The presence of a pelvic mass is a common clinical problem. Meconium passage into the amniotic fluid may be an antepartum or intrapartum event. The recent NICE guidelines suggest that the presence or absence of meconium should be documented. hypoxia and metabolic acidosis) causes added damage to the lungs and therefore further complicates the management of MAS. Meconium Stained Amniotic Fluid listed as MSAF. It is unclear how great this risk is or whether preterm MSAF is a risk factor for adverse neonatal outcome. Eur J Obstet Gynecol Reprod Biol 1998; 80 (2) 169-173 It describes the spectrum of disorders and pathophysiology of newborns born in meconium-stained amniotic fluid (MSAF) and have meconium within their lungs. Fetal infection is also associated with the passage of meconium. Therefore, in this study, we aimed to determine whether meconium-stained amniotic fluid (MSAF) represents a risk factor for postpartum hemorrhage (PPH) after vaginal delivery in a large unselected population. Out of the infants born through MSAF, 10% to 20% are nonvigorous and 3% to 5% develop meconium aspiration syndrome (MAS). The very first stool produced by a newborn infant is a dark green, sticky, tar-like substance called meconium. Women are offered comprehensive antenatal care screening for a range of pregnancy complications, including pre-eclampsia and gestational diabetes with the aim of early disease detection and management. It is Meconium Stained Amniotic Fluid. Passage of meconium in the preterm fetus should raise the possibility of intrauterine infection such as listeriosis. Fetal gastrointestinal maturation is probably responsible for meconium release in post-term pregnancies as the innervation of the anal sphincter is complete by the 34th week. 239-246, Obstetrics, Gynaecology & Reproductive Medicine, Volume 28, Issues 11–12, 2018, pp. Some post-dates pregnancies (when they are more than 40 weeks pregnant) may also have meconium-stained liquor without fetal distress. One is a function of fetal maturity, but it may also indicate possible fetal compromise. In oncology, new tools for population screening for ovarian cancer are being sought via prospective samples stored in biobanks. Meconium‐stained amniotic fluid is known to be associated with increased fetal and maternal risks, especially when fetal exposure has been extended and the fluid is concentrated. J Matern Fetal Neonatal Med 2011; 24 (7) 880-885 ; 5 Maymon E, Chaim W, Furman B, Ghezzi F, Shoham Vardi I, Mazor M. Meconium stained amniotic fluid in very low risk pregnancies at term gestation. Routine suctioning of the upper airway is not therefore recommended, for neonates born with clear or MSAF. A large RCT of 2514 neonates born through meconium stained amniotic fluid, compared intrapartum suctioning (before delivery of shoulders) with suctioning only after delivery and concluded that there is no significant difference in the incidence of MAS (5% in the suction group vs 4% in the non-suction group), mechanical ventilation, duration of ventilation and mortality rates. Keywords: MSAF-Meconium stained amniotic fluid, MAS-Meconium aspiration syndrome. Meconium-stained amniotic fluid is often caused by fetal hypoxia or other physiologic stress. 1 Although 75% of meconium is water, the remaining 25% consists of gastric secretions, bile salts, mucus, vernix, lanugo, blood, pancreatic enzymes, free fatty acids and squamous cells. Background/aim: Clinical data with respect to the impact of meconium on the risk of maternal hemorrhage are scarce. Family history information may indicate who should be assessed for cancer predisposition syndromes, but individual clinical and tumour characteristics are equally important to consider. MAS may occur if the … Sasikala A(1), Raghavan S, Mishra N, Khatoon S, Bupathy A, Rani R. Author information: (1)Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry. Meconium aspiration syndrome (MAS) is defined as respiratory distress in newborn infants born through meconium-stained amniotic fluid (MSAF) whose symptoms cannot be otherwise explained. Therefore, MAS has a wide range of severity depending on what conditions and complications … Recent reductions in prevalence are associated secondary to fewer prolonged pregnancies because of guidance recommending induction of labour at 41 completed weeks as well as improvements in fetal heart rate monitoring and abnormal pattern recognition. Ergonomics are important for the surgeon and will also help in the prevention of complications. We use cookies to help provide and enhance our service and tailor content and ads. With the advances in molecular medicine in recent years, novel biomarkers are being developed that have the potential to accurately predict these diseases long before their clinical onset. There is strong suggestive evidence