does not influence the mode of delivery
in this study
LN/CS
Total
NORMAL CS
Parity
1
Count 59 77 136
% of Total 43.4% 61.6% 68%
2
Count 16 36 52
% of Total 30.7% 69.3% 26%
3
Count 4 8 12
% within LN/CS 33.3% 66.7% 6%
59
P value is 0.258, which is not significant.
Parity
60
GDM and LSCS
LN/CS
Total
NORMAL CS
GDM
NO
Count 75 97 172
% within LN/CS 94.9% 80.2% 86.0%
% of Total 37.5% 48.5% 86.0%
YES
Count 4 24 28
% within LN/CS 5.1% 19.8% 14.0%
% of Total 2.0% 12.0% 14.0%
Total
Count 79 121 200
% within LN/CS 100.0% 100.0% 100.0%
% of Total 39.5% 60.5% 100.0%
The incidence of LSCS is more in GDM patients when compared
to others, suggesting GDM influences LSCS incidence due to LGA
babies.
61
Chi square is 8.992, P value is 0.003 which is significant.
GESTATIONAL DIABETUS MILETUS
62
BMI and LSCS
LN/CS
Total
NORMAL CS
BMI
GROUP
NORMAL
Count 32 28 60
% of Total 53.3% 46.7%
OVER
WEIGHT
Count 27 61 88
% of Total 10.3% 89.7%
OBESE
Count 20 32 52
% of Total 38.4% 61.6%
63
Chi-Square is 7.91 and P value is 0.21, which is significant
BODY MASS INDEX
This explains incidence of LSCS is more in high BMI women
when compared to normal BMI.
64
DISCUSSION
65
DISCUSSION
This prospective study consists of 200 women with meconium
stained liquor in labour room as study group. The age of women in this
study ranged from 19 yrs to 38 yrs with a mean age being 25.6 yrs.
Distribution of gestational age range from 37 weeks to 41wks.
GRADING OF MECONIUM AND NEONATAL
COMPLICATIONS
In this this study group 44.5% women had thin meconium stained
liquor (grade 1), 29% had moderate meconium stained liquor (grade 2)
and 25.5% had thick meconium stained liquor(grade 3).
Grade 1 Grade 2 Grade 3
Present study 44.5% 29% 25.5%
Shaikh et al 22% 22% 56%
In study population, 73% of grade 1 MSAL fetus, 79%of grade 2
MSAL fetus and 94% of grade 3 MSAL fetus respectively went for
complication postnatally. Postnatal complications being respiratory
distress, asphyxia, persistent pulmonary hypertension, sepsis, intubation
and death.
66
Chi square is16.766 and P value is 0.00 which is statistically significant.
This explains incidence of complications are common in thick
MSL when compared to thin and moderate MSL which is statistically
significant.
Similarly, many early reports related meconium passage to
increased risk of perinatal morbidity and mortality, increased risk of
perinatal morbidity and mortality, especially when associated with
abnormal fetal heart rate patterns. There were report by Fenton and steer,
Nathan et al, 1994, Ash AK, Cambridge(2000) have suggested that
meconium stained amniotic fluids might signify underlying acute or
chronic fetal hypoxia with adverse perinatal outcome, especially when
associated with cardiotocographic abnormalities.
Complications No. Percentage
Respiratory distress 17 8.42%
PPHN 5 2.25%
Asphyxia 31 15.5%
MAS 6 3.03%
Sepsis 5 2.42%
Intubation 35 17.5%
Death 5 2.63%
Total 104 52%
67
The incidence of MAS in study conducted by Davis et al., 1985;
Falciglia 1988 Rossi et al 1989 was 8-10 %.
In study MST. HOSNA ARA KHATUN1, JAHANARA ARZU2,
EMDADUL HAQUE3, MA KAMAL3, MOHAMMAD ABDULLAH
AL MAMUN4, MOHAMMAD FAIZUL HAQUE KHAN4, MD.
MAHBUBUL HOQUE5
It was 20.4%.
MAS
This study 6%
Hosna ara khatun at et al 20.4%
The incidence of birth asphyxia in hosna ara khatun et al was 16%
almost same as this study where axphyxia rate was 16%.
Birth asphyxia
This study 15.5%
Hosna ara khatun at et al 16%
In this study neonatal sepsis rate was 2.4%.In study conducted by
jyoti rokade cidya mule neonatal sepsis rate was 1.5%.
68
Sepsis
This study 2.4%
Jyoti rokade Vidya Mule 1.5%
According to Hosna ara khatun at et al, intubation were needed for
5% of neonates, but in this study 17.5% of neonates needed intubation.
Intubation
This study 17.5%
Hosna ara khatun at et al 5%
According to zaideh and sunna (2000), Jordan university the
perinatal mortality was 1% with MSAL. According to study, hosna ara
khatun at et al was 3.8%.
MSAL apgar<7 apgar>7 Total
Grade 1 13(13.9%) 76(82.1%) 89
Grade 2 9(14.7%) 49(85.3%) 58
Grade 3 18(32.6%) 35(67.4%) 53
Total 40(20%) 160(80%)
Its P value is 0.04,statistically significant.
In this study,perinatal mortality is 2.68%
69
Mortality
This study 2.68%
Hosna ara khatun at et al 3.8%
In this study with respect to CTG, there were no neonatal deaths in
those patients with reassuring CTG and there were 5 neonatal death in
patients with non-reassuring CTG.
Cardiotocography
The criteria for FHR abnormalities in this study are persistent
tachycardia >170beats/min, persistent bradycardia<100 beats/min,no beat
to beat variability and repetitive late decelerations.
Study
group
Neonatal
complications LSCS
Non reassuring CTG 89 81(91%) 72(80.9%)
Reassuring CTG 111 83(74.7%) 49(44.1%)
89 women in study group had non reassuring CTG, of which 81
neonates(91%) developed neonatal complications and 72 women (80.9%)
went for LSCS.
This explains CTG makes an important role in decision making in
MSAL.
70
p value in comparing reassuring and non-reassuring CTG in terms
of neonatal complications and LSCS are 0.00 and 0.03 (statistically
significant).
Depending upon the density of meconium, in pts with thick
meconium majority had non-reactive NST.
Similar observation was made by Halvax et al., (2002) showing
linear association between the thickness of meconium and abnormal fetal
heart rate during labour.
