Prevalence and grading of meconium-stained amniotic fluid plus associated puerperal sepsis within 7 days at Kawempe National Referral Hospital.

Abstract

Background: Meconium-stained amniotic liquor remains both a maternal and neonatal health challenge globally as it is associated with higher rate of caesarean delivery, increased need for neonatal resuscitation, puerperal sepsis and meconium aspiration syndrome and poor biophysical profile. This study aimed to determine the prevalence and grading of meconium-stained amniotic fluid and its association with puerperal sepsis. Methods: A prospective cohort study design was employed at the labor suite and obstetric theater of Kawempe National Referral Hospital. The study population comprised of 348 expectant mothers admitted to the labor ward and obstetric theatre. Recruitment was conducted daily, and mothers were followed up for 7 days postpartum. Univariate analysis was used to compute the prevalence of meconium-stained amniotic fluid and its grading. Bivariate analysis using Chi-square analysis was used to assess the relationship between meconium-stained amniotic fluid and puerperal sepsis while logistic regression analysis was used to assess the factors associated with puerperal sepsis among meconium-stained amniotic fluid mothers. A p-value < 0.05 was considered statistically significant. Results: A total of 348 women in labor were recruited with an average age of 26.45 (SD 5.26) years. The prevalence of meconium-stained amniotic fluid was 24.1%, of which majority (53.6%) had grade II meconium-stained amniotic fluid, 23.8% had grade1 and 22.6% had grade III meconium-stained amniotic fluid. The overall incidence of puerperal sepsis among all parturient mothers was 27.3% but notably higher among the meconium-stained amniotic fluid mothers (28.5%) as compared to the non-meconium-stained amniotic fluid mothers (26.9%). The odd ratio of developing puerperal sepsis in mothers with meconium-stained amniotic fluid was 1.087 (95% CI 0.630-1.877) and this was not statistically significant before (P=0.764) and after controlling for confounding factors (P=0.754). Conclusion: Meconium-stained amniotic fluid is a common complication in Uganda occurring in approximately a quarter of the deliveries. Although women with meconium-stained amniotic fluid may be at an increased risk of puerperal sepsis, there was no association between puerperal sepsis and meconium-stained amniotic fluid. Heightened monitoring for the mothers in labor should be done by health workers to prevent or diagnose early any meconium-stained amniotic fluid and prevent any potential complications.