European Journal of Cardiovascular Medicine

Meconium-stained amniotic fluid (MSAF) is a significant obstetric concern associated with adverse perinatal outcomes across various gestational ages [1,2]. The incidence of MSAF increases with advancing gestational age, reaching approximately 27% in post-term pregnancies [3]. In preterm deliveries, MSAF is less common but raises concerns about maternal and neonatal infectious risks [4]. Studies have shown that MSAF is linked to lower Apgar scores, higher rates of meconium aspiration syndrome (MAS), and increased neonatal intensive care unit admissions [5,6]. The risk of MAS is notably higher in thick meconium cases, with significant associations found between the grade of meconium and MAS development [5,7]. Additionally, emergency cesarean sections are more prevalent in MSAF cases, especially when complicated by MAS [8]. Maternal factors such as gestational diabetes and pregnancy-induced hypertension have been identified as significant risk factors for MAS [9]. The presence of MSAF, particularly when accompanied by abnormal fetal heart rate patterns, serves as a potential danger sign for fetal well-being, necessitating early intervention [10]. Given these associations, this study aims to evaluate the perinatal outcomes of MSAF in term, preterm, and postterm pregnancies, focusing on the incidence of MAS, mode of delivery, and neonatal outcomes.

The study aims to determine the incidence and grading of meconium-stained liquor (MSL) during labor, evaluate its association with gestational age (preterm, term, and postterm), and assess the resulting perinatal outcomes. Additionally, it seeks to compare these outcomes with a control group of clear liquor cases, focusing on parameters such as the grade of MSL, abnormal fetal heart rate patterns, low birth weight, Apgar scores, incidence of meconium aspiration syndrome (MAS), fetal distress, and need for neonatal intensive care unit (SNCU) admission, thereby providing a comprehensive evaluation of the impact of MSL on maternal and neonatal health.

Study design: Prospective, comparative study.

Study duration: 1^st December, 2019 to 30^th November, 2020 (1 year).

Study area: This study will be undertaken in Department of Obstetrics and Gynecology, MR Bangur Hospital, Tollygunge, Kolkata -700033. It caters to both the rural and urban population residing in South 24 Parganas district.

Study population: The study will be done on booked antenatal cases who will attend the antenatal clinic of M R Bangur Hospital regularly. Patients will be enrolled as per the inclusion and exclusion criteria.

Sample size: 108 Pregnant Women

Inclusion criteria:

• Singleton
• Primigravida and multigravida belonging to any
• Women in active phase of labour at any gestation (term, preterm or post term).
• Cephalic

Exclusion criteria:

•  
• Post caesarean pregnancy.
• Fetal malformation.
• Women with multiple pregnancies, molar pregnancy, known case of previous bad obstetrics, hyperemesis gravidarum

Study variables:

• Age
• Sex
• Maternal age
• Gravida
• Birth weight
• Fetal heart rate

Statistical analysis:

Data from the study were analyzed using SPSS software, with continuous variables (e.g., age, liver enzyme levels) expressed as mean ± SD and compared using t-tests or Mann–Whitney U tests. Categorical variables (e.g., gender, CBD stones, and complications) were presented as frequencies and percentages, and compared using Chi-square or Fisher’s exact tests. Diagnostic accuracy (sensitivity, specificity, PPV, NPV, and accuracy) was calculated for MRCP-first and EUS-first strategies, using ERCP/intraoperative findings as the reference. Kaplan-Meier analysis may be used for time-to-intervention comparisons. A p-value < 0.05 was considered significant.

Table 1: Comparison of maternal age among two groups.

Table 2: Comparison of gravida among two groups

Table 3: Comparison of birth weight among two groups

Table 4: Comparison of fetal heart rate among two groups.

Figure 1: Comparison of maternal age among two groups.

Figure 2: Comparison of gravida among two groups

Figure 3: Comparison of birth weight among two groups

In our study , among the 54 cases, 2 patients (3.7%) were aged <20 years, 17 patients (31.5%) were 20–25 years, 19 patients (35.2%) were 26–30 years, and 16 patients (29.6%) were >30 years. In the control group of 54 patients, 1 patient (1.8%) was <20 years, 13 patients (24%) were 20–25 years, 23 patients (42.6%) were 26–30 years, and 17 patients (31.6%) were >30 years. Which was not statistically significant (p = 0.546).

In our study, among the cases, 35 patients (65%) were primigravida and 19 patients (35%) were multigravida. In the control group, 34 patients (63%) were primigravida and 20 patients (37%) were multigravida. which was not statistically significant (p = 0.841).

In our study , among the 54 cases, 11 neonates (20.4%) had a birth weight <2 kg, 11 (20.4%) weighed 2–2.4 kg, 18 (33%) weighed 2.5–2.9 kg, and 14 (26%) weighed 3–3.5 kg. In the control group, 2 neonates (3.7%) had a birth weight <2 kg, 11 (20.4%) weighed 2–2.4 kg, 23 (42.6%) weighed 2.5–2.9 kg, and 18 (33.3%) weighed 3–3.5 kg. which was statistically significant (p = 0.015).

In our study, among the 54 cases, 24 fetuses (44.4%) had a heart rate <100/min, 15 (27.8%) had a heart rate of 100–120/min, and 15 (27.8%) had a heart rate >120/min. In the control group, 36 fetuses (66.7%) had a heart rate <100/min, 11 (20.4%) had a heart rate of 100–120/min, and 7 (12.9%) had a heart rate >120/min. which was statistically significant (p = 0.023).

In our study, maternal age and gravidity did not show a statistically significant association with neonatal outcomes. Among the 54 cases, 2 patients (3.7%) were aged <20 years, 17 (31.5%) were 20–25 years, 19 (35.2%) were 26–30 years, and 16 (29.6%) were >30 years, compared to controls where 1 patient (1.8%) was <20 years, 13 (24%) were 20–25 years, 23 (42.6%) were 26–30 years, and 17 (31.6%) were >30 years (p = 0.546). Similarly, 65% of cases were primigravida and 35% were multigravida, compared to 63% primigravida and 37% multigravida in controls (p = 0.841). These findings are consistent with previous studies reporting that maternal age and gravidity alone may not significantly influence neonatal outcomes [11,12,16]In contrast, birth weight and fetal heart rate showed significant associations with neonatal outcomes. In our study, 20.4% of cases had birth weight <2 kg, compared to 3.7% in controls, while other birth weight categories showed less pronounced differences (p = 0.015). This aligns with reports that low birth weight is a major predictor of neonatal morbidity and mortality [13,15,18]. Fetal heart rate distribution also differed significantly; 44.4% of cases had heart rate <100/min and 27.8% >120/min, compared to 66.7% and 12.9% in controls, respectively (p = 0.023). Abnormal fetal heart rate patterns have been associated with increased risk of fetal distress and adverse outcomes [13,14,17].Overall, our findings indicate that while maternal age and gravidity were not significant predictors, low birth weight and abnormal fetal heart rate were important determinants of neonatal outcomes, underscoring the need for careful monitoring of fetal growth and well-being during pregnancy [11–20].

In our study, maternal age and gravidity did not show a significant impact on neonatal outcomes. However, low birth weight and abnormal fetal heart rate were significantly associated with adverse neonatal outcomes, highlighting their importance as key predictors of neonatal health and the need for careful monitoring during pregnancy.

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