Comparison of neonatal outcome parameters between thick and thin meconium stained liquor: a prospective study

Rupa Vani K., Banishree Pati, Veena K. S., Hemanth Kumar V. R.


Background: Meconium stained liquor is a commonly observed phenomenon in the day-to-day obstetric practice, the incidence being 12-22%. Meconium stained liquor can be considered as a normal physiological event in a term fetus in the absence of fetal heart rate abnormalities. It has greater significance as one of the parameters of fetal distress, when associated with abnormal fetal heart rate pattern. The aim of the present study was to study the association of, fetal heart rate abnormalities, mode of delivery and neonatal outcome with different grades of meconium stained liquor.

Methods: A prospective study was conducted in one hundred and fifty cases of meconium stained liquor beyond 37 weeks gestation admitted to the labor room in a tertiary care Centre. Depending on the consistency of meconium, the patients were divided into two groups namely, Thick meconium stained liquor (group K) and Thin meconium stained liquor (group N). Maternal conditions, Intrapartum fetal heart rate pattern, Apgar scores and neonatal morbidities were studied in relation to the grade of meconium. The proportions between the two groups were compared using chi-square test and Fisher’s exact t-test.

Results: The incidence of post term pregnancy (p=0.004), unbooked (p=0.007) status and oligohydramnios (p=0.01) were significantly higher among group K when compared to group N. Non-reassuring fetal heart rate pattern (p=0.002) and Apgar score ≤7 (p=0.02) were significantly higher in group K. In group K, non-reassuring fetal heart rate pattern and reduced beat to beat variability were significantly associated with low Apgar score (p=0.01).

Conclusions: Neonatal outcomes like low Apgar score, meconium aspiration syndrome are strongly associated with thick meconium stained liquor. Visual grading of liquor into thick and thin meconium stained may help in timely obstetric intervention leading to a better neonatal outcome.


Apgar score, Cardiotocography, Neonatal outcome, Thick meconium stained liquor

Full Text:



Gary F Cunningham, Kenneth J Leveno, Steven L Bloom, John c Hauth, Larry GillstrapIII, Katharine D Wenstrom Williams Obstetrics,22nd ed. New York: Mc Graw Hill; 2005.

Fenton AN. Steer CM. Meconium in utero, a sign of fetal maturity. Am.J. Obstet Gynaecol. 1962;83:354.

Katz LV. Bowes WA. Meconium aspiration syndrome, reflection on a musky subject. Am. J.Obstet Gynaecol. 1992;166(1):171-83.

Ramin KD, Leveno KJ, Kelly MS, Carmody TJ. Amniotic fluid meconium: A fetal environmental hazard. Obst Gynecol. 1996;87(2):181-4.

Starks GC. Correlation of meconium-stained amniotic fluid, early intrapartum fetal pH, and Apgar scores as predictors of perinatal outcome. Obstet Gynecol. 1980; 56(5):604-9.

Kumari R, Srichand P, Saha SZ, Devrajani BR. Fetal outcome in patients with meconium stained liquor. J Pak Med Assoc. 2012;62(5):474-6.

Davis RO, Philips JB III, Haris BA Jr, Wilson ER, Huddleston JF. Fetal meconium aspiration syndrome occurring despite airway management considered appropriate. Am J Obstet Gynecol. 1985;151(6):731-6.

Lenovo KJ, Quirk JG Jr, Cunningham FG, Nelson SD, Santos-Ramos R, Toofanian A, et al. Prolonged pregnancy. 1. Observations concerning the causes of fetal distress. Am J Obstet Gynecol 1984;150(5):465-73.

Intrapartum Care NICE Clinical Guideline 55 September 2007.

Wong SF, Chow KM, Ho LC. The relative risk of 'fetal distress' in pregnancy associated with meconium-stained liquor at different gestation. J Obstet Gynaecol. 2002;22(6):594-9.

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.

Oyelese Y, Culin A, Ananth CV, Kaminsky LM, Vintzileos A, Smulian JC. Meconium-stained amniotic fluid across gestation and neonatal acid-base status. Obstet Gynecol. 2006;108(2):345-9.

Pushpa Bhatia, Neelam Ela. Fetal and neonatal outcome of babies in meconium stained amniotic fluid and meconium aspiration syndrome. J Obstet Gynaecol India. 2007;57(6):501-4.

Desai D, Maitra N, Patel P. Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):1030-5.

Patil Kamal P, Swami MK, Samatha K. A one-year cross sectional study of management practices of meconium stained amniotic fluid and perinatal outcome. J Obstet Gynaecol India. 2006;56(2):128-30.

Rossi EM, Philipson EH, Williams TG, Kalhan SC. Meconium aspiration syndrome: intrapartum and neonatal attributes. Am J Obstet Gynecol. 1989; 161(5):1106-10.

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

Gupta V, Bhatia BD, Mishra OP. Meconium stained amniotic fluid: antenatal, intrapartum and neonatal attributes. Indian Pediatr. 1996;33(4):293-7.

Alchalabi H, Abu-Heija AT, El-Sunna E, Zayed F, Badria LF, Obeidat A. Meconium-stained amniotic fluid in term pregnancies-a clinical view. J Obstet Gynaecol. 1999;19(3):262-4.