Does cesarean section prevent adverse neonatal outcomes associated with meconium amniotic fluid?

Background

Making decisions regarding the mode of delivery in the cases of meconium amniotic fluid (MAF) presents a challenge for healthcare providers. We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section (CS) versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes.

Methods

In this retrospective study, we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 2020-2022. Mothers with certain adverse pregnancy conditions were excluded from the study. These conditions included: abnormal fetal heart rate and pattern, bloody amniotic fluid, malpresentation, abnormal placentation, chorioamnionitis, intrauterine growth restriction, intrauterine fetal death, obstructed labor, and maternal comorbidities. The MAF mothers were divided into two groups based on the method of delivery: those who had CS and those who had a normal vaginal delivery (NVD). Demographic factors, obstetrical factors, and neonatal outcomes were compared between the two groups.

Results

Out of 746 MAF mothers, 213 (28.5%) underwent CS, while 533 (71.4%) had NVD. There were no significant differences between the groups in terms of demographic characteristics. Among MAF mothers who had CS, 66.2% were primiparous, and 33.8% were multiparous. For those who had NVD, 35.1% were primiparous, and 64.9% were multiparous. The first and 5-min Apgar values, rates of asphyxia, neonatal intensive care unit (NICU) admission, and neonatal death were not statistically different between the two delivery modes. The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery. Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS (11.1% vs. 2.3%), no correlation was found between the mode of delivery and the need for resuscitation using logistic regression.

Conclusions

Our research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers. Further studies are needed to provide more substantial evidence to support this conclusion.