4.8.4  Amniotic fluid as an indicator of fetal distress

Another indicator of fetal distress which has already been mentioned is meconium-stained amniotic fluid (greenish or blackish liquor). Lightly stained amniotic fluid may not necessarily indicate fetal distress, unless it is accompanied by persistent fetal heart rate deviations outside the normal range. The following observations are made at each vaginal examination and recorded on the partograph, immediately below the fetal heart rate recordings.

If the fetal membranes are intact, write the letter ‘I’ (for ‘intact’).

If the membranes are ruptured and:

  • liquor is absent, write ‘A’ (for ‘absent’)
  • liquor is clear, write ‘C’ (for ‘clear’)
  • liquor is blood-stained, record ‘B’
  • liquor is meconium-stained, record ‘M1’ for lightly stained, ‘M2’ for a little bit thick and ‘M3’ for very thick liquor which is like soup (see Box 4.2).

Box 4.2  Extent of meconium staining

Important! Refer the woman in labour to a higher health facility as early as possible if you see:

  • M1 liquor in latent first stage of labour, even with normal fetal heart rate.
  • M2 liquor in early active first stage of labour, even with normal fetal heart rate.
  • M3 liquor in any stage of labour, unless progressing fast.

4.8.3  Recording fetal heart rate on the partograph

4.9  Assessment of maternal wellbeing