Prevalence and immediate outcomes of neonates born through meconium-stained amniotic fluid at Kawempe National Referral Hospital.

Abstract

Background: Meconium-stained amniotic fluid is a sign of fetal compromise and is associated with increased risk of neonatal morbidity and mortality globally. Due to a number of factors, such as a socio-economic status, and fragile health systems, the impact of meconium-stained amniotic fluid on outcomes of neonates is even worse in developing countries. Understanding the prevalence and immediate outcomes of neonates born through meconium-stained amniotic fluid in our setting will help highlight the burden of the problem, and pave way to design interventions of prevention, and management in order to improve outcomes. Objectives: To determine the prevalence and immediate outcomes of neonates born through meconium-stained amniotic fluid at Kawempe National Referral Hospital, Kampala, Uganda. Methodology: Between December 2021 and January 2022, we conducted a prospective cohort study of 385 neonates at Kawempe National Referral Hospital. Expectant mothers aged 18 years and above in labour were followed until delivery. All deliveries were recorded and the state of the meconium at delivery was recorded. Neonates born through MSAF were followed up to 72 hours post-delivery to assess for outcomes. The proportion of neonates who had Apgar score of 6 or less, developed hypoxic ischemic encephalopathy, meconium aspiration syndrome and or death was recorded. Data was summarized using frequencies and percentages for categorical variables. Multivariable logistic regression was performed to assess factors associated with being born through meconium-stained amniotic fluid. Results: A total of 385 mothers were enrolled into the study. Majority of mothers 134(34.8%) were aged 25-29 years, and 187(48.65%) were not employed. The prevalence of MSAF was 89/385 (23.1 %). Among the neonates born through MSAF, the incidence of MAS was 4/89 (4.5%)while 13/89(14.6 %) had birth asphyxia and 12/89(13.5%) developed HIE. A total of 9/89(10.1%) neonates born through MSAF died. At multivariable analysis, the factors that were independently associated with being born through meconium-stained amniotic fluid were labor induction - aOR = 3.16, 95% C.I (1.484 - 6.75), p-0.003, maternal use of illicit drugs - aOR 2.43, 95% C.I (1.533-3.840), p<0.0001 and birth by vaginal delivery-aOR = 2.13, 95%CI (1.293 - 3.521),p-0.003. Conclusions: One in five neonates was born through MSAF at Kawempe National Referral Hospital. Induction of labor, use of illicit drugs and spontaneous vaginal birth were independently associated with meconium-stained amniotic fluid. In the immediate outcomes mortality (death) was at 10.1%, birth asphyxia 14.6%, overall incidence of HIE 13.5% and MAS 4.5%.