https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article Meconium-Stained Amniotic Fluid and Associated Factors among Women Undergoing Childbirth in Maternity Teaching Hospital in Erbil City ABSTRACT Background and objectives: The purpose of this study was to identify the risk factors for Meconium-Stained Amniotic Fluid among women who delivered vaginally and were ad- mitted to the delivery room at Maternity Teaching Hospital in Erbil city." Methods: A descriptive case-control study was conducted in the labor ward of Maternity Teaching Hospital in the Kurdistan region, Iraq. The study setting was the delivery room. A non-probability purposive sample included 342 mothers with singleton pregnancies: 171 cases with Meconium-Stained Amniotic Fluid and 171 controls with clear amniotic fluid. The data were analyzed using Version 23 of the Statistical Package for the Social Sciences. Results: The majority of women (82.7%) were illiterate, and more than half (58.2%) were multiparous. 57% of the newborns were male. Approximately 18.7% of cases had caesare- an sections compared to 5.3% in the control group, which is statistically highly significant (P-value < 0.001). Additionally, about 30% of cases involving neonates were admitted to the neonatal intensive care unit, compared to just 1.8% in the control group, which is also statistically highly significant (P-value < 0.001). Postdate (B Coefficient: 2.487, 95% Confi- dence Interval: 4.686 to 30.854) and fetal distress (B Coefficient: 3.048, 95% Confidence Interval: 5.662 to 78.393) were highly significantly associated with Meconium-Stained Amniotic Fluid. Conclusion: There is a highly significant association between risk factors such as postdate and fetal distress in the case-control groups. The following factors did not significantly correlate with the case-control groups: preeclampsia, premature rupture of membranes, polyhydramnios, oligohydramnios, prolonged labor, induction of labor, or spontaneous labor. Keywords: Meconium Stained; Amniotic Fluid; Risk Factors; Delivery Room. Sazan Bahram Ahmed; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. (Correspondence: sazan.ahmed@hmu.edu.krd) Srwa Abdulrahman Mustafa; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq Madiha Abbas Muhammed; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq Kazhan Ibrahim Mahmood; Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq Awaz Azeez Saeed; Department of Midwifery, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq. 11 Received: 29/11/2023 Accepted: 18/05/2024 Published: 30/05/2025 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. mailto:sazan.ahmed@hmu.edu.krd?subject=sazan.ahmed@hmu.edu.krd mailto:sazan.ahmed@hmu.edu.krd?subject=sazan.ahmed@hmu.edu.krd mailto:sazan.ahmed@hmu.edu.krd mailto:jawdat.baker@hmu.edu.krd?subject=jawdat.baker@hmu.edu.krd%20%20%20 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article Meconium is the first stool that is found in the intestine of the fetus from 14– 16 weeks gestation. Meconium amniotic fluid (MAF) occurs when there is a passage of the fetal colonic contents into the amni- otic cavity (1). MSAF can be found in 10– 20% of mothers during delivery across the world (2). Though the passage of meconi- um could be physiological, it may become an environmental risk in the presence of fetal acidemia. The latter supervenes acutely and thus it is highly unpredictable and unpreventable (3). The exact causes of meconium-stained amniotic fluid are not clear (4). Numerous factors are linked to Meconium-stained amniotic fluid, including advanced maternal age, early rupture of the membranes, obstructed labor, induced labor, an unsettling heart rate pattern, pregnancy longer than 42 weeks, labor longer than 15 hours, pregnancy-induced hypertension, oligohydramnios, inter- pregnancy intervals shorter than two years, and a monthly family income of less than 5000 Ethiopian birr (5). Meconium- stained amniotic fluid results in short and long-term prenatal outcomes such as low- er Apgar score, respiratory distress, meco- nium aspiration syndrome (MAS), neonatal sepsis (early onset neonatal sepsis and late -onset neonatal sepsis), and hyaline mem- brane disease. The meconium-stained am- niotic fluid causes respiratory distress, spe- cifically meconium aspiration syndrome, which results in morbidity and mortality of neonates (6). is beneficial for obtaining baseline rates of risk factors and identify- ing clues to the etiology of conditions This information is also helpful to plan and as- sess antenatal care for pregnant women, especially for high-risk populations. The main objectives of this study are to identify the main risk factors associated with the Meconium-Stained Amniotic Fluid in preg- nant women and to find out the association between socio-demographical characteristics and obstetric characteristics of women in case-control groups. A descriptive case-control study was used to conduct this study. The study was car- ried out at the