Diagnostic value of antenatal transabdominal ultrasound in detection of meconium-stained amniotic fluid and pregnancy outcomes

Background: Disagreement exists regarding the proper management of gestation known to involve meconium-stained amniotic fluid, and additional fetal, obstetrical, and ultrasonic assessments may be indicated. Patients and method: A Prospective cohort study was conducted at Al-Elwiya Maternity Teaching Hospital (2022 – 2023).  One hundred sixty-eight pregnant women at term with decreased fetal movement were recruited. All were subjected to abdominal ultrasonography to determine the echogenic pattern throughout the amniotic cavity. According to meconium-stained AF (MSAF) observed at the moment of membrane rupture, participants were classified into two groups: Group 1 (positive), 88 women, and Group 2 (negative), 80 women. The sensitivity, specificity, and accuracy of ultrasound in the detection of echogenic AF were calculated. Furthermore, the potential impact of MSAF on the fetal outcomes and emergency cesarean section (C/S) was assessed. Results: Out of 168 women who were enrolled, 105 (62.5%) had MSAF observed at membrane rupture. The sensitivity and specificity of US in detecting echogenic AF were 65.71% and 84.13% respectively. The positive and negative predictive values were 87.34% and 59.55%, respectively. The accuracy of the US in detecting echogenic AF was 72.62%. Each of emergency cesarean section (OR= 10.73, 95%CI= 4.65-24.83, p<0.001), neonatal intensive care unit admission (OR= 5.67, 95%CI= 2.54-12.65, p<0.001), and <7 Apgar score (OR= 2.47, 95%CI= 1.25- 4.91, p= 0.010) was significantly associated with the positivity to MSAF. Conclusion: Ultrasound showed a good predictive value in anticipating MSAF with 65.71% sensitivity and 84.13% specificity. A positive MSAF is significantly associated with emergency CS, neonatal admission to ICU, and low Apgar score