Maternal risk factors and meconium stained amniotic fluid


  • Onkar S. Bhinder Department of Pediatrics, Maulana Azad Medical College, Delhi, India
  • Gurmeet Singh Department of Pediatrics, SGRDIMSAR, Amritsar, Punjab, India
  • Karuna Thapar Department of Pediatrics, SGRDIMSAR, Amritsar, Punjab, India
  • Priyanshu Nain Maulana Azad Medical College, Delhi, India



MSAF, Meconium, Meconium aspiration syndrome


Background: Meconium is a sterile, thick, black-green, odourless material that results from accumulation of debris in fetal intestine during the third month of gestation. The risk factors for meconium-stained amniotic fluid (MSAF) are both maternal and fetal. MSAF is associated with higher rate of caesarean delivery, increased need for neonatal resuscitation and meconium aspiration syndrome. This observational study was undertaken so that such expecting mothers can be screened at an early stage and prompt intervention can be done to minimize neonatal morbidity and mortality.

Methods: This prospective observational study was conducted in department of paediatrics of Sri Guru Ram Das University from December 2014 to June 2016 included all deliveries with meconium stained amniotic fluid excluding Twins, neonates with congenital malformations, multi organ dysfunction or requiring surgical intervention.

Results: The incidence of MSAF was 3.42% with 10.5% mortality. Various maternal factors including multiparity, bad obstetric history, pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR), maternal diabetes, anaemia and non-reassuring cardiotocography (CTG) record were found to be statistically important and associated with poor outcome.

Conclusions: MSAF and poor neonatal outcome is related to antenatal care. Thus, good antenatal and perinatal care can prevent morbidity and mortality in neonate by early identification of signs of fetal distress and passage of meconium inutero and improve outcome.

Author Biographies

Onkar S. Bhinder, Department of Pediatrics, Maulana Azad Medical College, Delhi, India

Senior Resident

Gurmeet Singh, Department of Pediatrics, SGRDIMSAR, Amritsar, Punjab, India

Professor, Dept of Pediatrics

Karuna Thapar, Department of Pediatrics, SGRDIMSAR, Amritsar, Punjab, India

Ex HOD and Retired Professor


Heather H. Meconium Aspiration. In: John P. Cloherty, Eric C Eichenwald, Anne R. Hansen, et al., editors. Manual of Neonatal Care. 7th edition. Philadelphia. Lippincott Williams & Wilkins. 2012;429-34.

Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol. 2008;28(3):3-7.

Momoh JT. Hirschsprung's disease: problems of diagnosis and treatment. Ann Trop Paediatr. 1982;2(1):31-5.

Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics. 1990;85(5):715-21.

Wiswell TE, Fuloria M. The Meconium Aspiration Syndrome: The Saga continues. Indian Pediatr. 1998;35(11):1059-62.

Janet M, Giles R, Kendall S. A Manual of Neonatal Intensive Care. 5th edition. 2012;155.

Gelfand SL. Meconium stained fluid: Approach to the mother and the baby. Pediatr Clin N Am. 2004;51;655-67.

Vineeta G, Bhatia BD, Mishra OP. Meconium Stained Amniotic Fluid: antenatal, intrapartum and neonatal attributes. Indian Pediatr. 1996;33:293-7.

Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome: Unresolved issues. Pediatr Clin North Am. 1993;40(5):955-81.

Klingner MC, Kruse JJ. Meconium aspiration syndrome: pathophysiology and prevention. Am Board Fam Pract. 1999;12(6):450-66.

Ashtekar SD, Nand RS, Gaikwad K. Clinical study of meconium aspiration syndrome in relation to birth weight and gestational maturity at general hospital Sangli. Int Med J. 2014;1(5):189-92.

Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, Weiss K, et al. Delivery room management of apparently vigorous meconium-stained neonate: results of multicenter international collaborative trial. Paediatrics. 2000;105(1):1-7.

National Neonatal-Perinatal Database (NNPD). Morbidity and mortality among outborn neonates at 10 tertiary care institutes in India during the year 2000. J Trop Pediatr. 2004;50:170-4.

Hosna AK. Fetal Outcome in Deliveries with Meconium Stained Liquor. Bangladesh J Child Health. 2009;33(2):41-5.

Chakraborty A. Study on risk factors of meconium stained amniotic fluid and comparison of pregnancy outcome in clear and meconium stained amniotic fluid in a tertiary hospital, Kolkata, India. Int J Biol Med Res. 2013;4(2):3084-7.

Sankhyan N, Kumar SV, Ritu S, Kushia P. Predictors of meconium stained amniotic fluid: A possible strategy to reduce neonatal morbidity and mortality. J Obstet Gynecol India. 2006;56(6):514-7.

Hanoudi M, Murad AM, Duraid A. Meconium Staining of Amniotic Fluid: A Clinical Study. Br J Med Medical Res. 2014;4(3):914-21.

Chand S, Salman A, Abbassi R. Factors Leading To Meconium Aspiration Syndrome in Term- and Post-term Neonates. Cureus 2019;11(9):e5574.

Sharma U, Garg S, Tiwari K, Hans PS, Kumar B. Perinatal Outcome in Meconium Stained Amniotic Fluid. J Evol Med Dent Sci. 2015;48:8319-27.

Narang A, Nair PMC, Bhakoo ON, Vashist K. Management of meconium stained amniotic fluid- A team approach. Indian Pediatr. 1993;30:9-13.

Sori A, Demisew, Belete A. Meconium Stained Amniotic Fluid: Factors Affecting Maternal And Perinatal Outcomes At Jimma University Specialized Teaching Hospital, South West Ethiopia. Gynecol Obstet. 2016;6:8.

Afsar S, Motwani NP, Sudhakar C, Chaturvedi U. Assessment Of Incidence, Determinants And Co-Morbidities Associated With Meconium Aspiration Syndrome: A Hospital Based Study. Int J Contemp Pediatrics. 2016;3(4):1216-20.

David AN, Njokanma OF, Iroha E. Incidence of and factors associated with meconium staining of the amniotic fluid in a Nigerian University Teaching Hospital. J Obstet Gynaecol. 2006;26:518-20.

Asgharnia M, Faraji R, Salamat F, Ashrafkhani B, Heirati SF, Naimian S. Perinatal outcomes of pregnancies with borderline versus normal amniotic fluid index. Iranian J Reprod Med. 2013;11(9):705-10.

Rabie N, Magann E, Steelman S, Ounpraseuth S. Oligohydramnios in complicated and uncomplicated pregnancies: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016 Apr 7.

Berkus MD, Langer O, Samueloff A. Meconium stained amniotic fluid: Increased risk for adverse neonatal outcome. Obstet Gynecol. 1994;84:115-20.

Fenton A, Steer DA. Significance of meconium during labor. Am J Obstet Gynecol. 1975;122:573.

Resnick R. meconium staining. Perinatl Care. 1977;1:22.

Mahomed K, Nyoni R, Masona D. Meconium staining of the liquor in a low-risk population. Paediatric and Perinatal Epidemiology. 1994;8:292-300.






Original Research Articles