Fetal outcome in women presenting with meconium stained liquor at the University Teaching Hospital, Lusaka.

Abstract

The detection of meconium stained liquor (MSL) during labour often causes anxiety in the delivery room because of its association with increased perinatal mortality and morbidity. Meconium is graded into grade 1, grade 2 and 3 according to thickness. The higher the grade, the poorer the outcome. Therefore, the presence of MSL calls for intensified fetal monitoring during labour usually electronically with cardiotography (CTG) or with use of scalp electrodes or scalp PH in order to ensure good fetal outcome. However, this is not possible in resource constrained centres like UTH which might lead to poor outcome or unnecessary intervention through Caesarean sections in order to avoid poor outcome. The fetal outcome in women with MSL at UTH is not known. Therefore, the aim of the study was to determine the fetal outcome, magnitude of MSL, and risk factors responsible for MSL at University Teaching Hospital in Lusaka, Zambia. The study was a case control study conducted at University Teaching Hospital in Lusaka Zambia from May to August 2018. Information was collected from a calculated sample size of 186 women using a structured interview schedule of which 93 were cases and another 93 were controls. Patient files were also used to collect data. In order to ensure that the findings were valid, statistically significant was set at p < 0.05. The study found that the burden for MSL during the period under study at UTH was 10.2%. It also demonstrated no significant difference in terms of good fetal outcome at 5 minutes in women with MSL compared with those without MSL. (Adjusted p value= 0.773). Most women (90.2%) with MSL also had good outcome of Apgar score 7 or more at 5minute though less when compared to those without MSL at 97.8%. Caesarean section rate was high (37.6%) among women with MSL versus 19.4 % among those without MSL. There was also a strong association between MSL and being delivered by C/S (Adjusted odd ratio = 4.579 and adjusted p value = 0.002) indicating that women with MSL are 4.5 times more likely to be delivered by Caesarean section (C/S) as compared to those without MSL. Electronic monitoring of patients with MSL was low with only 33 (35.5%) of women with MSL being monitored with CTG. During the period under study 30 (32%) of women with MSL had associated complications. However, there was no significant association between any demographic characteristic, and or investigated obstetrics risk factor and MSL. In conclusion, the frequency of MSL at UTH was 10.2%. There was no significant difference in fetal outcome at 5 minutes in women with MSL compared with those without MSL. However caesarean rate was noted to be higher in those with MSL compared to those without MSL. No investigated complication was significantly associated MSL at UTH. Key Words: meconium stained liquor, maternal risk factors, fetal outcome