Addisu et al. BMC Pregnancy and Childbirth (2018) 18:429 https://doi.org/10.1186/s12884-018-2056-y RESEARCHARTICLE Open Access Prevalence of meconium stained amniotic fluid and its associated factors among women who gave birth at term in Felege Hiwot comprehensive specialized referral hospital, North West Ethiopia: a facility based cross-sectional study Dagne Addisu1* , Azezu Asres2, Getnet Gedefaw3 and Simegnew Asmer2 Abstract Background: Meconium stained amniotic fluid is one of the risk factors to increase the rate of perinatal morbidity and mortality both in developed and developing countries. Duetoamultitudeoffactorsassociated with socioeconomic and quality of service, the ill effect of meconium stained amniotic fluid is even worse in developing countries. But very little information is known about the situation in Ethiopia, particularly the study area to design appropriate prevention strategies. Hence, this study aimed to determine the prevalence of meconium-stained amniotic fluid and its associated factorsamongwomenwhogavebirthatterminFelege Hiwot Referral Hospital, North West Ethiopia. Methods: Institutional based cross-sectional study was conducted at Felege Hiwot Referral Hospital from March 02–May 27, 2018. A total of 495 mothers were included in the study. The study participants were selected by systematic random sampling technique. A combination of chart review and interview were used to collect the data. Data entry and analysis were made by using Epi-data version 3.1 and SPSS versions 23 respectively. Both descriptive & analytical statistics were computed. Statistical significance was considered at P < 0.05 and the strength of association was assessed by using adjusted odds ratio. Result: The prevalence of meconium stained amniotic fluid was found to be 17.8%. Women whose age greater than 30 years [AOR =5.63, 95%CI =3.35–9.44], duration of labor greater than 24 h [AOR = 7.1, 95%Cl =1.67–29.68], induced labor [AOR = 2.60, 95% CI =1.39–4.87], preeclampsia [AOR = 3.45, 95%CI =1.26–9.37] and obstructed labor [AOR =5.9, 95%CI =1. 29–29.68] were found to be associated with meconium stained amniotic fluid. Conclusions: The prevalence of meconium stained amniotic fluid was similar as compared to the international standard. Preeclampsia, maternal age, obstructed labor, induced labor and longer duration of labor were factors associated with an increased risk for meconium-stained amniotic fluid. Thus, early detection and timely intervention are mandatory to decrease prolonged and obstructed labor. Keywords: Meconium, Amniotic fluid, Meconium stained amniotic fluid, Meconium aspiration syndrome, Felege Hiwot * Correspondence: [email protected] 1Department of midwifery, College of medicine and health science, Debre Tabor University, Debre Tabor, Ethiopia Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Addisu et al. BMC Pregnancy and Childbirth (2018) 18:429 Page 2 of 7 Background information Meconium aspiration syndrome occurs all over the The occurrence of meconium-stained amniotic fluid world about 5–10.5% of neonates with MSAF; which (MSAF) during labor has been long considered the accounts around 12% of neonatal mortality (as much as predictor of adverse fetal outcomes such as meconium 40% case fatality rate for the neonate and around 2% of aspiration syndrome and perinatal asphyxia, which leads perinatal mortality). Furthermore, the rates of severe to perinatal and neonatal morbidity and mortality [1, 2]. mental retardation and cerebral palsy are significantly Meconium is a germ-free, thick, black-green, odorless greater among infants born with MSAF [13, 14]. material which is first recognized in the fetal intestine Meconium stained amniotic fluid significantly increase around 12 weeks of gestation and stores in the fetal the rate of maternal complications such as meconium- colon throughout gestation [3, 4]. laden amniotic fluid embolism, intrapartum chorioamnioni- Passage of meconium in the newborn infants is a devel- tis, Puerperal endometiritis, wound infection, increased risk opmentally programmed incident; normally occurring of operative delivery and its complication [12, 15]. within the first 24 to 48 h after birth. However, the fetus The perinatal morbidity and mortality related to MSAF may pass meconium in the amniotic fluid during pregnancy can be decreased if major risk factors are recognized early due to different reasons. Meconium-stained amniotic fluid and closely monitoring of the