Maternal Risk Factors and The Perinatal Outcome in Meconium-Stained Amniotic Fluid

Jyoti Sharma, Preeti Saini, Khushboo Kumari, Komal Tiwari, Kavita Chandnani, Lata Mehta
Author(s)
1Senior Resident, Department of Obstetrics and Gynaecology, S.N. Medical College (Umaid Hospital), Jodhpur, Rajasthan, India. 2Senior Resident, Department of Obstetrics and Gynaecology, RUHS College of Medical Sciences and Hospital, Jaipur, Rajasthan, India. 3Senior Resident, Department of Obstetrics and Gynaecology, Ananta Institute of Medical Sciences & Research Centre, Rajsamand, Rajasthan, India. 4Senior Resident, Department of Obstetrics and Gynaecology, Vyas Medical College and Hospital, Jodhpur, Rajasthan, India. 5Professor, Department of Obstetrics and Gynaecology, Ananta Institute of Medical Sciences & Research Centre, Rajsamand, Rajasthan, India.

Abstract

Background: Meconium-stained amniotic fluid (MSAF) is a frequent intrapartum observation, and is an important sign of potential fetal compromise. While meconium passage could be a physiological process of gastrointestinal maturation in term pregnancy, it is also linked to hypoxia, higher rates of operative delivery and poor neonatal outcomes. The current study aimed to determine the maternal risk factors for MSAF and to examine the perinatal outcome of pregnancies associated with MSAF. Material and Methods: This is a prospective observational study done in the Department of Obstetrics and Gynecology, Ananta Institute of Medical Sciences, Rajsamand, Rajasthan over a period of 18 months. 100 singleton term pregnancies ≥37 weeks with MSAF were recruited. Meconium was clinically graded as “thin” or “thick” on the basis of its color and consistency. Maternal demographic characteristics, antenatal and intrapartum risk factors, fetal heart rate monitoring, mode of delivery, APGAR scores, neonatal morbidity, NICU admission, and perinatal mortality were recorded. Data were analyzed using IBM SPSS Statistics version 25.0 and Microsoft Excel 2018 and p-values of <0.05 were deemed statistically significant. Results: Of the 100 cases, 66% were thin MSAF and 34% thick MSAF. The majority of women were in the 21-25 years age group (50%), primigravidae (53%) and delivered within 37-39 weeks of gestation (68%). The most common maternal risk factors were pregnancy-induced hypertension (8%) and hypothyroidism (6%). Non-reactive non-stress test results were significantly associated with the use of thick MSAF (p=0.020), cesarean section (p=0.030), lower APGAR scores (p<0.05), higher neonatal morbidity (64.7% vs. 16.7%) and greater NICU admission, as well as two early neonatal deaths caused by meconium aspiration syndrome. Conclusion: Thick meconium stained amniotic fluid is correlated with much poorer perinatal outcomes than thin meconium. To minimize neonatal morbidity and mortality related to MSAF, prompt recognition of maternal risk factors, careful intrapartum fetal monitoring, timely obstetric intervention, and appropriate neonatal resuscitation are key.

Keywords: Meconium-stained amniotic fluid, maternal risk factors, perinatal outcome, Meconium aspiration syndrome, Neonatal morbidity.

Outline