that prevention of meconium aspiration, Aggressive tracheal toilet at delivery helps to reduce the load but will not significantly impact on cases with pre-existing in utero aspiration. The appearance of meconium-stained liquor during labour is generally considered to be a sign of hypoxia and a predictor of poor fetal outcome. A pregnancy that goes beyond full term, in excess of 40 weeks, Extended and/or difficult, demanding labor, High blood pressure (hypertension) or diabetes in the mother, The baby’s skin is discolored, either blue or green, Breathing complications such as tachypnea (hurried breathing), apnea (suspended or interrupted breathing), or difficulty breathing, The baby is exhibiting signs of post maturity, like long nails. Exposure to the surgical field is essential, and correct positioning of the patient will allow saver surgery. Provide clinical handover to the Neonatal team on arrival to the birth room. Genomic analysis of tumours will increasingly be exploited to enable more accurate diagnosis, prognosis and targeted therapies with improved patient outcomes. νά, Concussion in Children: Signs and Management Tips, 12 Best Foods for Teenagers to Grow Height, Chronic Cough in Children: Causes & Treatments. Studies conducted in various. Meconium-stained amniotic fluid (MSAF) is a major perinatal clinical concern, which occurs in 8% to 15% of all deliveries. Sometimes, however, a baby has a bowel movement before or during birth. Fetal plasma levels of corticotrophin release factor hormone (CRF) and cortisol are increased after 36–37 weeks and especially after the onset of labour, as a response to fetal stress. The frequency of meconium-stained amniotic fluid increases as a function of the duration of labor. A combination of findings from the clinical history, examination and results of various investigations can help to determine the character and origin of the mass, determine risk of malignancy and guide management strategies. Overall rates are on a decline in recent years, as post-term pregnancies are reduced by induction at 41 weeks and advances have been made by early intervention with an abnormal fetal heart rate. Stress urinary incontinence is a common problem with 13.6% of women requiring surgery for it in their lifetime. However, challenges in implementing new screening will include cost efficacy and ethical considerations such as informed consent. The combination of increasing numbers of patients with significant co morbidities associated with a move to office gynaecology leading to a decline in the number of major gynaecological procedures means there is a tendency for trainees and consultants to perceive perioperative care as complex and better left to intensivists and physicians. The use of midurethral tapes is currently suspended due to concerns with chronic pelvic and vaginal pain. Identifying inherited mutations in cancer predisposition genes or somatic genetic variants within cancers has important implications for treatment decisions. Fetal defaecation is believed to be a normal process, as studies that have assessed the diameter and function of the fetal anus sonographically over the course of pregnancy have reported at least one episode of defaecation in all fetuses and that this is independent of labour. Or as Qadir et al. 236-238, Obstetrics, Gynaecology & Reproductive Medicine, Volume 26, Issue 8, 2016, pp. The baby has passed meconium (stool) into the amniotic fluid during labor or delivery. MECONIUM STAINED AMNIOTIC FLUID 2. Perinatal outcome in relation to mode of delivery in meconium stained amniotic fluid. The proposed mechanisms are (i) dilution of thick meconium, reducing its inflammatory and mechanical effects on the respiratory system of the new born, and (ii) cushioning of the umbilical cord, which reduces cord compression and subsequent hypoxia. (2016) suggests between 1 to 18%. 86-89, of the fetus and stimulate the fetus to pass meconium. Aggressive, and this is precipitated by gasping of the fetus as a result of hypoxia. Identifying people with an increased risk of developing cancer allows prophylactic surgery or screening to be offered, to try to reduce the chance of cancer developing or to detect it earlier. hypoxia and metabolic acidosis) causes added damage to the lungs and therefore further complicates the management of MAS. But is this always true? Meconium aspiration can happen in utero and this is precipitated by gasping of the fetus as a result of hypoxia. Risk factors for meconium release include the onset of labour, prelabour rupture of membranes and. prevention of infection, morbidity, and mortality among infants born through MSAF who have signs and symptoms compatible with meconium aspiration syndrome (MAS). MSAF - Meconium Stained Amniotic Fluid. Several studies suggest that the presence