labor and careful decisions is uncommon before 37 weeks of gestation and the occur- are made about the timing and mode of delivery [7]. rence of a meconium-stained amniotic fluid increases with Even though the magnitude and associated factors of increasing gestational age [1, 5]. meconium stained amniotic fluid were well studied in the Meconium stained liquor (MSL) is the passage of developed countries, there is a paucity of locally generated meconium by a fetus in utero during the antenatal evidence on the magnitude and associated factors of MSAF period or in labour. According to Royal College of to design appropriate prevention strategies in the study Obstetricians and Gynecologists (RCOG) intrapartum area. Therefore, this study was aimed to determine the care guideline, meconium stained amniotic fluid is prevalence of meconium stained amniotic fluid and its classified as significant MSL and non-significant MSL. associated factors among women who gave birth at term in Non- significant MSL is defined as a thin yellow or Felege Hiwot comprehensive Specialized Referral Hospital. greenish tinged fluid; containing non-particulate meco- nium whereas significant MSL is explained as dark green Methods or black amniotic fluid that is thick and tenacious and Study settings and design consists lumps of meconium [6]. Hospital based cross-sectional study was conducted at Meconium stained amniotic fluid contains masses of felege Hiwot Comprehensive Specialized Referral Hos- debris, desquamated cells from the intestine and skin, pital Obstetrics and Gynecology department, Obstetrics gastrointestinal mucin, lanugo hair, fatty material from ward from March 02–May 27, 2018 GC. This hospital is the vernix caseosa and intestinal secretions [4]. the only specialized hospital in Bahir Dar town and The exact etiology of meconium stained amniotic fluid located in the Amhara region, Bahir Dar special zone, is not clear. However, previous studies suggested that Bahir Dar City. It is located approximately 565 kms obstetric factors such as (prolonged labour, post-term North West of Addis Ababa. pregnancy, low-birth weight babies, oligohydramnios, Felege Hiwot Comprehensive Specialized Referral intrauterine growth retardation and hypertensive disor- Hospital is one of the top ten governmental hospitals in ders of pregnancy),medical factors (cholestasis of preg- Ethiopia. This Hospital is having around 400 beds & 9 nancy and anemia) and socio-demographic and operating tables, serving over 7 million people within its behavioral risk factors (higher maternal age, maternal catchment area. The labor ward gives services to around drug abuse especially tobacco and cocaine use) are the 612 deliveries per month. The Department of Obstetrics major contributory factors for the passage of meconium and Gynecology has a labor ward with seven beds in first into the amniotic fluid [7, 8]. stage room, two delivery couches in the second stage Evidence showed that the incidence of meconium stained room, four beds in the recovery unit and sixty nine beds liquor is increasing as the gestational age increases. From 7 in the maternity ward along with two operating rooms. to 22% of term pregnancy were complicated by meconium The ward is staffed with five obstetrics and gynecology stained liquor worldwide [9, 10]. specialists, thirty three midwives, seventeen clinical Meconium-stained amniotic fluid has adverse long nurses, thirty five residents of different years (levels) of and short-term fetal outcomes; especially it increased study and a varying number of interns. rates of neonatal resuscitation, respiratory distress, lower Apgar score, neonatal nursery admissions, meco- Characteristics of participants nium aspiration syndrome, neonatal sepsis and All women who gave birth at term in Felege Hiwot Re- pulmonary disease [2, 11, 12]. ferral hospital were the source population. This study Addisu et al. BMC Pregnancy and Childbirth (2018) 18:429 Page 3 of 7 included all women who gave birth at term throughout medical and behavioral information were collected the day and night during the data collection period. through interview of the mother and by reviewing her Those mothers who presented with breech presentation medical records. and intrauterine fetal death before the onset of labor were excluded from the study. Socio-demographic, obstetric, medical and behavioral variables Sample size determination Socio-demographic, obstetric, medical and other factors