Perinatal outcome of meconium stained amniotic fluid among labouring mothers at teaching referral hospital in urban Ethiopia

Determinants of meconium-stained amniotic fluid among laboring mother in Ethiopia, systematic review and meta-analysis

Background

Meconium-stained amniotic fluid (MSAF) occurs during childbirth when the amniotic fluid carries traces of meconium, the initial stool passed by a newborn. Often signaling fetal distress, MSAF is linked to heightened risks for both the mother and the newborn. In Ethiopia, there is insufficient attention given to this condition. Despite varied study results indicating a considerable range in MSAF occurrences, there is an absence of a comprehensive national overview. Therefore, this systematic review and meta-analysis aim to evaluate the aggregated prevalence of meconium-stained amniotic fluid among laboring mothers and its influencing factors in Ethiopia, providing a consolidated understanding for healthcare strategies and policies.

Method

Following PRISMA guidelines, a systematic review and meta-analysis were executed. Extensive literature searches were conducted on PubMed, Google Scholar, and African Online Journal databases. The pooled prevalence was estimated using a weighted inverse variance random effect model. Heterogeneity among studies was evaluated through Cochrane Q-test and I 2 statistics. To assess publication bias, a funnel plot and Egger's test were performed. The identification of factors associated with meconium-stained amniotic fluid among laboring mothers in Ethiopia was conducted using Stata v 18 software.

Result

In total, 63 articles were initially identified, and ultimately, four articles were deemed suitable for inclusion in this review. The combined prevalence of meconium-stained amniotic fluid among laboring mothers in Ethiopia was determined to be 20% (95% CI: 14%-25%). Upon conducting subgroup analysis, it was revealed that the prevalence of meconium-stained amniotic fluid was highest in the Oromia region and lowest in Addis Ababa. Notably, pregnancies complicated by pregnancy-induced hypertension disorder showed a significant association with the presence of meconium-stained amniotic fluid, with an odds ratio of 6.21 (95% CI: 4.04-8.38).

Conclusion

In conclusion, this review emphasizes the common occurrence of meconium-stained amniotic fluid (MSAF). Notably, it identifies a significant association between pregnancy complicated by hypertension and the presence of MSAF. This underscores the need for targeted interventions to reduce MSAF incidence and mitigate associated adverse outcomes in the Ethiopian.

Systematic Review Registration

http://www.library.ucsf.edu/, (CRD42023491725).

Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country

OBJECTIVE

The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation.

STUDY DESIGN

This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n = 276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n = 271).

RESULTS

Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p = 0.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p = 0.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p = 0.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p = 0.04) were significantly lesser.

CONCLUSION

Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed.

KEY POINTS

· Not performing ET suction in NV MSAF infants is not associated with increase in the incidence of MAS.. · Initiating immediate resuscitation without ET suctioning was associated with decreased risk of HIE but increased receipt of any respiratory support and air leak.. · Large multicentric trial is required to generate robust evidence..

Adverse Maternal and Perinatal Outcomes of Meconium-Stained Amniotic Fluid in Term Labor at Hospitals in South Gondar Zone, Northwest Ethiopia: A Prospective Cohort Study

Background

The passage of meconium during labor increased the chance of undesirable birth outcomes. The adverse effects of meconium are worsening in resource-limited countries. In Ethiopia, there is an argument concerning meconium's negative effects and management on pregnant women and their babies. Therefore, this study was intended to assess the adverse maternal and perinatal outcomes of meconium in term labor in the South Gondar Zone, Ethiopia.

Methods

A prospective cohort study was conducted using 580 laboring mothers (145 exposed and 435 nonexposed groups). A two-stage sampling method was implemented to get study subjects. The data were collected using an interviewer-administered structured questionnaire and a medical chart review. SPSS version 25 was used for data analysis. Chi-squared and Fisher's exact tests were used to compare the two groups' differences. The strength of the association was measured using relative risk with a 95% CI.

Result

There was more operative delivery (28.3% versus 5.3%), puerperal sepsis (79.54% versus 2.06%), nonreassuring fetal heart rate pattern (29.7% versus 2.1%), meconium aspiration syndrome (7.58% versus 0.68%), neonatal sepsis (9% versus 4.1%), perinatal asphyxia (13.8% versus 7.6%), admission to the neonatal intensive care unit (23.4% versus 3.2%), and early neonatal deaths (4.8% versus 1.4%) among meconium stained groups as compared to the clear amniotic fluid groups.