of labour significantly increases the incidence of MSAF. 1, 2 Modern obstetric practices, such as the avoidance of postmaturity, may have for the most part contributed to the reduction in the incidence of … Dr. Niranjan Chavan MD, FCPS, DGO, DFP, MICOG, DICOG, FICOG Professor and Unit Chief, L.T.M.M.C & L.T.M.G.H Chairperson, FOGSI Oncology and TT Committee (2012-2014) Treasurer, MOGS (2017- 2018) Chair and Convener, FOGSI Cell- Violence against Doctors (2015-2016) Chief … Meconium aspiration syndrome (MAS) refers to breathing problems that a newborn baby may have when: There are no other causes, and. Background: The incidence of preterm meconium staining of the amniotic fluid (MSAF) is uncertain. Likewise, non-invasive testing in fetal medicine for a variety of genetic conditions may supersede traditional first trimester screening. Meconium Stained Amniotic Fluid Page 1 of 4 Obstetrics & Gynaecology The midwife will: Notify the neonatal RMO and Registrar of the upcoming birth and relevant antenatal and intrapartum factors. It can therefore be a marker of maturation of the central nervous system and the gastrointestinal system. It can therefore be a marker of maturation of the central nervous system and the, . By continuing you agree to the use of cookies. However, sometimes a baby will have a bowel movement prior to birth, excreting the meconium into the amniotic fluid. Continuous monitoring and facilities for neonatal resuscitation have been recommended. MSAF is rare earlier than 34 weeks' gestation. Meconium aspiration syndrome (MAS) also known as neonatal aspiration of meconium is a medical condition affecting newborn infants. Typically this substance is not released in your baby's bowel movements until after birth. Selected primary and secondary sources are referenced in a summary that examines the implications and management of meconium‐stained amniotic fluid for the newborn. Resuscitation should follow the same principles for infants with meconium-stained fluid as for those with clear fluid. Tracking serial measurements from each patient may optimise the current use of CA125 rather than using predetermined thresholds. The objective of this article is to provide background on preventing, recognizing and treating complications of benign (non-endoscopic) gynaecological surgery. Therefore, this study was aimed to determine the Meconium stained amniotic fluid (MSAF) is an alarming sign of fetal compromise and associated with a poor perinatal outcome. It is also associated with prolonged or obstructed labour. Meconium-stained amniotic fluid is commonly found in obstetrics: it occurs in 9-20% of deliveries. Asphyxia (i.e. Traditionally meconium has been viewed as a harbinger of impending or ongoing fetal compromise; however some investigators believe that it is not associated with Introduction Meconium is found in fetal gut from 10 wks of gestation but passage of meconium in amniotic fluid is rare before 34 weeks. Meconium release, either in the antenatal or intrapartum period, is common in term gestations, and is related either to fetal maturity or hypoxia. In post-term pregnancies it is much more common as studies show rates as high as 23–52% in pregnancies at 42 weeks and 27.1% in pregnancies at 41 weeks' gestation. Traditionally, three grades of meconium are described: Grade 1 meconium (light) is diluted by a large volume of amniotic fluid which is lightly stained by meconium, Grade 2 (moderate) meconium is a reasonable amount of amniotic fluid with a heavy suspension of meconium and Grade 3 meconium (thick meconium) is in little amniotic fluid suggesting the presence of meconium in scanty amounts of … 1 Meconium staining of the amniotic fluid occurs in approximately 12% of pregnancies. Dana Brabbing-Goldstein, Dan Nir, Deborah Cohen, Ariel Many, Sharon Maslovitz, Preterm meconium-stained amniotic fluid is an ominous sign for the development of chorioamnionitis and for in utero cord compression , The Journal of Maternal-Fetal & Neonatal Medicine, 10.1080/14767058.2016.1236246, 30, 17, (2042-2045), (2017). This problem-based review presents three case histories that illustrate some of the key principles in the management of a pelvic mass. Hence the presence of thick meconium needs increased vigilance with continuous electronic fetal monitoring and a lower threshold for action with CTG abnormalities. If this happens, the amniotic fluid released when the mother's bag of water breaks will have a greenish tint. MECONIUM STAINED AMNIOTIC FLUID 1. 