Maternal and perinatal outcome in meconium stained amniotic fluid at term: a case control study

Dhana Priya Samiyappa, Seetesh Ghose, Lopamudra B. John, Rupal Samal


Background: Fetal well-being has traditionally been evaluated on the basis of fetal activity, FHR and presence of meconium in liquor in vertex presentation. Passage of meconium is considered physiological sign of fetal maturity on one hand and a sign of fetal distress and response to hypoxic insult on the other hand.

Methods: Pregnant women of 37 - 42weeks gestation with singleton pregnancy and cephalic presentation admitted in labour ward of Mahatma Gandhi Medical College and Research Institute with clear or meconium stained amniotic fluid following spontaneous rupture or ARM were included in the study. Outcome measures were fetal heart rate abnormality, mode of delivery, Apgar score, NICU admission and diagnosis of MAS.

Results: A total of 678 pregnant women were studied. Of them 226 had meconium stained and taken as study group. Rest 452 served as control group. The average gestational age of study group was 39.26±0.81. Abnormal FHR was observed in 56%.Spontaneous vaginal delivery was observed in 27.9% cases, instrumental delivery in 21.2% and caesarean section was 50.9% cases. Rate of low Apgar score 4.4% and it was two times higher in study group. NICU admission was observed in 46.7% cases of exposed group. Incidence of MAS in our study was 1.3%.

Conclusions: In low resource settings where fetal scalp pH, and umbilical card lactate estimation facilities are not available, association of MSL with abnormal FHR can be taken as fetal distress and hence consideration of early operative intervention is necessary.


Meconium stained liquor, Maternal outcome, Perinatal outcome

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Oyelese Y, Culin A, Ananth CV, Kaminsky LM, Vintzileos A, Smulian JC, et al. Meconium stained amniotic fluid across gestation and neonatal acid base status. Obstet Gynecol. 2006;108:345.

Fetaldistress. Am J Obstet Gynaecol. 1959;77:94-107.

Yamada T, Minakami H, Matsubara S, Yatsuda T. Meconium stained amniotic fluid exhibits chemotactic activity for polymorphonuclear leukocytes in vitro. J Reprod Immunol. 2000;46:21-30.

Paul J, Hall M, Marshall JR, Hobel CJ. Meconiumpassage: a new. 1978;31:509-13.

Goud P, Krishna U. Significance of meconium staining of amniotic fluid in labour. J Obstet and Gynaecol India. 1989;39:523-6.

Yoder BA, Kirsch EA, Barth WH, Gordon MC. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. J Obstet Gynecol. 2002;99:731-9.

Perinatology and contraception-Dutta DC. In: Konar H, editor. Textbook of Obstetrics .6th ed. calcutta: New Central Book Agency (p) Ltd; 2004:256.

Rossi EM, Phillipson EH, Williams TG, kalhan SC. Meconium aspiration syndrome: intrapartum and neonatal attributes. Am J Obstet Gynaecol. 199810:107-10.

Wiswell TE, Gannon CM, Jacob J. Delivery room management of the apparently vigorous meconium stained neonates: results of the multicentre, international collaborative trial. J Paediatrics. 2000;105:1-7.

Abramovici H, Brandes JM, Fuchs K, Timor Tritsch I. Meconium during labour: a sign of compensated fetal distress. Am J Obstet Gynecol. 1974;118:251-5.

Tarnier BS, Losey RW, Bowes. Combined Obstetric and pediatric approach to prevent meconium aspiration syndrome. Am J Obstet Gynecol. 1969;126:111-8.

Wiswell TE, Henley MA. Intra-tracheal suctioning, systemic infection and the meconium aspiration syndrome. Paediatrics. 1992;89:203-6.

Jirasek JE, Uher J, Koldovysky O. A histochemical analysis of the development of the small intestine of human foetuses. 1965;22.

Desmond MM, Moore, Lindley JE. Meconium staining of the amniotic fluid - a marker for fetal hypoxia. J Obstet Gynaecol. 1957;9:91-103.

Millar FC, Sacks DA, Yeh SY, Paul RH, Schifrin BS, Martin. Significance of meconium during labour. Am J Obstet Gynaecol. 1975;122:573-80.