Antenatal risk factors
In this study antenatal risk factors are analysed once the women
with meconium stained liquor gets into labour
Risk factors incidence complication P value
Post-dated 33(16.5%) 87.9% 0.336
Anaemia 49(24.5%) 91.8% 0.036
Oligohydramnios 45(22.5%) 64.4% 0.00
IUGR 29(14.5%) 86.3% 0.524
GDM 28(14%) 100% 0.008
PIH 24(12%) 66.7% 0.037
PROM>24hrs 21(10.5%) 81.5% 0.895
Hypothyroid 28(14%) 85.7% 0.581
Chronic respiratory disease 36(16.5%) 50% 0.003
Prolonged labour 8(4%) 50% 0.176
Low birth weight 22(11%) 24% 0.124
71
In study group, pregnancy period extending > 40wks, highest
gestational age being 41+5 wks, contributes 16.5% of study group. Of
them 87.9% developed complication due to MSAL. Its P valve is not
significant.
Anaemia according to WHO definition with Hb<11gms and
haematocrit <33%, which contributes to about 24.5% of study people. Of
them 91.8% went for neonatal complications due to MSL, its P value is
0.036, which is significant.
IUGR group includes AN mother with antenatal ultrasounds shows
statistic growth profiles, disparity more than 3 to 4 wks on per abdomen
examination. Of them 86.3% of IUGR fetus developed complications
postnatally. Its P value is 0.524, statistically not significant.
28 women (14%) were GDM in the study group, of them 100% of
neonates born to them developed complications postnatally. Its P value is
0.08 which is statistically significant.
PIH in this group was 24(12%). 66.7% developed complication
postnatally. Its P value is 0.037 which is statistically significant.
PROM 21(10.5%) women was PROM in this study, of this 81.5%
developed complication postnatally due to MSL, its P value is 0.895
which is statistically not significant.
72
Chronic respiratory disease contributes 36(16.5%) in study group.
Of this 50% developed complication due to MSAL postnatally. its
P value is 0.003 which is statistically significant.
Prolonged labour is defined as failure to progress when the labour
lasts for more than 20 hrs in primi and 14hrs in multigravida. There are 2
main types latent phase more than 12hrs and active phase more than
8hrs.8 women out 200 had prolonged labour as per definition, of them 4
developed neonatal complications postnatally. Its P value is 0.176, which
is statistically not significant.
Mode of delivery in MSAL
In this study, majority of the patients(60.5%) were delivered by
caesarean section, 2.5 % delivered by instrumental delivery and 27%
delivered by labour natural. Whereas in the study conducted by Faridi,
Aggarwal, Delhi (2004) the incidence of caesarean section in patients
with MSAL is 48%.This can be attributed to earlier detection abnormal
fetal heart rate due to continuous electronic heart monitoring and hence
earlier intervention.
Caesarean section incidence
Caesarean section incidence
Present study 60.5%
Faridi, Aggarwal, Delhi 48%
73
Distribution based on indication for LSCS
MSAF in early labour 97 48.5%
Fetal distress 83 41.5%
Arrest of descent 6 3%
Arrest of dilatation 10 5%
Non- progression of labour 4 2%
Common indications for caesarean section in study group is MSAF
in early labour (48.5%), next common being fetal distress (41.5%).
Parity and LSCS
LN/CS
Total NORMAL CS
Parity
1 Count 59 77 136
% of LN/CS 43.4% 61.6%
2 Count 16 36 52
% of LN/CS 30.8% 69.2%
3 Count 4 8 12
% of LN/CS 33.4% 66.6%
Total Count 79 121 200
% of LN/CS 39.5% 60.5% 100.0%
This shows incidence of LSCS was almost equal in primi,
2nd gravida and multigravida, explains that parity does not influence the
mode of delivery in this study.
74
Its chi square value is 2.707 and p value is 0.258, which is not
significant.
BMI and LSCS
LN/CS
Total
NORMAL CS
BMI
GROUP
NORMAL
Count 32 28 60
% of Total 53.3% 46.7%
OVER
WEIGHT
Count 27 61 88
% of Total 10.3% 89.7%
OBESE
Count 20 32 52
% of Total 38.4% 61.6%
This explains incidence of LSCS is more in high BMI women
when compared to normal BMI
Chi-Square is 7.91 and P value is 0.21, which is significant.
The incidence of LSCS is more in overweight and obese women
compared to women with normal weight.
75
Maternal complications
Out of study population, 8 women went for puerperal fever
postnatally. In those women, all have undergone for LSCS, 6 women had
LSCS and 2 had labour natural.
4 women had sub involution post natally. All of them had vaginal
delivery, and all the women had history of severe anaemia in antenatal
period treated with blood transfusion.
8 women went for resuturing postnatally, of them 4 had caesarean
section and 4 had labour natural.
76
SUMMARY
77
SUMMARY
This prospective study was conducted to study the perinatal and
maternal outcome in meconium stained amniotic fluid. This study group
consist of 200 patients in labour room with meconium stained amniotic
fluid.
The age of the patients in this study range from 19 to 38 years with
a mean age of 25.6 years. P value is 0.10. Majority of patients fall in age
group of 20 to 30yrs.
Gestational age ranges from 37 to 41 weeks.Post-dated being
16.5%.
The percentage of primigravida in the study group was 68%,2nd
gravida was 26%,3rd gravida was 12%.Of this neonatal complication was
lesser in 3rd gravida (33%),when compared to primi and second gravida.
Its P value is 0.33. In this study the parity doesnot influence the caesarean
section. P value is 0.258, statistically not significant.
Majority of patients had spontaneous onset of labour almost 70%.
The P value is 0.04 which is statistically significant.
Of neonatal complication due to MSAL, complications are in order
intubation (17%), asphyxia (15%), respiratory distress (8%), MAS (3%),
sepsis (2.4%), PPHN (2.6%), death (2.5%)
78
Of listed risk factors for MSAL, statistically significant results
came for following
Anaemia was seen in 49(24.5%) women, of them 91.8% developed
postnatal complication due to MSAL, P value is 0.039.
28 women had GDM. Women with GDM developed fetal
complications due to MSAL in 100% fetus. Majority fetus had respiratory
distress, intubated for intra tracheal suctioning.
P value is 0.008.
24 women in study group developed PIH during antenatal period.
Of them 66.7% developed complication due to meconium postnatally and
84.7% women without PIH developed complications.its P value is 0.037.
this suggest that PIH doesnot influence development of postnatal
complications.
Chronic respiratory disease had 50% risk of developing neonatal
complications postnatally, P value is 0.003.
Women with prolonged labour had 50% risk of developing
complications due to MSAL, P value is 1.76.
Other associated complication oligohydramnios, IUGR, PROM,
hypothyroid does not influence the development of complications
postnatally.
79
In study group, 44.5% women had thin meconium stained
liquor(grade 1),29% had moderate meconium stained liquor (grade 2) and
25.5% had thick meconium stained liquor (grade 3).