347-352, Obstetrics, Gynaecology & Reproductive Medicine, Volume 29, Issue 3, 2019, pp. CRF is believed to be, Instillation of 500–800 ml of warm saline into the amniotic cavity and a continuous infusion of up to 1500 ml, via a trans-cervical catheter, has been proposed as a method of reducing adverse outcomes secondary to MSAF. Any reflexive "gasping" of the unborn fetus, due to hypoxia, can depress the fetal diaphragm mechanically, squeezing the contents of the bowels into the amniotic fluid. Although fetuses do not normally draw amniotic fluid into the airway, they gasp when hypoxic and therefore the coexistence of hypoxia and acidosis may precipitate meconium aspiration. Induction at 41 completed weeks is associated with a significant reduction in MAS (RR 0.43, 95% CI 0.23–0.79) and related perinatal deaths (RR 0.31, 95% CI 0.11–0.88). 2015). The incidence of meconium staining of the liquor increases from 36 to 42 weeks gestation, reaching around 20–30% at full term. Technological advances have expanded the availability of genetic analysis, which is now becoming mainstreamed into cancer diagnostic pathways. It has a dark green colour, high viscosity and accumulates in the fetal intestinal tract during the 3rd trimester of pregnancy, being the first intestinal discharge released within 48 hours after birth. A study of induction of labour at term with different prostaglandins. Surgical treatments either create suburethral support or augment urethral closure. These patients also had hyperstimulation and oxytocin augmentation pre-operatively and meconium staining of liquor was invariably observed in all cases. The cases, which include a leiomyosarcoma, an adnexal mass in pregnancy, and a tubo-ovarian abscess, describe commonly encountered clinical scenarios with an evidence-based approach to subsequent management. The importance of understating the design of surgical instruments in highlighted. Screening in reproductive healthcare in the UK has expanded rapidly since the introduction of cervical screening by the NHS in 1981. Meconium Stained Amniotic Fluid. Before or at birth, the doctor will likely notice one or more symptoms of MAS, including: 1. There are few reasons why meconium is passed by the fetus in utero. Meconium is made up of mucus, bile, epithelial cells, water, and other materials consumed by the infant during its time in the womb. meconium stained amniotic fluid were well studied in the developed countries, there is a paucity of locally generated evidence on the magnitude and associated factors of MSAF to design appropriate prevention strategies in the study area. Meconium-stained amniotic fluid has been associated with poor perinatal outcomes, including low Apgar scores, meconium aspiration syndrome, increased rates of chorioamnionitis, increased incidence of neonatal intensive care admissions, and higher rates of perinatal death. Meconium is comprised of gastrointestinal secretions, bile, mucus, vernix caseosa, lanugo hair, cellular debris and amniotic fluid. With a breech presentation in the late first or second stage the passage of meconium is likely to be due to mechanical causes and therefore less sinister than a cephalic presentation, or when it occurs in an early breech labour with a high presenting part. The significance of meconium varies with presentation. MAS is defined as respiratory distress in an infant born through MSAF whose symptoms cannot be otherwise explained. When instruments are used in their intended way, iatrogenic complications can be prevented. Discharge from Baby’s Belly Button, What Does It Mean? Objectives: We conducted this review to assess the efficacy and safety of antibiotics for:1. prevention of infection, morbidity, and mortality among infants born through meconium-stained amniotic fluid (MSAF) who are asymptomatic at birth; and2. The stained amniotic fluid (called "meconium liquor" or "meconium-stained liquor") is recognized by medical staff as a possible sign of fetal distress. Perinatal outcome in meconium stained amniotic fluid. Statistics for the presence of meconium-stained amniotic fluid vary greatly between 5% to 25% (Hirani et al. Approximately 13% of all live births are complicated by meconium stained amniotic fluid (MSAF). Nothing could be further from the truth and this article seeks to demystify many aspects of perioperative care and demonstrate that high quality care, delivered by the host surgical team will lead to the best outcomes for patients. Meconium staining of the amniotic fluid (MSAF) is found in approximately 15% of pregnancies. Hence the presence of thick meconium needs increased vigilance with continuous, Avoiding and managing complications in gynaecological surgery, Surgical treatment of stress urinary incontinence in women, The principles of screening tests as applied to obstetrics and gynaecology, Modern considerations in perioperative care in gynaecology, Genetic testing for cancer risk in women's health. These developments highlight the move towards more personalised medicine. Perioperative care is a critical but sometimes overlooked part of any surgical discipline. Intrauterine growth restriction is also a risk factor for MSAF, as higher rates have been reported in such populations of neonates. PGs can increase the intestinal motility of the fetus and stimulate the fetus to pass meconium. Up to one in every five babies born after 34 weeks' gestation has meconium in the amniotic fluid… Meconium Stained Amniotic Fluid - How is Meconium Stained Amniotic Fluid abbreviated? Management of Infants Born through Meconium Stained Amniotic Fluid BACKGROUND: In 10-20% of deliveries, there is meconium in the amniotic fluid. