Background: Meconium-stained amniotic fluid (MSAF) is a common intrapartum finding associated with increased maternal intervention and neonatal morbidity. Although the presence of meconium does not always indicate fetal distress, thick meconium and abnormal fetal heart rate patterns are frequently linked with adverse neonatal outcomes, including meconium aspiration syndrome (MAS), birth asphyxia, and neonatal intensive care unit (NICU) admission. This study aimed to assess fetal and neonatal outcomes in pregnancies complicated by MSAF.

Methods: A prospective observational study was conducted over 18 months at a tertiary care center from July 2024 to January 2026. A total of 66 pregnant women with meconium-stained amniotic fluid were enrolled according to predefined inclusion and exclusion criteria. Maternal demographic details, obstetric characteristics, intrapartum findings, cardiotocography (CTG) patterns, mode of delivery, and neonatal outcomes were recorded. Neonates were assessed using Apgar scores at 1 and 5 minutes and monitored for complications such as meconium aspiration, MAS, respiratory distress, birth asphyxia, sepsis, NICU admission, and early neonatal death. Data were analysed using descriptive statistics.

Results: The mean maternal age was 29.29 ± 6.73 years, and the mean gestational age was 38.80 ± 1.81 weeks. Abnormal fetal heart rate patterns were observed in 28.8% of cases. Caesarean delivery was required in 50% of women. Meconium aspiration occurred in 25.8% of neonates, while 13.6% developed MAS. NICU admission was required in 37.9% of newborns. The mean Apgar score improved from 7.37 ± 1.36 at 1 minute to 8.30 ± 1.50 at 5 minutes. Early neonatal mortality was low (1.5%), and 86.4% of neonates were discharged healthy.

Conclusion: MSAF remains an important intrapartum risk factor associated with increased operative delivery and neonatal morbidity. Careful fetal monitoring, early identification of fetal distress, and timely neonatal resuscitation significantly improve perinatal outcomes. Thick meconium and abnormal CTG findings were strongly associated with adverse neonatal outcomes.

KEYWORDS: Meconium-stained Amniotic Fluid, Meconium Aspiration Syndrome, Cardiotocography, Neonatal Outcome, Fetal Distress, NICU.