There was 100% risk of developing complication in thick
MSAL,79% in moderate MSL,73% in thin MSAL explaining
complications are more in thick MSL when compare to moderate and thin
MSL.
40% of neonates had low Apgar <7, of which are 32,6% from thick
MSAL, 14.7% from moderate MSAL,13.9% from thin MSAL, explaining
risk of low Apgar with thick MSAL, probably due to aspiration of
meconium in intrapartum period.
Percentage of LSCS in thin MSL is 54%,moderate MSL is 70%,
thick MSL is 60%.
Non- reassuring CTG was seen in 89 women in study group, of
them 72(80.9%) went for LSCS, when compared to 44% in reassuring
CTG women. P value is 0.00.
Of 89 women with non-reassuring CTG,81 women(91%)
developed postnatal complications, when compared to 74% with
reassuring CTG.P value is 0.003.
80
This signifies that there is linear association between the thickness
of meconium and abnormal fetal heart rate during labour.
Rate of LSCS is more in overweight (89%), obese(61%) when
compared to women with normal BMI(46%), explaining high BMI
influences the caesarean in this study.
In terms of maternal complications, 8 women had puerperal fever,
8 women had resuturing, 4 women had subinvolution.
81
CONCLUSION
82
CONCLUSION
The main clinical value of meconium stained amniotic fluid is to
alert the obstetrician to look for further signs of fetal compromise such as
non-reactive CTG.
Patients with thin MSL can be delivered vaginally safely if no fetal
heart rate abnormality, with favourable bishop score. women with grade
2 and 3 MSAL, should be cautious in intrapartum fetal heart rate
monitoring as risk of neonatal complications more with this group.
So, meconium in amniotic fluid is associated with obstetric hazard
and postnatal complication mostly in women with non-reassuring
intrapartum, fetal heart rate monitoring.
LSCS rate and low Apgar, post-natal complications is in linear
association with thickness of meconium and non-reassuring intrapartum
cardiotocography.
83
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84
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95
ANNEXURE
96
PROFORMA
NAME ADDRESS
AGE
EDUCATION
PARITY
MENSTRUAL HISTORY
MARITAL HISTORY AND STATUS
FAMILY HISTORY
PAST HISTORY
OBSTETRIC HISTORY
RISK FACTORS
OBSTETRIC HISTORY
RISK FACTORS
Post-dated oligohydramnios
Anaemia Teenage pregnancy
IUGR PROM
PIH GDM
Prolonged labour chronic res. disease
97
EXAMINATION
HEIGHT WEIGHT BMI
PR BP RR
Per abdomen
Per vagina
COLOUR OF LIQUOR
SPONTANEOUS RUPTURE/ARTIFICIAL RUPTURE
PARTOGRAM
USE OF SYNTOCIN
MODE OF DELIVERY
FETAL OUTCOME
Apgar < 7
Birth weight
Baby admitted/not
98
Postnatal complications
Meconium aspiration syndrome
Intubation
Asphyxia
PPHN
Sepsis
Neonatal death
MATERNAL COMPLICATIONS
Puerperal fever,
sub involution of uterus,
wound resuturing
99
100
101
NA
ME
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LN/C
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PY
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MA
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PP
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sep
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INT
UB
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dis
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lab
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lab
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RE
SU
TU
R
E
selvi 25 2 38 0 0 0 0 0 0 0 1 1 153 50 3 1 21.3 1 0 0 2020 <7 1 1 1 0 0 1 18 0 8 0 0 0 0
narmadha 26 1 39 0 1 1 0 0 0 0 0 0 165 91 1 1 33.4 1 0 0 2500 >7 0 0 0 0 0 0 0 0 9 0 0 1 0
SABANA 27 2 37 0 0 0 0 1 0 0 1 0 143 83 3 0 40.5 0 2 1 3650 <7 1 1 1 0 1 1 30 0 7 0 0 0 0
chinnaponnu 35 3 37 0 0 0 0 0 0 0 0 0 144 54 1 0 26 0 0 0 2020 >7 1 0 0 0 0 0 8 0 6 0 0 0 0