Conclusion

Meconium-stained amniotic fluid significantly increased adverse maternal and perinatal outcomes in Ethiopia. The risk of perinatal asphyxia, nonreassuring fetal heart rate pattern, neonatal sepsis, meconium aspiration syndrome, admission to the NICU, early neonatal death, operative delivery, and puerperal sepsis were significantly higher in meconium-exposed groups. Special attention should be given to meconium-exposed mothers during the intrapartum period and in postnatal follow-up.

Effect of fetal malposition, primiparous, and premature rupture of membrane on Neonatal Near miss mediated by grade three meconium-stained amniotic fluids and duration of the active first stage of labor: Mediation analysis

BACKGROUND

In many low-income countries, including Ethiopia, neonatal mortality remains a major concern. For every newborn that dies, many more neonates survived (near-miss neonates) the first 28 days after birth from life-threatening conditions. The generation of evidence on neonatal near-miss determinants could be a critical step in reducing neonatal mortality rates. However, studies causal pathway determinants are limited in Ethiopia. This study aimed to investigate the Neonatal Near-miss determinants in public health hospitals in Amhara Regional State, northwest Ethiopia.

METHOD

A cross-sectional study was conducted on 1277 mother-newborn pairs at six hospitals between July 2021 and January 2022. A validated interviewer-administered questionnaire and a review of medical records were used to collect data. Data were entered into Epi-Info version 7.1.2 and exported to STATA version 16 in California, America for analysis. The paths from exposure variables to Neonatal Near-Miss via mediators were examined using multiple logistic regression analysis. The adjusted odds ratio (AOR) and ß-coefficients were calculated and reported with a 95% confidence interval and a p-value of 0.05.

RESULTS

The proportion of neonatal near-misses was 28.6% (365/1277) (95% CI: 26-31%). Women who could not read and write (AOR = 1.67,95%CI:1.14-2.47), being primiparous (AOR = 2.48,95% CI:1.63-3.79), pregnancy-induced hypertension (AOR = 2.10,95% CI:1.49-2.95),being referred from other health facilities (AOR = 2.28,95% CI:1.88-3.29), premature rupture of membrane (AOR = 1.47,95% CI:1.09-1.98), and fetal malposition (AOR = 1.89,95% CI:1.14-3.16) were associated with Neonatal Near-miss. Grade III meconium stained amniotic fluid partially mediated the relationship between primiparous (ß = 0.517), fetal malposition (ß = 0.526), pregnant women referred from other health facilities (ß = 0.948) and Neonatal Near-Miss at P-value < 0.01. Duration of the active first stage of labour partially mediated the relationship between primiparous (ß = -0.345), fetal malposition (ß = -0.656), premature rupture of membranes (ß = -0.550) and Neonatal Near-Miss at P- value <0.01.It had also a significant indirect effect (ß = 0.581, P<0.001) on NNM with variables (primiparous, fetal malposition, and premature rupture of membranes).

CONCLUSIONS

The relationship between fetal malposition, primiparous, referred from other health facilities, premature rupture of membrane, and Neonatal Near miss were partially mediated by grade III meconium stained amniotic fluid and duration of the active first stage of labour. Early diagnosis of these potential danger signs and appropriate intervention could be of supreme importance in reducing NNM.

The incidence and determinants of the meconium-aspiration syndrome among mothers with meconium-stained amniotic fluid after emergency cesarean section: A prospective cross-sectional study in a specialized hospital, south Ethiopia

Background

Meconium aspiration syndrome is respiratory distress diagnosed in neonates delivered with meconium-stained amniotic fluid that is unexplained by other pathologies. It has severe neonatal respiratory complications and a significant impact on the prevalence of neonatal mortality.

Objective

To identify the incidence and determinants associated with meconium aspiration syndrome among mothers with meconium-stained amniotic fluid after emergency cesarean section in Wolkite University specialized hospitals in Ethiopia from September 1, 2021, to August 30, 2022.

