Meconium-stained liquor (MSL) is defined as the presence of meconium in the amniotic fluid, occurring in approximately 10-20% of all deliveries.¹ It is often considered a sign of fetal distress and is associated with increased perinatal morbidity and mortality.² Meconium is the first stool of the newborn, and its passage in utero can be triggered by hypoxia, infection, or other stressors.³ The presence of MSL can lead to complications such as meconium aspiration syndrome (MAS), which is a severe respiratory condition in neonates.⁴

The pathophysiology of MSL involves the release of meconium due to fetal gut maturation or hypoxia-induced peristalsis and anal sphincter relaxation.⁵ When meconium mixes with amniotic fluid, it can cause chemical pneumonitis and airway obstruction, leading to MAS.⁶ Additionally, MSL is associated with an increased risk of maternal complications, including cesarean delivery, postpartum hemorrhage, and infections.⁷

Despite advances in obstetric and neonatal care, MSL remains a significant concern due to its potential to adversely affect both the mother and the newborn.⁸ This study aims to evaluate the influence of MSL on fetomaternal outcomes, with a focus on maternal complications, neonatal morbidity, and mortality. The findings will contribute to better clinical management and improved outcomes for pregnancies complicated by MSL.

Study Design and Setting:

This was a prospective observational study conducted over 12 months at a tertiary care hospital. The study included 90 pregnant women, divided into two groups: those with meconium-stained liquor (MSL group, n=45) and those with clear amniotic fluid (control group, n=45). The study was approved by the institutional ethics committee, and informed consent was obtained from all participants.

Inclusion Criteria:

1. Singleton pregnancies at term (37-42 weeks).
2. Pregnant women in active labor.
3. Willingness to participate in the study.

Exclusion Criteria:

1. Multiple pregnancies.
2. Preterm labor (<37 weeks).
3. Congenital fetal anomalies.
4. Maternal medical complications such as diabetes, hypertension, or preeclampsia.

Data Collection:

Data were collected on maternal age, parity, gestational age, mode of delivery, and neonatal outcomes. The presence of MSL was confirmed during labor, and cases were categorized into thin or thick meconium based on the consistency of the amniotic fluid. Neonatal outcomes were assessed using Apgar scores at 1 and 5 minutes, NICU admissions, and the incidence of MAS. Maternal outcomes included postpartum hemorrhage, infections, and the need for cesarean delivery.

Statistical Analysis:

Data were analyzed using SPSS software (version 25). Descriptive statistics were used to summarize demographic and clinical characteristics. Chi-square tests were used for categorical variables, and independent t-tests were used for continuous variables. A p-value <0.05 was considered statistically significant.

Table 1: Demographic Characteristics of Study Participants

Table 2: Mode of Delivery

Table 3: Neonatal Outcomes

Table 4: Maternal Complications

Table 5: Thick vs. Thin Meconium Outcomes

The findings of this study highlight the significant impact of meconium-stained liquor (MSL) on fetomaternal outcomes. The MSL group had a higher rate of cesarean deliveries (44.5%) compared to the control group (22.2%), reflecting the association between MSL and fetal distress. This is consistent with previous studies that have reported increased operative interventions in pregnancies complicated by MSL.⁸ The need for cesarean delivery in these cases is often driven by non-reassuring fetal heart rate patterns, which are more common in the presence of thick meconium.⁹

Neonatal outcomes were notably worse in the MSL group, with a 13.3% incidence of low Apgar scores (<7 at 5 minutes) and an 11.1% incidence of MAS. These findings align with global data, which indicate that MSL is a significant risk factor for neonatal morbidity and mortality.¹⁰ The pathophysiology of MAS involves the aspiration of meconium-stained amniotic fluid, leading to airway obstruction, chemical pneumonitis, and pulmonary hypertension.¹¹ Prompt neonatal resuscitation and advanced respiratory support are critical in managing MAS and reducing its associated complications.¹²

Thick meconium was associated with a higher risk of adverse outcomes compared to thin meconium. In this study, 60% of women with thick meconium required cesarean delivery, compared to 25% of those with thin meconium. Similarly, the incidence of MAS was higher in the thick meconium group (16%) compared to the thin meconium group (5%). These findings underscore the importance of careful monitoring and timely intervention in cases of thick meconium.¹³

Maternal complications, including postpartum hemorrhage and infections, were also more prevalent in the MSL group. The increased incidence of cesarean deliveries in this group likely contributed to these complications, as operative deliveries are associated with higher risks of hemorrhage and infection.¹⁴ These findings highlight the need for vigilant postpartum care in women with MSL to prevent and manage complications effectively.

The results of this study are consistent with previous research, reinforcing the importance of early detection and management of MSL to mitigate its adverse effects. Interventions such as amnioinfusion, which involves the instillation of saline into the amniotic cavity to dilute meconium, have been shown to reduce the risk of MAS in some cases.¹⁵ Additionally, prompt neonatal resuscitation and advanced respiratory support are critical in managing MAS and improving neonatal outcomes.¹⁶

Meconium-stained liquor is a significant risk factor for adverse fetomaternal outcomes, including increased cesarean delivery rates, neonatal morbidity, and maternal complications. Thick meconium poses a greater risk than thin meconium, necessitating tailored management strategies. Early identification and timely intervention are crucial to improving outcomes in pregnancies complicated by MSL.

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