elizabeth 30 1 38 0 0 0 0 1 0 0 0 0 148 68 2 1 31 0 2 1 2810 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
GAYATHRI 32 1 41 1 0 0 0 0 0 0 1 0 158 75 3 1 30.04 0 2 1 2860 >7 1 0 0 0 0 0 6 0 7 0 0 0 0
kalyani 20 1 40 0 1 1 0 0 0 0 0 0 164 48 1 0 17.8 0 2 1 2450 <7 1 1 0 0 0 1 12 0 9 0 0 0 0
SIVASANKARI 32 1 39 0 0 0 0 0 0 0 1 0 148 75 3 0 34.24 0 2 1 2670 <7 1 0 0 0 0 1 10 0 4 0 0 0 0
YASHMI 27 1 40 0 0 1 0 0 0 0 0 0 152 58 2 1 25.1 1 2 1 2890 >7 1 0 1 0 0 1 32 0 8 0 0 0 0
suganya 24 1 39 0 0 1 1 0 0 0 0 0 149 54 1 1 24.32 0 0 0 2000 >7 1 0 1 0 0 1 12 0 15 1 0 0 0
MADINI 24 1 40 0 0 0 0 0 0 0 0 1 145 56 1 1 26.6 0 2 1 3120 >7 0 0 0 0 0 0 0 0 7 0 0 0 0
DEVI 30 2 40 0 1 0 0 0 0 0 0 1 142 67 1 1 33.27 1 2 1 2660 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
kalaimam 30 3 38 0 0 0 0 0 0 0 0 0 148 68 3 0 31.04 0 2 1 3400 >7 1 0 0 0 0 0 5 0 1 0 1 0 0
rajathi 23 1 38 0 0 1 0 0 0 0 0 0 156 68 3 1 27.94 1 1 0 3260 >7 1 1 0 0 0 1 18 0 6 0 0 0 0
JEYALAKSHMI 23 1 37 0 1 0 0 0 0 1 0 0 160 69 3 1 26.95 0 2 1 3400 >7 1 0 0 0 0 0 4 0 4 0 0 0 0
POORANI 27 1 40 0 0 0 1 0 0 0 0 0 149 58 3 1 26.12 1 1 0 2200 >7 1 0 1 0 0 1 34 0 2 0 0 0 0
CHANDRA 24 1 39 0 0 0 0 0 0 1 0 0 154 64 2 1 26.98 1 0 0 2340 <7 1 1 1 0 0 0 48 0 2 0 0 0 0
JENIFER 28 1 40 0 0 1 0 0 1 0 0 0 158 58 1 1 23.23 1 1 0 1780 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
REVATHY 27 2 41 1 1 0 0 1 0 1 0 0 158 59 1 1 23.63 1 2 1 3180 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
NADIYA 29 2 40 0 0 1 1 0 0 0 0 0 160 68 2 0 26.56 1 2 1 2600 >7 1 0 0 0 0 0 12 0 1 0 0 0 0
CHITHRA 21 1 41 1 0 0 0 0 0 0 0 0 148 58 1 0 26.47 1 2 1 2890 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
MANIMEGALAI 20 1 40 0 0 0 0 0 0 0 0 0 153 64 1 0 27.33 1 2 1 2600 <7 1 0 1 0 0 0 14 0 7 0 0 0 0
SAKTHI 31 1 39 0 1 0 0 0 0 0 0 0 146 69 2 0 28.35 1 2 1 2560 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
RAJATHI 23 1 39 0 0 1 0 0 1 0 0 0 140 59 2 1 30.1 1 2 1 2100 >7 0 0 0 0 0 0 0 0 4 0 0 0 1
RANJANI 30 1 41 1 0 0 0 0 1 0 0 0 156 69 1 0 28.35 1 2 1 2900 <7 1 0 0 0 0 1 6 0 3 0 0 0 0
SAJI 28 1 41 1 1 0 0 0 0 0 0 1 160 72 1 0 28.125 0 0 0 3560 <7 1 1 1 0 0 1 32 0 1 0 0 0 0
ragini 30 1 38 0 0 0 0 0 0 0 0 0 158 76 1 1 30.04 1 1 0 3020 >7 0 0 0 0 0 0 0 0 3 0 0 0 0
prema 34 1 37 0 0 0 0 1 1 0 0 1 157 70 3 0 28.39 1 2 1 3080 <7 1 1 1 0 1 0 0 1 4 0 0 0 0
jamuna 29 3 40 0 0 0 0 1 0 0 0 0 160 64 2 0 25 0 2 1 4800 <7 1 1 0 0 0 1 0 1 3 0 0 0 0
pushpa 22 2 39 0 0 0 0 0 0 0 0 0 154 64 1 0 26.98 0 2 1 3800 >7 1 0 0 1 0 1 0 1 4 0 0 0 0
SULTANA 33 1 39 0 1 0 0 0 0 0 0 0 147 54 3 0 24.98 0 2 1 3410 <7 1 1 1 1 0 1 0 1 6 0 0 0 0
CHITRA 23 1 37 0 0 0 0 0 0 0 0 0 165 68 3 0 24.97 0 0 0 2260 <7 1 1 1 0 0 0 0 1 15 1 0 0 0
ANU 26 1 40 0 1 0 0 0 0 0 0 0 156 58 2 0 23.83 0 0 0 1980 >7 1 1 0 1 0 0 0 1 5 0 0 0 0
chitra 23 1 37 0 0 1 1 0 1 0 0 0 148 58 2 1 26.47 0 2 1 1890 <7 1 1 0 0 0 1 6 0 6 0 0 0 0
manju 24 1 40 0 0 0 0 0 0 0 0 0 149 58 1 1 26.12 1 1 0 2200 >7 0 0 0 0 0 0 0 0 8 0 0 0 0
rani 34 1 40 0 0 0 0 0 0 0 1 1 154 56 1 1 23.61 1 0 0 2460 >7 0 0 0 0 0 0 0 0 13 0 0 0 0
elavarasi 25 2 41 1 1 1 1 0 0 0 0 0 160 58 3 0 22.65 1 2 2 1890 >7 1 0 1 0 0 1 14 0 2 0 1 0 0
santhosh 26 1 37 0 0 0 0 0 0 0 0 0 154 64 2 0 26.98 1 2 2 2160 >7 1 0 0 0 0 1 10 0 1 0 0 0 0
rekha 21 1 29 0 1 0 0 0 1 0 0 0 160 68 1 1 24.09 1 0 0 2590 <7 1 1 0 0 0 1 10 0 5 0 0 0 0
raji 19 2 38 0 0 0 0 0 0 1 0 1 174 70 2 1 24.22 1 0 0 2910 <7 1 0 0 0 0 0 2 0 5 0 0 0 0
saji 20 2 39 0 0 0 1 0 0 0 0 0 146 54 1 1 25.33 0 2 2 3100 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
daisy 36 2 40 0 0 0 0 1 0 0 1 0 156 58 2 0 23.83 0 2 2 2800 <7 1 1 0 0 0 0 1 0 15 0 0 0 0
rama 20 1 41 1 0 0 0 0 0 0 0 0 160 60 1 0 23.43 0 2 2 2100 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