Method

An institution-based cross-sectional study was done prospectively through meticulous chart review and interviews with 275 mothers with meconium-stained amniotic fluid who gave birth with an emergency cesarean section. Data were entered using EpiData 7 and analyzed with SPSS 26. The association between independent variables and the meconium-aspiration syndrome was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at a p-value of 0.05.

Result

The prevalence of the meconium-aspiration syndrome is 28.7%. The factors associated are: latent phase (AOR: 2.580; 95% CI: 1.126, 5.913), low 1st minute APGAR score (AOR: 2.43; 95% CI: 0.892, 6.625), and thick meconium (AOR: 31.018; 95% CI: 9.982, 96.390). The neonatal death rate associated with meconium aspiration syndrome is 1.8%, and thick meconium contributed to 65% of admissions to the neonatal intensive care unit and all deaths.

Conclusion

The incidence of meconium aspiration syndrome is high, and thick meconium, meconium at early labor, and low APGAR scores all contributed to this. Thick meconium has a substantial effect on neonatal mortality and morbidity. Therefore, an improvement in the quality of obstetric and neonatal care through early intervention in the case of thick meconium and meconium in the early phase of labor is recommended.

Meconium-stained Amniotic Fluid among Term Deliveries in a Tertiary Care Centre: A Descriptive Cross-sectional Study

Introduction

Although the precise aetiology of meconium-stained amniotic fluid is still unclear, risk factors include advanced gestational age at delivery, mode of delivery, the prolonged second stage of labour, and intrauterine infection. It has been associated with poor perinatal outcomes including low Apgar scores, increased incidence of neonatal intensive care admission, and a high rate of perinatal death. The objective of the study was to find out the prevalence of meconium-stained amniotic fluid in term deliveries in a tertiary care centre.

Methods

A descriptive cross-sectional study was done among term deliveries in the Department of Obstetrics and Gynaecology, in a tertiary care centre from inpatient records starting from 1 November 2019 to 1 November 2020 after obtaining ethical approval from the Institutional Review Committee (Reference number: PMG1911281316). Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated.

Results

Out of 1699 term deliveries, meconium-stained amniotic fluid was seen in 91 (5.35%) (4.28-6.42, 95% Confidence Interval). Among these 69 (75.82%) newborns were delivered through lower segment caesarean section and 61 (67%) newborns had Grade II meconium-stained amniotic fluid.

Conclusions

The prevalence of meconium-stained amniotic fluid was similar to the studies done in similar settings.

Keywords

apgar score; caesarean section; gestational age; perinatal death; pregnancy.

[Clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for severe MAS in neonates with meconium-stained amniotic fluid]

OBJECTIVES

To study the clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for the development of severe MAS in neonates with meconium-stained amniotic fluid (MSAF).

METHODS

A total of 295 neonates who were hospitalized due to Ⅲ° MSAF from January 2018 to December 2019 were enrolled as subjects. The neonates were classified to a non-MAS group (n=199), a mild/moderate MAS group (n=77), and a severe MAS group (n=19). A retrospective analysis was performed for general clinical data, blood gas parameters, infection indicators, and perinatal clinical data of the mother. The respiratory support regimens after birth were compared among the three groups. The receiver operating characteristic (ROC) curve and multivariate logistic regression analysis were used to investigate predicting factors for the development of severe MAS in neonates with MSAF.

RESULTS

Among the 295 neonates with MSAF, 32.5% (96/295) experienced MAS, among whom 20% (19/96) had severe MAS. Compared with the mild/moderate MAS group and the non-MAS group, the severe MAS group had a significantly lower 5-minute Apgar score (P<0.05) and a significantly higher blood lactate level in the umbilical artery (P<0.05). Compared with the non-MAS group, the severe MAS group had a significantly higher level of interleukin-6 (IL-6) in peripheral blood at 1 hour after birth (P<0.017). In the severe MAS group, 79% (15/19) of the neonates were born inactive, among whom 13 underwent meconium suctioning, and 100% of the neonates started to receive mechanical ventilation within 24 hours. Peripheral blood IL-6 >39.02 pg/mL and white blood cell count (WBC) >30.345×109/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (P<0.05).

CONCLUSIONS

Meconium suctioning cannot completely prevent the onset of severe MAS in neonates with MSAF. The neonates with severe MAS may develop severe respiratory distress and require mechanical ventilation early after birth. Close monitoring of blood lactate in the umbilical artery and peripheral blood IL-6 and WBC at 1 hour after birth may help with early prediction of the development and severity of MAS.

