A cross-sectional study of meconium-stained amniotic fluid among women giving birth at a tertiary teaching hospital in Tanzania

Background/Aims Meconium-stained amniotic fluid is associated with adverse perinatal outcomes, and occurs in approximately 7–22% of all live births. The aim of this study was to determine the proportion of births with infected meconium-stained amniotic fluid and explore associated bacteriological patterns and perinatal outcomes in a tertiary teaching hospital in Dar es Salaam, Tanzania. Methods This cross-sectional study was conducted at Muhimbili National Hospital between August and December 2018 with women at ≥28 weeks' gestation about to give birth to a singleton baby with longitudinal lie and cephalic presentation. A sample of fluid was collected from each woman and transported for Gram staining at a university teaching microbiology laboratory. Univariate and bivariate analysis were used to calculate associations between variables and meconium-stained amniotic fluid. Results In total, 222 (8.7%) women out of 2566 births had meconium-stained amniotic fluid, 155 of whom (69.8%) had infected meconium. Mixed bacterial morphology was found in 59 cases (38.1%). Newborns from infected meconium-stained amniotic fluid were more likely to be admitted to the neonatal intensive care unit (32.9% vs 7.5%, P<0.001), to be fresh stillbirth (15.5% vs 3.0%, P=0.008) and to have an Apgar score ≤7 at 5 minutes (38.7% vs 7.5%, P=0.001). Conclusions There is an increased risk of neonatal morbidity and mortality among mothers diagnosed with meconium-stained amniotic fluid. Detecting bacteria in the fluid raises concerns related to bacterial inoculation during routine obstetric vaginal examinations. Assessing antimicrobial culture and sensitivity pattern is highly recommended in future studies to improve current antimicrobial protocols when caring for babies born to mothers with meconium-stained amniotic fluid. Implications for practice Healthcare professionals supervising labour and birth should be aware of the risks of neonatal morbidity in cases of meconium-stained amniotic fluid. Parenteral broad-spectrum antibiotics should be given to mothers with this diagnosis before birth to reduce neonatal morbidity. Ensuring sterile vaginal examinations is important to reduce the chances of mixed bacterial inoculation.