kalyani 32 1 42 0 0 0 0 0 0 1 0 0 141 68 1 1 33.25 1 2 2 3100 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
sundari 26 2 38 0 0 0 0 0 0 0 0 0 145 70 1 1 33.39 1 1 0 2800 >7 1 0 0 0 0 1 8 0 14 0 0 0 0
mano 24 1 39 0 1 0 0 0 0 0 1 0 156 66 2 0 27.12 0 2 2 2870 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
ANU 28 1 39 0 0 0 0 1 0 0 0 0 158 76 3 1 30.44 0 0 0 2680 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
anandi 23 2 37 0 0 1 1 0 0 0 0 1 150 78 2 1 31.24 0 0 0 2100 <7 1 0 0 0 0 0 0 0 8 0 0 0 1
ramya 32 2 38 1 0 0 0 0 0 0 0 0 164 66 1 1 24.53 0 2 2 2890 <7 1 0 1 0 0 1 23 0 6 0 0 0 0
Divya 25 2 38 0 0 0 0 0 0 0 1 1 153 50 3 1 21.3 1 0 0 2020 <7 1 1 1 0 0 1 18 0 8 0 0 0 0
Cauvery 26 1 39 0 1 1 0 0 0 0 0 0 165 91 1 1 33.4 1 0 0 2500 >7 0 0 0 0 0 0 0 0 9 0 0 1 0
Sandhya 27 2 37 0 0 0 0 1 0 0 1 0 143 83 3 0 40.5 0 2 1 3650 <7 1 1 1 0 1 1 30 0 7 0 0 0 0
Lalitha 3 37 0 0 0 0 0 0 0 0 0 144 54 1 0 26 0 0 0 2020 >7 1 0 0 0 0 0 8 0 6 0 0 0 0
Evangulin 30 1 38 0 0 0 0 1 0 0 0 0 148 68 2 1 31 0 2 1 2810 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
Gokila 32 1 41 1 0 0 0 0 0 0 1 0 158 75 3 1 30.04 0 2 1 2860 >7 1 0 0 0 0 0 6 0 7 0 0 0 0
kalaivani 20 1 40 0 1 1 0 0 0 0 0 0 164 48 1 0 17.8 0 2 1 2450 <7 1 1 0 0 0 1 12 0 9 0 0 0 0
Shankari 32 1 39 0 0 0 0 0 0 0 1 0 148 75 3 0 34.24 0 2 1 2670 <7 1 0 0 0 0 1 10 0 4 0 0 0 0
Sundhari 27 1 40 0 0 1 0 0 0 0 0 0 152 58 2 1 25.1 1 2 1 2890 >7 1 0 1 0 0 1 32 0 8 0 0 0 0
Aarthi 24 1 39 0 0 1 1 0 0 0 0 0 149 54 1 1 24.32 0 0 0 2000 >7 1 0 1 0 0 1 12 0 15 1 0 0 0
Madhu 24 1 40 0 0 0 0 0 0 0 0 1 145 56 1 1 26.6 0 2 1 3120 >7 0 0 0 0 0 0 0 0 7 0 0 0 0
Diana 30 2 40 0 1 0 0 0 0 0 0 1 142 67 1 1 33.27 1 2 1 2660 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Banu 30 3 38 0 0 0 0 0 0 0 0 0 148 68 3 0 31.04 0 2 1 3400 >7 1 0 0 0 0 0 5 0 1 0 1 0 0
Ranjitha 23 1 38 0 0 1 0 0 0 0 0 0 156 68 3 1 27.94 1 1 0 3260 >7 1 1 0 0 0 1 18 0 6 0 0 0 0
lakshmi 1 37 0 1 0 0 0 0 1 0 0 160 69 3 1 26.95 0 2 1 3400 >7 1 0 0 0 0 0 4 0 4 0 0 0 0
Ponni 27 1 40 0 0 0 1 0 0 0 0 0 149 58 3 1 26.12 1 1 0 2200 >7 1 0 1 0 0 1 34 0 2 0 0 0 0
Rekha 24 1 39 0 0 0 0 0 0 1 0 0 154 64 2 1 26.98 1 0 0 2340 <7 1 1 1 0 0 0 48 0 2 0 0 0 0
Julie 28 1 40 0 0 1 0 0 1 0 0 0 158 58 1 1 23.23 1 1 0 1780 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Sathya 27 2 41 1 1 0 0 1 0 1 0 0 158 59 1 1 23.63 1 2 1 3180 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
Renuka 29 2 40 0 0 1 1 0 0 0 0 0 160 68 2 0 26.56 1 2 1 2600 >7 1 0 0 0 0 0 12 0 1 0 0 0 0
Kavya 21 1 41 1 0 0 0 0 0 0 0 0 148 58 1 0 26.47 1 2 1 2890 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Bhavani 1 40 0 0 0 0 0 0 0 0 0 153 64 1 0 27.33 1 2 1 2600 <7 1 0 1 0 0 0 14 0 7 0 0 0 0
Harini 31 1 39 0 1 0 0 0 0 0 0 0 146 69 2 0 28.35 1 2 1 2560 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Asaiponnu 23 1 39 0 0 1 0 0 1 0 0 0 140 59 2 1 30.1 1 2 1 2100 >7 0 0 0 0 0 0 0 0 4 0 0 0 1
Eshwari 30 1 41 1 0 0 0 0 1 0 0 0 156 69 1 0 28.35 1 2 1 2900 <7 1 0 0 0 0 1 6 0 3 0 0 0 0
Sindhuja 28 1 41 1 1 0 0 0 0 0 0 1 160 72 1 0 28.125 0 0 0 3560 <7 1 1 1 0 0 1 32 0 1 0 0 0 0
Ranjini 30 1 38 0 0 0 0 0 0 0 0 0 158 76 1 1 30.04 1 1 0 3020 >7 0 0 0 0 0 0 0 0 3 0 0 0 0
Priya 34 1 37 0 0 0 0 1 1 0 0 1 157 70 3 0 28.39 1 2 1 3080 <7 1 1 1 0 1 0 0 1 4 0 0 0 0
jamuna 29 3 40 0 0 0 0 1 0 0 0 0 160 64 2 0 25 0 2 1 4800 <7 1 1 0 0 0 1 0 1 3 0 0 0 0
Vanitha 22 2 39 0 0 0 0 0 0 0 0 0 154 64 1 0 26.98 0 2 1 3800 >7 1 0 0 1 0 1 0 1 4 0 0 0 0
Vani 33 1 39 0 1 0 0 0 0 0 0 0 147 54 3 0 24.98 0 2 1 3410 <7 1 1 1 1 0 1 0 1 6 0 0 0 0
CHANDRA 24 1 37 0 0 0 0 0 0 0 0 0 165 68 3 0 24.97 0 0 0 2260 <7 1 1 1 0 0 0 0 1 15 1 0 0 0
Pradeepa 26 1 40 0 1 0 0 0 0 0 0 0 156 58 2 0 23.83 0 0 0 1980 >7 1 1 0 1 0 0 0 1 5 0 0 0 0
Muniyamma 23 1 37 0 0 1 1 0 1 0 0 0 148 58 2 1 26.47 0 2 1 1890 <7 1 1 0 0 0 1 6 0 6 0 0 0 0
