English

Abstract

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. KEYWORDS Risk Factors, Meconium, Amniotic Fluid, Term Pregnancy, Caesarean Section, Perinatal Outcome