(218) Incidental Meconium-Stained Amniotic Fluid During Elective Cesarean Deliveries: A Potential Concern?

To evaluate the association of meconium-stained amniotic fluid (MSAF) incidentally found during elective cesarean delivery (CD) with maternal morbidity and adverse neonatal outcomes.

Study Design:

A retrospective cohort study in a single university affiliated tertiary center with approximately 12,500 deliveries annually, including all women who underwent elective CD with singleton and twin pregnancies between 2011 and 2023. Data analysis encompassed demographic, pregnancy, intraoperative, postoperative and neonatal characteristics. Deliveries with clear amniotic fluid (CAF), MSAF, and thick MSAF were compared for singletons and twins.

Results:

1. During the study period, 13,111 patients with singleton pregnancies and 884 patients with twin pregnancies underwent elective CD.

2. The incidence of MSAF and thick MSAF was 452 (4.4%) and 21 (0.16%) in singleton deliveries and 14 (1.6%) and 2 (0.2%) in twin deliveries, respectively.

3. In singleton pregnancies, patients with MSAF underwent CD at a more advanced gestational age, were more likely to be nulliparous and have had no history of previous cesarean section compared with patients with CAF.

4. Intraoperative complications were comparable between the groups (Table 1).

5. Postoperative maternal morbidity did not differ between the groups, with similar rates of postpartum fever, need for RBC transfusion, postpartum hemorrhage, ICU admission, PE/DVT, surgical site infection, relaparotomy and readmission (Table 1).

6. In singleton pregnancies, NICU admission rates were higher in the thick MSAF group (24%) compared to CAF (3%) and MSAF (4%) groups (p< 0.001). (Table 2).

7. MSAF and thick MSAF remained a significant risk factor for NICU admission in multivariate analysis, with OR of 2.08 (CI 1.259 to 3.274) and 14.84 (CI 4.462 to 42.79), respectively.

Conclusion:

In singleton pregnancies, a more advanced gestational age is associated with incidental MASF in elective CD. However, the later seem to not impact adverse maternal outcomes. In singleton pregnancies, MSAF is linked to increased risk of adverse neonatal outcomes.