Asha P.S.1, Sujatha T.L.2
BACKGROUND
Meconium stained amniotic fluid is a significant contributor to perinatal and
neonatal morbidity and mortality. The study was conducted to determine the risk
factors of meconium stained amniotic fluid in term pregnancy.
METHODS
This study is a prospective case control study done in a tertiary care hospital in
South India over a period of one year. 100 women with meconium stained amniotic
fluid detected at any time during the course of labour, prior to it or meconium
detected in hind waters were enrolled in the study group. The inclusion criteria
were term pregnancy, cephalic presentation and singleton pregnancy. 200 women
who satisfied the same set of inclusion criteria with clear amniotic fluid, selected
on random basis were taken as controls. A standardised pretested proforma was
used for data collection.
RESULTS
In the study, incidence of grade 1, grade 2 and grade 3 meconium were 31 %, 42
% and 27 % respectively. 83 % of cases were in the 20 – 24 year age group and
advanced maternal age was not a risk factor in the study. Primiparity (86 % cases
vs. 47 % controls) and advanced gestational age (56 % cases and 33 % controls)
were significant risk factors. Maternal obesity, socioeconomic status and treatment
for infertility were not significant risk factors. Among medical disorders, gestational
diabetes mellitus (21 % cases vs. 5 % controls), gestational hypertension (12 %
vs. 3.5 %) and hypothyroidism (13 % cases vs. 4.5 % controls) showed statistical
significance. Oligoamnios (9 % vs. 1 %), fetal growth restriction (13 % vs. 4.5 %)
and maternal infection (12 % vs. 2 %) were significant risk factors. Induced labour
and prolonged labour were the significant intrapartum risk factors. Caesarean
section rates were nearly doubled in cases (40 %) compared to controls (21.5 %).
Babies born to mothers with meconium stained amniotic fluid had low Apgar scores
at birth (25 %) and increased neonatal intensive care unit (NICU) admission.
CONCLUSIONS
Meconium stained amniotic fluid is associated with increased rates of maternal
morbidity due to higher rates of operative deliveries and increased incidence of
perinatal asphyxia, perinatal morbidity and mortality. Meticulous antenatal care
and early identification of risk factors help in reducing the incidence of meconium
stained amniotic fluid and preventing adverse maternal and neonatal outcome.