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Obstetrics, Gynaecology & Reproductive Medicine, https://doi.org/10.1016/j.ogrm.2016.05.001. Fetal infection is also associated with the passage of meconium. Meconium stained liquor and its neonatal outcome. © 2016 Elsevier Ltd. All rights reserved. A retrospective study by Lee et al., reported a rate of 2.8% before the onset of labour and 23.1% after the onset of labour. MAS can present with varying degrees of severity from mild respiratory distress to life-threatening respiratory failure. Meconium is a thick, green, tar-like substance that lines your baby's intestines during pregnancy. Although fetuses do not normally draw, (i.e. Passage of meconium in the preterm fetus should raise the possibility of, or after birth. Antenatal or intrapartum meconium release is referred to as meconium staining of amniotic fluid (MSAF) and it has been estimated to occur in approximately 13% of all live births with rates reported between 8 and 20%. Colposuspensions and autologous rectus fascial slings are effective first-line surgical options. The amniotic fluid will keep any meconium diluted and provide plenty of cushioning to protect against compression of the cord. Looking for abbreviations of MSAF? The incidence of meconium staining of the liquor increases from 36 to 42 weeks gestation, reaching around 20–30% at full term. Other reasons include the use of misoprostol, a prostaglandin (PG E1) given for induction of labour. If no amniotic fluid is obtained at artificial rupture of membranes, one should consider the possibility of Grade 3 meconium behind the fetus and the fetal condition should be observed closely. In addition, meconium-stained amniotic fluid is a condition that requires the notification and availability of an appropriately credentialed team (Neonatal Advanced Life Support) with full resuscitation skills, including endotracheal intubation 2. The prevention of vaginal vault haematoma, wound infection and uterine perforation will be discussed in more detail. Discuss with your care provider the type of meconium present, in consideration of your gestational dates, and any signs of fetal distress, so you can make an informed decision about necessary monitoring and interventions. Traditionally, three grades of meconium are described: Grade 1 meconium (light) is diluted by a large volume of amniotic fluid which is lightly stained by meconium, Grade 2 (moderate) meconium is a reasonable amount of amniotic fluid with a heavy suspension of meconium and Grade 3 meconium (thick meconium) is in little amniotic fluid suggesting the presence of meconium in scanty amounts of amniotic fluid. 70-73, Obstetrics, Gynaecology & Reproductive Medicine, Volume 29, Issue 3, 2019, pp. Labour is generally considered to be a sign of hypoxia continuous electronic fetal monitoring and facilities neonatal... Cancers has important implications for treatment decisions distress to life-threatening respiratory failure cases pre-existing! A pelvic mass is a thick, green, tar-like substance that lines your baby intestines... Are effective first-line surgical options substance is not therefore recommended, for neonates born with clear or MSAF:! Every five babies born after 34 weeks a newborn infant is a perinatal. And enhance our service and tailor content and ads it can therefore be a sign of.! To 25 % ( Hirani et al spectrum of disorders and pathophysiology of newborns born in meconium-stained fluid. The liquor increases from 36 to 42 weeks gestation, reaching around 20–30 at. Tracheal toilet at delivery helps to reduce the load but will not impact!: it occurs in approximately 15 % of deliveries - a cross sectional study in a rural.! Maturation of the fetus in utero some post-dates pregnancies ( when they are more 40. Mas is defined as dark green, tar-like substance that lines your baby 's during. Can present with varying degrees of severity from mild respiratory distress in an born. Surgeon and will also help in the prevention of vaginal vault haematoma, wound infection uterine... The management of infants born through meconium stained amniotic fluid ( MSAF is... Background: the significance of meconium in the prevention of vaginal vault haematoma, infection. Handover to the surgical field is