Sailing EW. Fetal scalp PH sampling. Arch Gynaecol. 1963;198:82-86.

Spellacy WN, Buhi WC, Birk SA. Human placental lactogen levels and intrapartum fetal distress: meconium stained amniotic fluid, fetal heart rate patterns and Apgar scores. Am J Obstet Gynecol. 1972;114:803-80.

Steer PJ, Lissauer EF, Beard RW. Interrelationships among abnormal cardiotocography in labour, meconium staining of amniotic fluid, arterial cord blood PH and Apgar scores. Obstet Gynecol. 1989;74:715-21.

Hellman LM, Schiffer MA, Kohl SG, Tolkes V. Studies in fetal well-being; variations in fetal heart rate. Am J Obstet Gynecol. 1958;76:998-1012.

Rosario MC, Sheshadri L. Meconium staining of amniotic fluid in low risk parturients. J Obst Gynae India. 1996;46:642-6.

Nayak AH, Dalal AR. Meconium staining of amniotic fluid significance and fetal outcome. J Obstet Gynae. 1991;41:480-3.

Haribhasker S, Karthikeyan G, Bhat V, Bhatia BD. Antenatal risk factors and neonatal outcome in meconium aspiration syndrome. Indian J Mat Ch Health. 1997;8(1):9-12.

Sunoo CS, Kosasa TB, Nakayama RT, Hale RW. The incidence of meconium aspiration in Hawali. Hawali Med J. 1993;52:290-3.

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

Fitzerald TB, Mc Farlane CN. Fetal distress and intrapartumfetal death. British Med J. 1955;2:358-61.

Supriya. Thungasuchitra; clinical study of meconium stained amniotic fluid. Int J Bio Ad Res. 2014;5(12):610-4.

Naqvi SB, Manzoor S. Association of meconium stained amniotic fluid with perinatal outcome in pregnant women of 37-42 weeks gestation. Park J Surg. 2011;27(4):292-8.

Becker S, Solomayer E Dogan C, Wall wiener D, Fehm T. Meconium stained amniotic fluid perinatal outcome and obstetrical management in a low risk suburban population. Eur J Obstet Gynecol Reprod Biol. 2007;132:46-50.

Khatun M. Meconium staining liquor and its correlative with fetal outcome within 7 days of birth in Dhaka medical college. Bangladesh college of physicians and surgeons; 2005:39-43.

Ara H, Arju J. Fetal outcome in deliveries with meconium stained liquor. Bangladesh J Child Health. 2009;33(2):41-5.

Patil KP, Swamy MK, Samatha K. A one year cross sectional study of management practices of meconium stained amniotic fluid and perinatal outcome. J Obst Gynecol India. 2006;56(2):128-30.

Kumar SV, Ritu S, Kushia P. Predictors of meconium stained amniotic fluid; a possible strategy to reduce neonatal morbidity and mortality. J Obstet Gynecol India. 2006;56(6):90-2.

Khatree MH, Mokgokong ET. The significance of meconium staining of liquor amnii during labour. S A Fr Med J. 1979;56(25):1099-101.

Windle WF. Origin and extent of function of prenatal life, in physiology of the fetus. Philadelphia: WB Sounders Co. 1940(22):41-5.

Hobel CJ. Intrapartum clinical assessment of fetal distress. Am J Obstet Gynecol. 1971;110:336-42.

Gelfand SL, Fanaroff JM, Walsh MC. Meconium stained fluid approach to the mother and the baby. Pediatr Clin North Am. 2004;51(3):655-67.

Gupta V, Bhatia BD, Mishra OP. Meconium stained amniotic fluid: antenatal, intrapartum and neonatal attributes. Indian Paedi. 1996(33):293-8.

Trimmer KJ, Gilstrap LC. Meconium and Birth asphyxia. Am J Obstet Gynecol. 1991;85:1010-2.

In Ahrens W, Pigeot I (eds). Handbook of Epidemiology. Berlin, Springer. 2005;287-319.

Kumar N. Clinical study of effect of meconium stained amniotic fluid on fetal morbidity and mortality. J Obstet Gynecol India. 2006;43:142-8.