Impact of Meconium-Stained Amniotic Fluid on Neonatal Outcome in a Tertiary Hospital

Objective

The aim of this study was to determine the perinatal outcome of pregnant patients complicated with meconium-stained amniotic fluid (MSAF) compared with clear amniotic fluid.

Methodology

This prospective cross-sectional study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Pediatrics at Indira Gandhi Institute of Medical Sciences, Patna, India, from September 2016 to January 2018. A total of 200 patients were included in the study after taking their written consent. Out of these 200 patients, 100 patients had MSAF, and the other 100 patients with clear liquor were taken as controls after fulfilling the inclusion and exclusion criteria. These two groups of patients were compared regarding various maternal and neonatal parameters. These parameters were compared and tested statistically for significance.

Results

Among the 100 patients with MSAF, 20 patients had grade 1 meconium (X), 22 patients had grade 2 meconium (Y), and 58 patients had grade 3 meconium (Z). The majority of patients in the MSAF group were primigravida and more than 25 years of age. In addition, 47% of patients in the MSAF group had some associated high-risk factors and 50% of patients had non-reassuring fetal heart rate patterns, and among these, 39 patients had grade 3 MSAF (X). In the MSAF group, 49% of patients had undergone lower segment cesarean section (LSCS), whereas in the non-MSAF group, it was 37%. Also, 30% of babies in the MSAF group and 13% in the non-MSAF group had neonatal intensive care unit (NICU) admission; 22% of babies in the MSAF group and 12% of babies in the non-MSAF group had an adverse neonatal outcome. Meconium aspiration syndrome was present in 14% of the patients in the MSAF group, and among these, two babies had neonatal death and both had severe birth asphyxia. In the non-MSAF group, there was one neonatal death due to neonatal sepsis. However, after statistically analyzing the neonatal outcome in both the groups, there was no statistical difference between the two groups (p<0.001).

Conclusion

MSAF is associated with increased frequency of operative delivery, poor neonatal outcomes, and increased NICU admission. Management of labor with MSAF requires appropriate intrapartum care with continuous fetal heart rate monitoring, and this can reduce unnecessary cesarean sections in patients with MSAF.

Biological and Psychosocial Factors, Risk Behaviors, and Perinatal Asphyxia in a University Hospital: Matched Case-Control Study, Cali, Colombia (2012-2014)

Introduction: Perinatal asphyxia is one of the main causes of morbidity and mortality in newborns. It generates high costs, both social and economic, and presents modifiable risk factors. Objective: To determine the biological and psychosocial factors and risk behaviors associated with the development of perinatal asphyxia (Sarnat II-III) in newborns from low socioeconomic status in a tier III university hospital in the city of Cali, Colombia. Materials and Methods: With a case and control design, 216 patients were studied (54 cases/162 controls) (1 case/3 matched controls). The cases were defined as newborns with modified or severe perinatal asphyxia (Sarnat II-III) between 2012 and 2014, with gestational age ≥ 36 weeks, with neurological signs not attributable to other causes, multiorgan compromise, advanced reanimation, and presence of a sentinel event. For the analysis, conditional logistic regression models were developed to evaluate association (OR), considering that the cases and controls had been paired by the birth and gestational age variables. Results: The final model showed that, from the group of biological variables, meconium amniotic fluid was identified as a risk factor (OR 15.28, 95%CI 2.78-83.94). Induction of labor lowered the risk of perinatal asphyxia by 97% (OR 0.03, 95%CI 0.01-0.21), and monitoring of fetal heart rate was associated with lower odds by 99% (OR 0.01, 95%CI 0.00-0.31) of developing perinatal asphyxia in the newborn. Regarding social variables, the lack of social support was identified as a risk factor for the development of perinatal asphyxia (OR 6.44, 95%CI 1.16-35.66); in contrast, secondary education lowered the odds of developing perinatal asphyxia by 85% when compared with pregnant women who only had primary school education (OR 0.15, 95%CI 0.03-0.77). Conclusion: Assessment of biological and psychosocial factors and social support is important in pregnant women to determine the risk of developing perinatal asphyxia in a low-income population.