Chinnama 24 1 40 0 0 0 0 0 0 0 0 0 149 58 1 1 26.12 1 1 0 2200 >7 0 0 0 0 0 0 0 0 8 0 0 0 0
rani 34 1 40 0 0 0 0 0 0 0 1 1 154 56 1 1 23.61 1 0 0 2460 >7 0 0 0 0 0 0 0 0 13 0 0 0 0
Saranya 25 2 41 1 1 1 1 0 0 0 0 0 160 58 3 0 22.65 1 2 2 1890 >7 1 0 1 0 0 1 14 0 2 0 1 0 0
Poovizhi 26 1 37 0 0 0 0 0 0 0 0 0 154 64 2 0 26.98 1 2 2 2160 >7 1 0 0 0 0 1 10 0 1 0 0 0 0
Muthukani 21 1 29 0 1 0 0 0 1 0 0 0 160 68 1 1 24.09 1 0 0 2590 <7 1 1 0 0 0 1 10 0 5 0 0 0 0
Gomathi 19 2 38 0 0 0 0 0 0 1 0 1 174 70 2 1 24.22 1 0 0 2910 <7 1 0 0 0 0 0 2 0 5 0 0 0 0
Jesmitha 20 2 39 0 0 0 1 0 0 0 0 0 146 54 1 1 25.33 0 2 2 3100 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Bhararthi 36 2 40 0 0 0 0 1 0 0 1 0 156 58 2 0 23.83 0 2 2 2800 <7 1 1 0 0 0 0 1 0 15 0 0 0 0
Tamanna 20 1 41 1 0 0 0 0 0 0 0 0 160 60 1 0 23.43 0 2 2 2100 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
kalyani 32 1 42 0 0 0 0 0 0 1 0 0 141 68 1 1 33.25 1 2 2 3100 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
Kushbu 26 2 38 0 0 0 0 0 0 0 0 0 145 70 1 1 33.39 1 1 0 2800 >7 1 0 0 0 0 1 8 0 14 0 0 0 0
Priyanka 24 1 39 0 1 0 0 0 0 0 1 0 156 66 2 0 27.12 0 2 2 2870 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
Deepika 28 1 39 0 0 0 0 1 0 0 0 0 158 76 3 1 30.44 0 0 0 2680 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
Nandhini 23 2 37 0 0 1 1 0 0 0 0 1 150 78 2 1 31.24 0 0 0 2100 <7 1 0 0 0 0 0 0 0 8 0 0 0 1
Chandini 32 2 38 1 0 0 0 0 0 0 0 0 164 66 1 1 24.53 0 2 2 2890 <7 1 0 1 0 0 1 23 0 6 0 0 0 0
Kumari 25 2 38 0 0 0 0 0 0 0 1 1 153 50 3 1 21.3 1 0 0 2020 <7 1 1 1 0 0 1 18 0 8 0 0 0 0
Praveena 26 1 39 0 1 1 0 0 0 0 0 0 165 91 1 1 33.4 1 0 0 2500 >7 0 0 0 0 0 0 0 0 9 0 0 1 0
Surya 27 2 37 0 0 0 0 1 0 0 1 0 143 83 3 0 40.5 0 2 1 3650 <7 1 1 1 0 1 1 30 0 7 0 0 0 0
Rani 3 37 0 0 0 0 0 0 0 0 0 144 54 1 0 26 0 0 0 2020 >7 1 0 0 0 0 0 8 0 6 0 0 0 0
Radhika 30 1 38 0 0 0 0 1 0 0 0 0 148 68 2 1 31 0 2 1 2810 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
Rajeswari 32 1 41 1 0 0 0 0 0 0 1 0 158 75 3 1 30.04 0 2 1 2860 >7 1 0 0 0 0 0 6 0 7 0 0 0 0
Kiruthika 20 1 40 0 1 1 0 0 0 0 0 0 164 48 1 0 17.8 0 2 1 2450 <7 1 1 0 0 0 1 12 0 9 0 0 0 0
Gowri 32 1 39 0 0 0 0 0 0 0 1 0 148 75 3 0 34.24 0 2 1 2670 <7 1 0 0 0 0 1 10 0 4 0 0 0 0
Aruna 27 1 40 0 0 1 0 0 0 0 0 0 152 58 2 1 25.1 1 2 1 2890 >7 1 0 1 0 0 1 32 0 8 0 0 0 0
Aranya 24 1 39 0 0 1 1 0 0 0 0 0 149 54 1 1 24.32 0 0 0 2000 >7 1 0 1 0 0 1 12 0 15 1 0 0 0
Rosie 24 1 40 0 0 0 0 0 0 0 0 1 145 56 1 1 26.6 0 2 1 3120 >7 0 0 0 0 0 0 0 0 7 0 0 0 0
Prathika 30 2 40 0 1 0 0 0 0 0 0 1 142 67 1 1 33.27 1 2 1 2660 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Bhavana 30 3 38 0 0 0 0 0 0 0 0 0 148 68 3 0 31.04 0 2 1 3400 >7 1 0 0 0 0 0 5 0 1 0 1 0 0
Hema 23 1 38 0 0 1 0 0 0 0 0 0 156 68 3 1 27.94 1 1 0 3260 >7 1 1 0 0 0 1 18 0 6 0 0 0 0
Indhumathi 1 37 0 1 0 0 0 0 1 0 0 160 69 3 1 26.95 0 2 1 3400 >7 1 0 0 0 0 0 4 0 4 0 0 0 0
Jubeida 27 1 40 0 0 0 1 0 0 0 0 0 149 58 3 1 26.12 1 1 0 2200 >7 1 0 1 0 0 1 34 0 2 0 0 0 0
Kavipriya 24 1 39 0 0 0 0 0 0 1 0 0 154 64 2 1 26.98 1 0 0 2340 <7 1 1 1 0 0 0 48 0 2 0 0 0 0
Karthika 28 1 40 0 0 1 0 0 1 0 0 0 158 58 1 1 23.23 1 1 0 1780 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Manjusha 27 2 41 1 1 0 0 1 0 1 0 0 158 59 1 1 23.63 1 2 1 3180 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
Devapriya 29 2 40 0 0 1 1 0 0 0 0 0 160 68 2 0 26.56 1 2 1 2600 >7 1 0 0 0 0 0 12 0 1 0 0 0 0
Selvi 21 1 41 1 0 0 0 0 0 0 0 0 148 58 1 0 26.47 1 2 1 2890 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Noorjahan 1 40 0 0 0 0 0 0 0 0 0 153 64 1 0 27.33 1 2 1 2600 <7 1 0 1 0 0 0 14 0 7 0 0 0 0
Sandhini 31 1 39 0 1 0 0 0 0 0 0 0 146 69 2 0 28.35 1 2 1 2560 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