essential, and poor neonatal outcomes is greater when there is meconium! And stimulate the fetus as a result of hypoxia is currently suspended due to with. Therefore recommended, for neonates born with clear fluid in all cases: //doi.org/10.1016/j.ogrm.2016.05.001,... Between 5 % to 15 % of deliveries Button, What Does it Mean MSAF as! Distress in an infant born through meconium stained amniotic fluid vary greatly 5... Caseosa, lanugo hair, cellular debris and amniotic fluid 1 and the.... Msaf, as higher rates have been reported in such populations of neonates licensors or contributors sought via prospective stored., cellular debris and amniotic fluid is a function of the upper airway is not therefore recommended for. Tenacious or gelatinous type of meconium staining of the fetus as a result of hypoxia fluid released when mother! 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( i.e fluid is commonly found in approximately 15 % of pregnancies in Reproductive healthcare in amniotic! The UK has expanded rapidly since the introduction of cervical screening by the fetus in utero or after.. In all cases review presents three case histories that illustrate some of fetus! Perinatal clinical concern, which is now becoming mainstreamed into cancer diagnostic pathways debated subject Does it?. Fetus as a function of fetal maturity, but it may also have meconium-stained liquor during labour is generally to! A dark green or black fluid with thick clumps of meconium in amniotic (..., vernix caseosa, lanugo hair, cellular debris and amniotic fluid for the meconium-stained amniotic fluid! Or delivery a result of hypoxia substance is not released in your baby bowel... Analysis, which is now becoming mainstreamed into cancer diagnostic pathways the of! As 14 16 weeks ' gestation has meconium in the amniotic fluid may be an antepartum intrapartum... The UK has expanded rapidly since the introduction of cervical screening by the fetus in utero and this precipitated... As informed consent the move towards more personalised Medicine keywords: MSAF-Meconium stained amniotic is! In utero or after birth passed by the NHS in 1981 not be otherwise explained be to. Patient outcomes ( MSAF ) oxytocin augmentation pre-operatively and meconium staining of the patient will allow surgery! Facilities for neonatal resuscitation have been recommended UK has expanded rapidly since the of. Therefore recommended, for neonates born with clear fluid, prognosis and targeted therapies with improved patient outcomes UK expanded... Use of midurethral tapes is currently suspended due to concerns with chronic pelvic vaginal. Increased vigilance with continuous electronic fetal monitoring and a lower threshold for action with abnormalities. May be an antepartum or intrapartum event are referenced in a rural setup, can be aspirated in.... 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Fetus to pass meconium efficacy and ethical considerations such as informed consent we use cookies to help and! Suggest that the presence of a pelvic mass for it in their intended way, iatrogenic complications can be in... The possibility of intrauterine infection such as informed consent been recommended reasons why meconium is function... The possibility of, or after birth but it may also have meconium-stained liquor without fetal distress in populations! Precipitated by gasping of the fetus in utero births are not frequently associated with the passage meconium! The implications and management of a pelvic mass is a major perinatal clinical concern, which is becoming! Pass meconium is often caused by fetal hypoxia or other physiologic stress introduction meconium passed... New screening will include cost efficacy and ethical considerations such as listeriosis during labor delivery... Reproductive healthcare in the preterm fetus should raise the possibility of, or after birth pass.. Suggest that the presence of thick meconium stained amniotic fluid is a risk factor for MSAF, higher... The importance of understating the design of surgical instruments in highlighted gestation has meconium in amniotic (... By fetal hypoxia or other physiologic stress normally draw, ( i.e problem-based. Genomic analysis of tumours will increasingly be exploited to enable more accurate diagnosis prognosis... Routine suctioning of the amniotic fluid… meconium stained amniotic fluid is often caused by fetal hypoxia or other physiologic.... As respiratory distress that, in severe cases, can be life threatening is to provide background preventing... As early as 14 16 weeks ' gestation movement before or during.! Concerns with chronic pelvic and vaginal pain several studies suggest that the presence of meconium! Increases from 36 to 42 weeks gestation, reaching around 20–30 % at term.

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