Background: Meconium is not only a potential sign of fetal hypoxia but is also a potential toxin if the fetus aspirates particulate matters with a gasping breath in utero or when it takes its first breaths following birth. In addition to this the condition of the mother who gives birth in such circumstances is a concern.
Methods: A hospital based cross-sectional descriptive study was carried out on labouring mothers with meconium stained amniotic fluid who delivered in the labor ward of Jimma University Specialized Hospital during October1, 2012 to December 30, 2012. All labouring mothers with meconium stained amniotic fluid (MSAF) during the study period were included. Data on history of the patient, patient specific demographics and obstetric information was collected using pretested structured questionnaire. Relevant data was abstracted from the neonatal chart and the logbook in the neonatology ward. Statistical tests of association using SPSS (version 16.0, IBM Corporation) were employed at the level of significance of 5%.
Results: The overall rate of meconium stained amniotic fluid was 15.4% (151/979) and 74.8% of the cases had moderate to thick meconium stained amniotic fluid. Mode of delivery in 70.2% of cases was operative delivery; and those mothers with a grade three meconium stained liquor had about 5 times increased risk of operative delivery when compared with mothers with grade 1 staining (OR=4.66, 95%CI:1.52-14.30). First minute Apgar score was less than 7 in 88% of the new born while it was less than 4 in 15% of the cases. However, there was no statistically significant association between the thickness of meconium and low first minute Apgar score. Those babies who were delivered with operative delivery had 16 times increased risk of low 5th minute Apgar score. Among the 27.1% of new born sent to the Neonatal Intensive Care Unit, 71.4% (19.9% of the total) were diagnosed to have Meconium Aspiration Syndrome with clinical examination alone. Those new-borns with first minute Apgar score<7 had three times increased risk of MAS (95% CI: 1.087-10.668) and the presence of meconium stained secretion in the oropharynx of a new born resulted in 9 times increased risk of Meconium Aspiration Syndrome.
Conclusion: The study revealed that Moderate to thick meconium stained amniotic fluid was associated with increased risk of operative delivery, low 5th minute Apgar score and Meconium Aspiration Syndrome. Shortening the threshold for intervention for labor with fetal heart rate abnormalities in the presence of meconium stained amniotic fluid and introducing further fetal evaluation methods like fetal scalp PH analysis are recommended.