leelavathi 23 1 39 0 0 1 0 0 1 0 0 0 140 59 2 1 30.1 1 2 1 2100 >7 0 0 0 0 0 0 0 0 4 0 0 0 1
Sarala 30 1 41 1 0 0 0 0 1 0 0 0 156 69 1 0 28.35 1 2 1 2900 <7 1 0 0 0 0 1 6 0 3 0 0 0 0
Vimala 28 1 41 1 1 0 0 0 0 0 0 1 160 72 1 0 28.125 0 0 0 3560 <7 1 1 1 0 0 1 32 0 1 0 0 0 0
Venuka 30 1 38 0 0 0 0 0 0 0 0 0 158 76 1 1 30.04 1 1 0 3020 >7 0 0 0 0 0 0 0 0 3 0 0 0 0
Abinaya 34 1 37 0 0 0 0 1 1 0 0 1 157 70 3 0 28.39 1 2 1 3080 <7 1 1 1 0 1 0 0 1 4 0 0 0 0
Abinamithra 29 3 40 0 0 0 0 1 0 0 0 0 160 64 2 0 25 0 2 1 4800 <7 1 1 0 0 0 1 0 1 3 0 0 0 0
Riyaz 22 2 39 0 0 0 0 0 0 0 0 0 154 64 1 0 26.98 0 2 1 3800 >7 1 0 0 1 0 1 0 1 4 0 0 0 0
Shaja 33 1 39 0 1 0 0 0 0 0 0 0 147 54 3 0 24.98 0 2 1 3410 <7 1 1 1 1 0 1 0 1 6 0 0 0 0
Esther 23 1 37 0 0 0 0 0 0 0 0 0 165 68 3 0 24.97 0 0 0 2260 <7 1 1 1 0 0 0 0 1 15 1 0 0 0
Samantha 26 1 40 0 1 0 0 0 0 0 0 0 156 58 2 0 23.83 0 0 0 1980 >7 1 1 0 1 0 0 0 1 5 0 0 0 0
Sameera 23 1 37 0 0 1 1 0 1 0 0 0 148 58 2 1 26.47 0 2 1 1890 <7 1 1 0 0 0 1 6 0 6 0 0 0 0
Brindha 24 1 40 0 0 0 0 0 0 0 0 0 149 58 1 1 26.12 1 1 0 2200 >7 0 0 0 0 0 0 0 0 8 0 0 0 0
Aswini 34 1 40 0 0 0 0 0 0 0 1 1 154 56 1 1 23.61 1 0 0 2460 >7 0 0 0 0 0 0 0 0 13 0 0 0 0
Sowmiya 25 2 41 1 1 1 1 0 0 0 0 0 160 58 3 0 22.65 1 2 2 1890 >7 1 0 1 0 0 1 14 0 2 0 1 0 0
Nikitha 26 1 37 0 0 0 0 0 0 0 0 0 154 64 2 0 26.98 1 2 2 2160 >7 1 0 0 0 0 1 10 0 1 0 0 0 0
Ruthra 21 1 29 0 1 0 0 0 1 0 0 0 160 68 1 1 24.09 1 0 0 2590 <7 1 1 0 0 0 1 10 0 5 0 0 0 0
Ramani 19 2 38 0 0 0 0 0 0 1 0 1 174 70 2 1 24.22 1 0 0 2910 <7 1 0 0 0 0 0 2 0 5 0 0 0 0
Thamarai 20 2 39 0 0 0 1 0 0 0 0 0 146 54 1 1 25.33 0 2 2 3100 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
daisy 36 2 40 0 0 0 0 1 0 0 1 0 156 58 2 0 23.83 0 2 2 2800 <7 1 1 0 0 0 0 1 0 15 0 0 0 0
Thara 20 1 41 1 0 0 0 0 0 0 0 0 160 60 1 0 23.43 0 2 2 2100 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
Kala 32 1 42 0 0 0 0 0 0 1 0 0 141 68 1 1 33.25 1 2 2 3100 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
Radha 26 2 38 0 0 0 0 0 0 0 0 0 145 70 1 1 33.39 1 1 0 2800 >7 1 0 0 0 0 1 8 0 14 0 0 0 0
Sridevi 24 1 39 0 1 0 0 0 0 0 1 0 156 66 2 0 27.12 0 2 2 2870 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
Jaya 28 1 39 0 0 0 0 1 0 0 0 0 158 76 3 1 30.44 0 0 0 2680 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
Pooguzhali 23 2 37 0 0 1 1 0 0 0 0 1 150 78 2 1 31.24 0 0 0 2100 <7 1 0 0 0 0 0 0 0 8 0 0 0 1
ramya 32 2 38 1 0 0 0 0 0 0 0 0 164 66 1 1 24.53 0 2 2 2890 <7 1 0 1 0 0 1 23 0 6 0 0 0 0
kavitha 25 2 38 0 0 0 0 0 0 0 1 1 153 50 3 1 21.3 1 0 0 2020 <7 1 1 1 0 0 1 18 0 8 0 0 0 0
Nandhitha 26 1 39 0 1 1 0 0 0 0 0 0 165 91 1 1 33.4 1 0 0 2500 >7 0 0 0 0 0 0 0 0 9 0 0 1 0
Sabrina 27 2 37 0 0 0 0 1 0 0 1 0 143 83 3 0 40.5 0 2 1 3650 <7 1 1 1 0 1 1 30 0 7 0 0 0 0
Cinnatha 3 37 0 0 0 0 0 0 0 0 0 144 54 1 0 26 0 0 0 2020 >7 1 0 0 0 0 0 8 0 6 0 0 0 0
ammani 30 1 38 0 0 0 0 1 0 0 0 0 148 68 2 1 31 0 2 1 2810 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
Rini 32 1 41 1 0 0 0 0 0 0 1 0 158 75 3 1 30.04 0 2 1 2860 >7 1 0 0 0 0 0 6 0 7 0 0 0 0
Pavithra 20 1 40 0 1 1 0 0 0 0 0 0 164 48 1 0 17.8 0 2 1 2450 <7 1 1 0 0 0 1 12 0 9 0 0 0 0
Parvathi 32 1 39 0 0 0 0 0 0 0 1 0 148 75 3 0 34.24 0 2 1 2670 <7 1 0 0 0 0 1 10 0 4 0 0 0 0
Yazhini 27 1 40 0 0 1 0 0 0 0 0 0 152 58 2 1 25.1 1 2 1 2890 >7 1 0 1 0 0 1 32 0 8 0 0 0 0
Varshini 24 1 39 0 0 1 1 0 0 0 0 0 149 54 1 1 24.32 0 0 0 2000 >7 1 0 1 0 0 1 12 0 15 1 0 0 0
Sindhuja 24 1 40 0 0 0 0 0 0 0 0 1 145 56 1 1 26.6 0 2 1 3120 >7 0 0 0 0 0 0 0 0 7 0 0 0 0
Nalini 30 2 40 0 1 0 0 0 0 0 0 1 142 67 1 1 33.27 1 2 1 2660 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
narmadha 30 3 38 0 0 0 0 0 0 0 0 0 148 68 3 0 31.04 0 2 1 3400 >7 1 0 0 0 0 0 5 0 1 0 1 0 0
Inba 23 1 38 0 0 1 0 0 0 0 0 0 156 68 3 1 27.94 1 1 0 3260 >7 1 1 0 0 0 1 18 0 6 0 0 0 0