Maternity Teaching Hospital in Erbil city. This hospital is located on the main street of Shaqlawa and has been es- tablished since 2004 in Erbil city in the Ira- qi Kurdistan Region. The Maternity Teaching Hospital consists of many depart- ments, including Emergency, In Vitro Fer- tilization, Postpartum unit, Postoperative unit, Delivery unit, and Neonatal Intensive Care Unit (NICU). The study was conducted in the Delivery unit. The duration of the study from 1st of February to 1st of Oc- tober 2023.A non-probability purposive sample of 342 mothers with singleton pregnancies (171 cases and 171 controls) admitted to the Delivery room at MTH we- re respectfully asked to participate in the study. Mothers were divided into two groups: the first group diagnosed with meconium amniotic fluid (MAF) and the second group with clear amniotic fluid (CAF). Epi Info 7 was used to determine the sample size by entering the total num- ber of 3100 women who gave birth during three months in the delivery room in Erbil city. The sample size was calculated using this method, yielding a 95% confidence level and a 5% margin of error. The calcula- tion resulted in 342 samples. The inclusion criteria for this study were all pregnant mothers with singleton fetuses (not twin pregnancies) admitted to delivery room. Additionally, the exclusion criteria were intrauterine fetal death (IUFD), mothers with psychological problems, mothers with bloody amniotic fluid, and preterm birth.Data were collected using a patient file records by the researchers and through 12 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article study, benefits, rights to privacy, rights to withdraw at any time, and that their infor- mation would be kept confidential and anonymous. The data were analyzed using the Statistical Package for the Social Sci- ences version 27 (SPSS). Descriptive statis- tics were used to report frequency and percentages, regression analysis was used to explore the factors associated with me- conium amniotic fluid (MAF), and odds ra- tios (OR) with 95% confidence intervals (95% CI) were calculated. The chi-square test was used to find the association be- tween case and control groups. The association between socio- demographical and obstetrical characteris- tics of women and case control groups was illustrated in Table 1. The analysis shows no statistically significant associations be- tween the case control groups and the fol- lowing variables: age category, residency place, and new-born sex. There were a sig- nificant statistical association between the case control groups and educational level (P-value=0.002). The majority (90.1%) of the case group was illiterate compared to 75.4% in the control group. There was also a significant statistically association be- tween the case control groups and smok- ing status (P-value=0.037). The majority (99.4%, 95.3%) of the control and case groups were non-smokers, respectively. In addition, there were a significant statistical association between the case control groups and parity (P-value=0.014). The ma- jority (63.7%) of the control group was multiparous and 52.6% of cases were mul- tiparous. Furthermore, there were a sig- nificant statistical association between the case control groups and access to prenatal care (P-value=0.005). Fifty-five percent of the cases had no access to prenatal care compared to 39.8% of the control group. direct (face to face) interviews with preg- nant women in the labor room who kindly accepted to participate in the study. The interviews were conducted in the Delivery unit of MTH. Data collection started from the period 1st of February to 1st of May 2023. To avoid overcrowding, the re- searcher attended the hospital during the evening shift from 2 PM to 6 PM. The questionnaire format was categorized into three parts, including the following: Part one: The socio-demographic characteris- tics of mothers such as age, level of educa- tion, residential area, occupation, income status, access to prenatal care and smok- ing.Part two: Women’s obstetrical history, including gestational age, parity, newborn sex, oligohydramnios, preeclampsia, gesta- tional diabetes mellitus (GDM), abnormal placentation, placental abrup- tion, chorioamnionitis, intrauterine growth restriction (IUGR). Part three: Maternal comorbidities including overt diabetes mellitus, chronic hypertension, cardio- vascular disease, thyroid dysfunction, drug addiction, hepatitis, anemia, infertility, and COVID-19 at the time of admission). After constructing the questionnaire, it was sent to a number of experts in the fields of medicine, nursing, and biostatistics. The comments of experts were taken into con- sideration regarding clarity relevance, and adequacy to achieve the objectives, and the pilot study of 30 patients in the deliv- ery room indicated that the tool was suita- ble for data collection. Before data collec- tion, formal permission was obtained from Hawler Medical University/College of Nurs- ing and Maternity Teaching