Troubled Waters: The Hidden Risks of Meconium-Stained Liquor

Authors

  • Soniya Rasheed A
  • Vargheese Yohannan
  • Lillykutty Antony
  • Malik Al Natour
  • Thilagavathi Krishnaswami
  • Babli Shama

DOI:

https://doi.org/10.52783/jns.v14.2480

Keywords:

Meconium-stained Amniotic fluid (MSAF), Meconium aspiration syndrome, Caesarean rates, Neonatal outcome

Abstract

Background: Meconium is a dark green substance made up of shed cells, mucus, and bile that usually accumulates in the fetal intestines and is expelled after birth. When meconium is present in the amniotic fluid, it is often regarded as an indicator of fetal distress, which can be associated with negative perinatal outcomes. This study aimed to investigate the different grades of meconium-stained amniotic fluid and their effects on immediate maternal and neonatal outcomes.

Methods: This prospective observational study was conducted from May 2023 to June 2024 at Karuna Hospital, Sendhwa, Madhya Pradesh. The study included 54 women with singleton pregnancies of gestational age ≥35 weeks presenting with meconium-stained amniotic fluid during labour. Continuous fetal monitoring using cardiotocography was performed. Maternal outcomes (delivery mode) and neonatal outcomes (APGAR scores, NICU admissions, neonatal complications) were documented and analyzed.

Results: Out of 54 cases, 37 (68.1%) were delivered by caesarean section, while the remaining 17 (31.9%) were delivered vaginally. Differences in delivery methods were observed based on meconium thickness (χ² = 20.66, p < 0.001). Caesarean delivery rates were higher in cases of moderate meconium (59.5%) and thick meconium (29.7%) compared to cases of thin meconium (10.8%). Furthermore, APGAR scores significantly improved from the first to the fifth minute (p < 0.05). NICU admissions were notably higher for thick meconium cases (58.3%) and moderate meconium cases (41.7%), which was statistically significant (p < 0.05). Complications reported included birth asphyxia (16.66%), meconium aspiration syndrome with pneumonia (3.7%), and neonatal sepsis (1.85%).

Conclusion: The findings of this study indicate that MSAF is associated with an increased rate of caesarean deliveries, higher NICU admission rates, and significant neonatal complications. Early identification and prompt intrapartum management can enhance both maternal and neonatal outcomes.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Goel A, Nangia S, Saili A, Garg A, Sharma S, Randhawa VS. Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)--a randomized controlled trial. Eur J Pediatr. 2015 Feb;174(2):237-43. doi: 10.1007/s00431-014-2385-4. Epub 2014 Aug 3. PMID: 25084971.

S. B., S. S., Devaraj, S., & E., N. Meconium aspiration syndrome and neonatal outcome: a hospital based study. International Journal of Contemporary Pediatrics, 2019 6(3), 1330–1335. https://doi.org/10.18203/2349-3291.ijcp20192038

Halle-Ekane GE, N. Fon P, Koki PN, Tazinya AA, Ekollo R, Mboudou E. Maternal and Perinatal Outcomes in Childbirths with Meconium Stained Amniotic Fluid in a Low-resource Setting: A Prospective Cohort Study. Arch. Curr. Res. Int. [Internet]. 2019 Mar. 30 [cited 2025 Mar. 7];17(1):1-11. Available from: https://journalacri.com/index.php/ACRI/article/view/298

Singh G, Singh O, Thapar K. Neonatal outcome in meconium stained amniotic fluid: a hospital based study. Int J Contemp Pediatr [Internet]. 2017 2025 ;4(2):356-60. Available from: https://www.ijpediatrics.com/index.php/ijcp/article/view/434

Sori D, Belete A, Wolde M. Meconium-stained amniotic fluid: factors affecting maternal and perinatal outcomes at Jimma University Specialized Teaching Hospital, South West Ethiopia. Gynecol Obstet (Sunnyvale). 2016. 6(394):2161-0932.1000394. doi: 10.4172/2161-0932.1000394

Sundaram, R., & Murugesan, A. Risk factors for meconium-stained amniotic fluid and its implications. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017, 5(8), 2503–2506. https://doi.org/10.18203/2320-1770.ijrcog20162247

Tolu LB, Birara M, Teshome T, Feyissa GT. Perinatal outcome of meconium stained amniotic fluid among labouring mothers at teaching referral hospital in urban Ethiopia. PloS One. (2020) 15(11):e0242025. Available from https://doi.org/10.1371/journal.pone.0242025

Unnisa S, Sowmya B, Rao SB, Rajagopal K. Maternal and fetal out come in meconium stained amniotic fluid in a tertiary centre. Int J Reprod Contracept Obstet Gynecol. (2016) 5(3):813–7. doi: 10.18203/2320-1770.ijrcog20160590

Oliveira CPL, Flôr-de-Lima F, Rocha GMD, Machado AP, Guimarães Pereira Areias MHF. Meconium aspiration syndrome: risk factors and predictors of severity. JMatern Fetal Neonatal Med. 2019: 32(9):1492–8. doi: 10.1080/14767058.2017.1410700

Ward C, Caughey AB. The risk of meconium aspiration syndrome (MAS) increases with gestational age at term. J Matern Fetal Neonatal Med. (2022) 35 (1):155–60. doi: 10.1080/14767058.2020.1713744

Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics. (1990) 85(5):715–21. doi: 10.1542/peds.85. 5.715

Sheiner E, Hadar A, Shoham-Vardi I, Hallak M, Katz M, Mazor M. The effect of meconium on perinatal outcome: a prospective analysis. J Matern Fetal Neonatal Med. (2002) 11(1):54–9. doi: 10.1080/jmf.11.1.54.59

Gelfand SL, Fanaroff JM, Walsh MC. Meconium stained fluid: approach to the mother and the baby. Pediatr Clin North Am 2004;51:655–667; ix.

