Maternal and Fetal Outcomes of Meconium-Stained Amniotic Fluid at KCMC Teaching Zonal Referral Hospital: A Prospective Cohort Study

Aims Meconium-stained amniotic fluid (MSAF) remains a significant obstetric concern due to its association with adverse maternal and neonatal outcomes. However, the absence of standardized management guidelines contributes to clinical uncertainty regarding appropriate interventions, such as operative delivery particularly in low-resource settings like Tanzania. This study aimed to determine the maternal and fetal outcomes associated with different grades of MSAF. Methods The prospective cohort of 362 term pregnant women with singleton pregnancies were conducted between September 2024 to February 2025 at KCMC hospital. Maternal and neonatal outcomes were compared between women with and without MSAF, and Poisson regression models with robust standard errors estimated crude and adjusted risk ratios (aRRs), controlling for key confounders. Results Among 362 women (median age: 31 years, IQR: 27–35), 29.3% experienced MSAF. Women with MSAF had significantly higher risks of cesarean delivery (aRR 5.8; 95% CI 3.6–9.1), postpartum hemorrhage (aRR 9.8; 95% CI 4.1–23.2), and puerperal sepsis (aRR 2.1; 95% CI 1.1–4.1). Neonates exposed to MSAF had significant increased risks of NICU admission (aRR 3.2; 95% CI 1.9–5.3), respiratory distress (aRR 2.4; 95% CI 1.2–4.8), and meconium aspiration syndrome (aRR 7.6; 95% CI 2.9–19.9), with risks increasing progressively across MSAF grades. Conclusion MSAF, particularly in its thicker grades, is associated with substantially increased risks of adverse maternal and neonatal outcomes. Strengthening intrapartum monitoring, timely intervention, and provider training is critical to mitigate these risks. Findings underscore the need for context-specific guidelines to enhance outcomes in resource-limited settings.