TITLE:
Maternal and Fetal Outcomes Following Labour at Term in Singleton Pregnancies with Meconium-Stained Amniotic Fluid: A Prospective Cohort Study
AUTHORS:
Julius Sama Dohbit, Evelyne M. Mah, Felix Essiben, Edmond Mesumbe Nzene, Esther U. N. Meka, Pascal Foumane, Joel Noutakdie Tochie, Benjamin Momo Kadia, Felix A. Elong, Philip Njotang Nana
KEYWORDS:
Meconium Stained Amniotic Fluid, Labour, Maternal and Neonatal Outcomes
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.9,
August
6,
2018
ABSTRACT: Background: Meconium stained amniotic fluid (MSAF) is frequently encountered in
obstetric practice. Literature on the subject is still poorly documented in the
African setting. Objective: The aim of this study was to determine the maternal and fetal outcomes in
case of meconium stained amniotic fluid observed during term labour. Materials
and Methods: We conducted a prospective cohort study enrolling all
consenting pregnant women with term singleton fetus in cephalic presentation
admitted for labour with ruptured fetal membranes in the maternity units of the
Yaoundé Central Hospital (YCH) and the Yaoundé Gynaeco-Obstetric and Pediatric
Hospital (YGOPH) of Cameroon between December 2014 and April 2015. The exposed
grouped was considered as participants having MSAF, while the non-exposed group
comprised those with clear amniotic fluid (CAF). The two groups were monitored
during labor using the WHO partograph, and then followed up till 72 hours after delivery.
Variables studied included the colour and texture of amniotic fluid as well as
maternal and fetal complications. Data was analyzed using Epi-info version
3.5.4. The chi-square and Fischer’s exact tests were appropriately used to compare the two
groups. A p-value less than 5% was considered statistically significant. Results: 2376 vaginal deliveries were recorded during the study period among which
MSAF was observed in 265 cases, hence a prevalence rate of MSAF of 11.15%.
Among these cases of MSAF, 52.1% was thick meconium and 47.9% was light meconium.
Maternal morbidity was high in the group with MSAF; these included: Higher proportions of caesarean delivery (RR = 2.35
p -4) and prolonged labor (RR = 3 p -4). In
this same group, the incidences of chorioamnionitis and puerperal sepsis were
low (0.94% and 0.70% respectively), although there was a three-fold higher risk
that was not statistically significant (RR = 3, P = 0.31). Fetal and neonatal
outcomes were poorer in the MSAF group compared to the CAF group. The
complications included fetal heart rate abnormalities, low Apgar score at the 5th minute, need for neonatal resuscitation, neonatal asphyxia and neonatal
infection which were significantly higher in the MSAF group (all p Conclusion: MSAF observed during labour is associated with increased perinatal morbidity
and mortality. Its detection during labor should strongly indicate very
rigorous intra partum and postpartum monitoring. This will ensure optimal
management and reduction in the risks of complications.