OUTCOMES OF TERM NEONATES WITH MECONIUM-STAINED AMNIOTIC FLUID

Abstract

Background: Meconium-stained amniotic fluid (MSAF) is a common complication in term pregnancies, occurring in approximately 5-20% of deliveries and often indicating fetal distress. While MSAF can lead to serious neonatal complications, including respiratory distress syndrome (RDS), hypoxic ischemic encephalopathy (HIE), and sepsis, not all cases of MSAF result in adverse outcomes. Identifying factors associated with MSAF is essential to enhance clinical management and improve neonatal outcomes.

Objectives: The primary objective was to determine the frequency of complications associated with MSAF in term neonates. The second objective was to assess the risk of maternal, neonatal, and gestational factors associated with the occurrence of MSAF in term neonates.

Methods: This case-control study was conducted in the Department of Pediatrics, Combined Military Hospital, Kharian, from October 2022 to September 2023. A total of 100 term neonates (50 with MSAF and 50 without) were enrolled. Neonates born between 37 and 42 weeks who experienced a trial of labor were included, while those delivered by elective cesarean section, with major congenital anomalies, or hemorrhagic amniotic fluid were excluded. Data on maternal, neonatal, and gestational characteristics were collected. All neonates were monitored for one month post-birth for any adverse outcomes in both inpatient and outpatient settings.

Results: Complications among neonates with MSAF included HIE in 3 (6.0%), RDS in 6 (12.0%), pneumothorax in 1 (2.0%), persistent pulmonary hypertension in 2 (4.0%), and sepsis in 12 (24.0%). Significant risk factors for MSAF included prolonged active labor over 6 hours (adjusted odds ratio [aOR]: 2.84, 95% confidence interval [CI]: 1.08–7.45, p=0.034), induction of labor (aOR: 4.65, 95% CI: 1.55–13.95, p=0.006), and gestational age at birth greater than 39 weeks (aOR: 4.01, 95% CI: 1.47–10.97, p=0.007).

Conclusion: MSAF is associated with significant neonatal complications, highlighting the need for careful management of risk factors such as prolonged labor, labor induction, and advanced gestational age to reduce the incidence and impact of MSAF.