Gelfand SL, Fanaroff JM, Walsh MC. Meconium stained fluid: approach to the mother and the baby. Pediatr Clin North Am 2004;51:655–667; ix.

Rawat M, Nangia S, Chandrasekharan P, et al. Approach to infants born through meconium stained amniotic fluid: evolution based on evidence? Am J Perinatol 2018;35:815–822.

Ramakishore AV, Subramanyam KL, Mahesh G. A study on meconium aspiration syndrome cases attending to government general hospital Anantapuramu, Andhra Pradesh. Int J Res Health Sci. 2015;3(1):169-73

Ahanya SN, Lakshmanan J, Morgan BL, Ross MG (2005) Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv 60(1): 45-56.

Vani RK, Pati B, Veena KS, Kumar HVR. Comparison of neonatal outcome parameters between thick and thin meconium-stained liquor: a prospective study. Int J Reprod Contracept Obstet Gynecol 2018;7:4407-12.

Neke Akhtar, Fazilatunnesa, Sharmeen Yasmean. Mode of delivery and fetal outcome in meconium stained amniotic fluid in DMCH, 2006. Available at: www.jemds.com/data_pdf/Dr%20Uday%20Rajput2.doc.

Gupta V, Bhatia BD, Mishra OP. Meconium stained amniotic fluid: Antenatal intrapartum and neonatal attributes. Indian Paediatr. 1996;33:293-7.

Oyelese Y, Culin A, Ananth CV, Kaminsky LM, Vintzileos AM, Smulian JC. Meconium-stained amniotic fluid across gestation and neonatal acidbase status. Am J Obstet Gynaecol. 2006;108:345-9.

Sedaghatian MR, Otheman L, Rashid N, Ramachandran P, Bener BA. An 8 year study of meconium stained amniotic fluid in different ethnic groups. Kuwait Med J. 2004;36:266-9.

Erum Majid Sheikh, Sedaf Mehmood, Majed ahmed sheikh. Neonatal outcome in meconium stained amniotic fluid: one year experience. J Pak Med Assoc. 2010 Sep;60(9):711-4. 6.

Piper JM, Newton ER, Berkus MD, Peairs WA. Meconium a marker of peripartum infection. Obstet Gynaecol (USA). 1998;91(5 Pt.1):741-5

Shaikh EM, Mehmood S, Shaikh MA: Neonatal outcome in meconium stained amniotic fluid-one year experience. J Pak Med Assoc. 2010, 60:711-4.

David AN, Njokanma OF, Iroha E: Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hospital. J Obstet Gynaecol. 2006, 26:518-20. 10.1080/01443610600797426

Lakshmanan J, Ahanya SN, Rehan V, Oyachi N, Ross MG. Elevated plasma corticotrophin release factor levels and in utero meconium passage. Pediatr Res. (2007) 61(2):176–9. doi: 10.1203/pdr.0b013e31802d8a81

Lakshmanan J, Oyachi N, Ahanya SA, Liu G, Mazdak M, Ross MG. Corticotropin-releasing factor inhibition of sheep fetal colonic contractility: mechanisms to prevent meconium passage in utero. Am J Obstet Gynecol. (2007) 196(4):357.e1–e7. doi: 10.1016/j.ajog.2006.11.034

Khazardoost S, Hantoushzadeh S, Khooshideh M, Borna S. Risk factors for meconium aspiration in meconium stained amniotic fluid. J Obstet Gynaecol. (2007) 27(6):577–9. doi: 10.1080/01443610701469636

Dohbit JS, Mah EM, Essiben F, Nzene EM, Meka EU, Foumane P, et al. Maternal and fetal outcomes following labour at term in singleton pregnancies with meconium stained amniotic fluid: a prospective cohort study. Open J Obstet Gynecol. (2018) 8 (09):790. doi: 10.4236/ojog.2018.89082

Qadir S, Jan S, Chachoo JA, Parveen S: Perinatal and neonatal outcome in meconium-stained amniotic fluid. Int J Reprod Contracept Obstet Gynecol. 2016, 5:1400-5. 10.18203/2320-1770.ijrcog20161293

Jain PG, Sharma R, Bhargava M. Perinatal outcome of meconium stained liquor in pre-term, term and post-term pregnancy. Indian J Obstet Gynecol Res. 2017;4(2):146-50.

Mundhra R, Agarwal M. Fetal outcome in meconium stained deliveries. J Clin Diagn Res. 2013;7(12):2874-76.

Khatun MHA, Arzu J, Haque E. Fetal outcome in deliveries with meconium stained liquor. Bangladish J Child Health. 2009;33(2):41-5.

Downloads

Published

2025-03-22

How to Cite

1.
Rasheed A S, Yohannan V, Antony L, Al Natour M, Krishnaswami T, Shama B. Troubled Waters: The Hidden Risks of Meconium-Stained Liquor. J Neonatal Surg [Internet]. 2025Mar.22 [cited 2025Jul.17];14(4):76-82. Available from: https://jneonatalsurg.com/index.php/jns/article/view/2480