Maternal and perinatal outcomes of laboring mothers with meconium stained amniotic fluid (msaf) in jumc labor ward, southwest Ethiopia

Abstract

Background: Meconium in the amniotic fluid at birth is a common event which has been estimated to occur in up to 25% of births at term and 23–52% among post-term gestations. It may be a normal physiologic event reflecting fetal maturity or it mayreflect fetal hypoxia. Objectives: To determine maternal and perinatal outcomes of laboring mothers with meconium stained amniotic fluid in Jimma University Medical Center labor ward, Southwest Ethiopia from July 1, 2016 to June 30, 2017. Methods: A Hospital based prospective cohort study was conducted among 428 laboring mothers. Data was edited and entered into Epi data version 3.1 and then exported to SPSS version 20 for cleaning and analysis. Bivariate logistic regression was conducted to identify explanatory variables for multivariable regression at p-value <0.25. The findings were presented using crude and adjusted odds ratio (OR), 95%CIs of OR . A p-value less than 0.05 was taken to declare statistical significance. Results: There were 40.7% cases of non reassuring fetal heart rate status, 18.7% neonatal intensive care unit admissions, 14% cases of meconium aspiration syndrme among mothers with meconium stained amniotic fluid. It was found that there was a significant increased risk of unfavorable fetal and neonatal outcomes, as the thickness of meconium increased (grade1: AOR=1.84, 95%CI; 0.94-3.62, Grade 2: AOR=2.81, 95%CI; 1.52-5.2 and Grade 3: AOR=7.36, 95%CI; 3.62-14.99) compared to mothers who had CAF. There was 39.7% cesarean section rate, 15.9% instrumenal deliveries, 19.6% puerperal fever, 3.7% surgical site infectios among mothers with meconium stained amniotic fluid. Mothers with grade 3 meconium stained amniotic fluid were 3 times more likely to have unfavorable maternal outcome compared to those with clear amniotic fluid (AOR=2.59,95CI:1.42-4.73). Conclusion: Presence of grade 2 and above meconium stained amniotic fluid warrants close fetal monitoring as there are increased risk maternal, fetal and neonatal morbidities in this group. And Presence of non reassuring fetal heart rate status in Grade 2 and above meconium stained amniotic fluid may be considered as a red light to shorten the threshold for intervention. In addition Mothers who delivered through grade 2 and above meconium stained amniotic fluid needs close follow-up after delivery as they are at high risk of having puerperal infections.