Meconium below the vocal cords at delivery: correlation with intrapartum events

Intrapartum events were studied in 272 patients with meconium-stained amniotic fluid. All infants underwent DeLee suction followed by intubation and 58 of 272 had meconium present below the vocal cords at delivery. Neither the total duration of variable fetal heart rate decelerations or a continuous saltatory pattern nor the presence or absence of late decelerations could be related to an increased risk of meconium below the vocal cords. When a rising baseline fetal heart rate and decreased variability were present as well, a significantly greater proportion of patients had meconium below the vocal cords. Routine obstetric and pediatric suctioning did not prevent the single death that occurred in a fetus who had deep meconium aspiration in utero.