Maternal and fetal outcome in meconium stained amniotic fluid in Yaounde

Gynaecology and obstetrics, The University of Yaoundé I
July, 2015


Meconiun stained amniotic fluid (MSAF) is frequently encountered in obstetric practice. Its association to increased perinatal morbidity and mortality has been described in studies carried out in many countries, notably in Asia (India, Pakistan). However, literature on the subject is still poorly documented in our setting: the incidence of MSAF is not known and its consequences have not been described. This study was therefore aimed at determining the maternal and fetal outcome in meconiun stained amniotic fluid in two reference hospitals of Yaounde.
Methodology: this was a prospective cohort study targeting pregnant women admitted in the labour wards of the maternity services of the Central Hospital of Yaoundé (CHY) and Gynaeco-Obstetric and Pediatric Hospital of Yaoundé (GOPHY). It was conducted during a 5 months period from December 2014 to April 2015. Women fulfilling the inclusion criteria and who had given their informed consent were included in the study. They were classified according to the color of amniotic fluid in exposed, for those with MSAF and non-exposed, for those with clear amniotic fluid(CAF).Was considered as non-exposed the first delivery with clear amniotic fluid following the exposed case. Women were matched based on parity.The two groups were followed up during labor (using a partogram),and 72hours following delivery, checking for maternal, fetal and neonatal complications. Data was collected using a pretested questionnaire and analyzed using EPI-INFO version 3.5.4 and Microsoft Excel 2010.
Results: the incidence of MSAF was 11.15%, of which 52.1% was thick meconium stained and 47, 9% light meconium stained. Maternal morbidity was high in the group of MSAF, such as higherproportions of caesarian delivery (RR=2.35 p<10-4). The incidence of chorioamnionitis and puerperal sepsis was low (0.94 and 0.70% respectively) but the risk was three (3) times higher in the MSAF group. Fetuses and neonates born with MSAF had higher morbidity and mortality when compared to those with CAF. The complications included fetal heart rate abnormalities, low Apgar score at 1 minute and 5 minutes, need for neonatal resuscitation, neonatal asphyxia and neonatal infection which were significantly higher in the MSAF group. Meconium aspiration syndrome (MAS) was present in 2.34% of MSAF cases. Perinatal mortality was 23.4%o and all cases of death (10) were seen in the thick MSAF group.

Conclusion: MSAF is associated with increased perinatal morbidity and mortality. Its detection during labor should call for rigorous intra partum monitoring with a partogram, a cardiotocograph and fetal scalp pH. This can insure an optimal management and reduce the risk of complications.