Meconium staining of amniotic fluid in labour: experience from a low resource setting

Abstract

Objective: To determine the incidence and clinical significance of meconium stained amniotic fluid (MSAF) at onset of labour and to investigate whether MSAF could predict intrapartum and perinatal morbidity.
Method: This prospective observational study was conducted over a 5-month period amongst a low risk population with pregnant women admitted for delivery at term. Two groups of 89 patients and 424 patients, were identified according to the presence or absence respectively, of meconium in the amniotic fluid (at admission into labour), and the outcomes of the two groups were compared.
Results: Eighty-nine out of the 513 cohort of parturients studiedhad MSAF giving a prevalence of 17.3%. Age and parity did not influence presence of MSAF. The mean gestational age at delivery and birth weight were significantly higher for parturients with MSAF(39.6 weeks vs 38.9; P= 0.0001 and 3.5kg vs 3.2; P=0.0001). There was no difference in labour duration but Caesarean delivery was twice more likely with MSAF (20.2% vs 9.2, P=0.003). Similarly, suspicious/abnormal fetal heart patterns on CTG were observed more in those with MSAF(9/89 vs 15/424) and they also had more need for resuscitation (16.9% vs 8.7, OR 10.75, 95% CI 4.81 – 24.37; P=0.001), especially when it was thick meconium(TMS). However, there was no statistical difference in the Apgar scores at 1 minute and no observed difference with fetal gender, SCBU admission or early neonatal death.
Conclusion: MSAF may predict adverse labour outcome. In settings with deficientintrapartum monitoring facilities, the presence of meconium stained liquor, particularly with thick meconium, should attract high level intrapartum vigilance and incisive neonatal resuscitation.

Keywords: Meconium-stained amniotic fluid, intrapartum care, perinatal outcome