Dharshini 1 37 0 1 0 0 0 0 1 0 0 160 69 3 1 26.95 0 2 1 3400 >7 1 0 0 0 0 0 4 0 4 0 0 0 0
Karunya 27 1 40 0 0 0 1 0 0 0 0 0 149 58 3 1 26.12 1 1 0 2200 >7 1 0 1 0 0 1 34 0 2 0 0 0 0
Nivethitha 24 1 39 0 0 0 0 0 0 1 0 0 154 64 2 1 26.98 1 0 0 2340 <7 1 1 1 0 0 0 48 0 2 0 0 0 0
Thasayini 28 1 40 0 0 1 0 0 1 0 0 0 158 58 1 1 23.23 1 1 0 1780 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
REVATHY 27 2 41 1 1 0 0 1 0 1 0 0 158 59 1 1 23.63 1 2 1 3180 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
Vijaya 29 2 40 0 0 1 1 0 0 0 0 0 160 68 2 0 26.56 1 2 1 2600 >7 1 0 0 0 0 0 12 0 1 0 0 0 0
CHANDRA 24 21 1 41 1 0 0 0 0 0 0 0 0 148 58 1 0 26.47 1 2 1 2890 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Mithuna 1 40 0 0 0 0 0 0 0 0 0 153 64 1 0 27.33 1 2 1 2600 <7 1 0 1 0 0 0 14 0 7 0 0 0 0
mathavi 31 1 39 0 1 0 0 0 0 0 0 0 146 69 2 0 28.35 1 2 1 2560 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
Rishika 23 1 39 0 0 1 0 0 1 0 0 0 140 59 2 1 30.1 1 2 1 2100 >7 0 0 0 0 0 0 0 0 4 0 0 0 1
Selvi 30 1 41 1 0 0 0 0 1 0 0 0 156 69 1 0 28.35 1 2 1 2900 <7 1 0 0 0 0 1 6 0 3 0 0 0 0
Tara 28 1 41 1 1 0 0 0 0 0 0 1 160 72 1 0 28.125 0 0 0 3560 <7 1 1 1 0 0 1 32 0 1 0 0 0 0
Bhargavi 30 1 38 0 0 0 0 0 0 0 0 0 158 76 1 1 30.04 1 1 0 3020 >7 0 0 0 0 0 0 0 0 3 0 0 0 0
Latha 34 1 37 0 0 0 0 1 1 0 0 1 157 70 3 0 28.39 1 2 1 3080 <7 1 1 1 0 1 0 0 1 4 0 0 0 0
Vidhyasree 29 3 40 0 0 0 0 1 0 0 0 0 160 64 2 0 25 0 2 1 4800 <7 1 1 0 0 0 1 0 1 3 0 0 0 0
Gopika 22 2 39 0 0 0 0 0 0 0 0 0 154 64 1 0 26.98 0 2 1 3800 >7 1 0 0 1 0 1 0 1 4 0 0 0 0
Haritha 33 1 39 0 1 0 0 0 0 0 0 0 147 54 3 0 24.98 0 2 1 3410 <7 1 1 1 1 0 1 0 1 6 0 0 0 0
hasini 23 1 37 0 0 0 0 0 0 0 0 0 165 68 3 0 24.97 0 0 0 2260 <7 1 1 1 0 0 0 0 1 15 1 0 0 0
Anitha 26 1 40 0 1 0 0 0 0 0 0 0 156 58 2 0 23.83 0 0 0 1980 >7 1 1 0 1 0 0 0 1 5 0 0 0 0
Avanthika 23 1 37 0 0 1 1 0 1 0 0 0 148 58 2 1 26.47 0 2 1 1890 <7 1 1 0 0 0 1 6 0 6 0 0 0 0
Savathri 24 1 40 0 0 0 0 0 0 0 0 0 149 58 1 1 26.12 1 1 0 2200 >7 0 0 0 0 0 0 0 0 8 0 0 0 0
kannagi 34 1 40 0 0 0 0 0 0 0 1 1 154 56 1 1 23.61 1 0 0 2460 >7 0 0 0 0 0 0 0 0 13 0 0 0 0
Reshma 25 2 41 1 1 1 1 0 0 0 0 0 160 58 3 0 22.65 1 2 2 1890 >7 1 0 1 0 0 1 14 0 2 0 1 0 0
Lalitha 26 1 37 0 0 0 0 0 0 0 0 0 154 64 2 0 26.98 1 2 2 2160 >7 1 0 0 0 0 1 10 0 1 0 0 0 0
Roja 21 1 29 0 1 0 0 0 1 0 0 0 160 68 1 1 24.09 1 0 0 2590 <7 1 1 0 0 0 1 10 0 5 0 0 0 0
Rajammal 19 2 38 0 0 0 0 0 0 1 0 1 174 70 2 1 24.22 1 0 0 2910 <7 1 0 0 0 0 0 2 0 5 0 0 0 0
Rajamani 20 2 39 0 0 0 1 0 0 0 0 0 146 54 1 1 25.33 0 2 2 3100 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
silambarasi 36 2 40 0 0 0 0 1 0 0 1 0 156 58 2 0 23.83 0 2 2 2800 <7 1 1 0 0 0 0 1 0 15 0 0 0 0
ramadevi 20 1 41 1 0 0 0 0 0 0 0 0 160 60 1 0 23.43 0 2 2 2100 >7 0 0 0 0 0 0 0 0 5 0 0 0 0
Vaijeyanthi 32 1 42 0 0 0 0 0 0 1 0 0 141 68 1 1 33.25 1 2 2 3100 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
Sudha 26 2 38 0 0 0 0 0 0 0 0 0 145 70 1 1 33.39 1 1 0 2800 >7 1 0 0 0 0 1 8 0 14 0 0 0 0
Raghavi 24 1 39 0 1 0 0 0 0 0 1 0 156 66 2 0 27.12 0 2 2 2870 <7 1 0 0 0 0 1 12 0 3 0 0 0 0
Ranjini 28 1 39 0 0 0 0 1 0 0 0 0 158 76 3 1 30.44 0 0 0 2680 >7 0 0 0 0 0 0 0 0 6 0 0 0 0
anandi 23 2 37 0 0 1 1 0 0 0 0 1 150 78 2 1 31.24 0 0 0 2100 <7 1 0 0 0 0 0 0 0 8 0 0 0 1
ramya 32 2 38 1 0 0 0 0 0 0 0 0 164 66 1 1 24.53 0 2 2 2890 <7 1 0 1 0 0 1 23 0 6 0 0 0 0
Varalakshmi 1 37 0 1 0 0 0 0 1 0 0 160 69 3 1 26.95 0 2 1 3400 >7 1 0 0 0 0 0 4 0 4 0 0 0 0
Poornima 27 1 40 0 0 0 1 0 0 0 0 0 149 58 3 1 26.12 1 1 0 2200 >7 1 0 1 0 0 1 34 0 2 0 0 0 0
Lekhasree 24 1 39 0 0 0 0 0 0 1 0 0 154 64 2 1 26.98 1 0 0 2340 <7 1 1 1 0 0 0 48 0 2 0 0 0 0
JENIFER 28 1 40 0 0 1 0 0 1 0 0 0 158 58 1 1 23.23 1 1 0 1780 >7 0 0 0 0 0 0 0 0 2 0 0 0 0