Hospital to conduct the study. Ethical approval was obtained from the Hawler Medical Univer- sity/Nursing College. The code number was 5, and the date of approval was January 30, 2023. Verbal Informed consent was obtained from women before data collec- tion, after explaining the purpose of the 13 Copyright ©2025The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULT https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article compared to 5.3% in the control group and this is statistically highly significant at P- value<0.001. In addition, regarding those babies who were admitted to NICU, around The association between risk factors and case-control groups is illustrated in Table 2. The analysis reveals a significant associa- tion between postdate and case-control groups, as 28.1% of the cases were post- date compared to only 4.1% in the control group, and this is statistically highly signifi- cant at P-value < 0.001. In addition, around 29% of the cases had fetal distress com- pared to only 1.8% in the control 30% of the cases were admitted to NICU compared to only 1.8% in the control group. This is statistically highly significant at P-value<0.001. group, and this is statistically highly signifi- cant at P-value < 0.001. Furthermore, there was a significant statistical associa- tion between the case-control groups and anemia (P-value = 0.021). Around 19% of the cases had anemia compared to 9.9% in the control group. The analysis shows no significant statistical associations between the case-control groups and the following factors: spontaneous labor, induction 14 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Association between socio-demographical and obstetrical characteristics of women in both groups Socio-demographic and Obstetric variables Case Control Total P- value No. (%) No. (%) No. (%) Age category (years) < 20 38 (22.2) 28 (16.4) 66 (19.3) 0.651 20-26 61 (35.7) 62 (36.3) 123 (36.0) 27-33 48 (28.1) 51 (29.8) 99 (28.9) 34-40 21 (12.3) 25 (14.6) 46 (13.5) > 40 3 (1.8) 5 (2.9) 8 (2.3) Educational level Illiterate 154 (90.1) 129 (75.4) 283 (82.7) 0.002 Elementary 13 (7.6) 22 (12.9) 35 (10.2) High school/ diploma 2 (1.2) 12 (7.0) 14 (4.1) College 2 (1.2) 8 (4.7) 10 (2.9) Residency place Urban 133 (77.8) 139 (81.3) 272 (79.5) 0.421 Rural 38 (22.2) 32 (18.7) 70 (20.5) Smoking Yes 8 (4.7) 1 (0.6) 9 (2.6) 0.037 No 163 (95.3) 170 (99.4) 333 (97.4) Parity Primipara 70 (40.9) 45 (26.3) 115 (33.6) 0.014 Multipara 90 (52.6) 109 (63.7) 199 (58.2) Grand mul- tipara 11 (6.4) 17 (9.9) 28 (8.2) Access to prenatal care Yes 77 (45.0) 103 (60.2) 180 (52.6) 0.005 No 94 (55.0) 68 (39.8) 162 (47.4) Current Cesarean section Yes 32 (18.7) 9 (5.3) 41 (12) <0.001 No 139 (81.3) 162 (94.7) 301 (88) Admitted to NICU Yes 51 (29.8) 3 (1.8) 54 (15.8) <0.001 No 120 (70.2) 168 (98.2) 288 (84.2) Current Newborn sex Female 66 (38.6) 81 (47.4) 147 (43) 0.101 Male 105 (61.4) 90 (52.6) 195 (57) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article 15 diabetes, IUGR, chorioamnionitis, and chronic hypertension. of labor, prolonged labor, polyhydramnios, oligohydramnios, preeclampsia, premature rupture of membranes, PIH, gestational Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 2. Association between risk factors and case control groups. Risk factors Case Control Total P-value No. (%) No. (%) No. (%) Spontaneous labour Yes 30 (17.5) 24 (14.0) 54 (15.8) 0.374 No 141 (82.5) 147 (86.0) 288 (84.2) Post date (40-42 weeks) Yes 48 (28.1) 7 (4.1) 55 (16.1) <0.001 No 123 (71.9) 164 (95.9) 287 (83.9) Induction of labour Yes 13 (7.6) 6 (3.5) 19 (5.6) 0.098 No 158 (92.4) 165 (96.5) 323 (94.4) Prolonged labour Yes 5 (2.9) 1 (0.6) 6 (1.8) 0.085 No 166 (97.1) 170 (99.4) 336 (98.2) Fetal distress Yes 49 (28.7) 3 (1.8) 52 (15.2) <0.001 No 122 (71.3) 168 (98.2) 290 (84.8) Oligohydramnious Yes 5 (2.9) 4 (2.3) 9 (2.6) 0.735 No 166 (97.1) 167 (97.7) 333 (97.4) Preeclampsia Yes 5 (2.9) 2 (1.2) 7 (2.0) 0.244 No 166 (97.1) 169 (98.8) 335 (98.0) Anaemia Yes 32 (18.7) 17 (9.9) 49 (14.3) 0.021 No 139 (81.3) 154 (90.1) 293 (85.7) PROM Yes 0 (0.0) 1 (0.6) 1 (0.3) 0.239 No 171 (100.0) 170 (99.4) 341 (99.7) IUGR Yes 2 (1.2) 0 (0.0) 2 (0.6) 0.095 No 169 (98.8) 171 (100.0 ) 340 (99.4) Gestational diabetes Yes 0 (0.0) 1 (0.6) 1 (0.3) 0.239 No 171 (100.0) 170 (99.4) 341 (99.7) Chorioamnionitis Yes 4 (2.3) 1 (0.6) 5 (1.5) 0.162 No 167 (97.7) 170 (99.4) 337 (98.5) Chronic hypertension Yes 3 (1.8) 3 (1.8) 6 (1.8) 1.000 No 168 (98.2) 168 (98.2) 336 (98.2) PIH Yes 2 (1.2) 1 (0.6) 3 (0.9) 0.558 No 169 (98.8) 170 (99.4) 339 (99.1) Polyhydramnious Yes 2 (1.2) 0 (0.0) 2 (0.6) 0.095 No 169 (98.8) 171 (100.0) 340 (99.4) Post term (After 42 weeks) Yes 2 (1.2) 0 (0.0) 2 (0.6) 0.095 No 169 (98.8) 171 (100.0) 340 (99.4) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article 2.686, 2.487, and 3.048, respectively, indi- cating that there are positive effects of these variables on the outcome variable. The odds of cases are 3.094 times greater for babies who were delivered by C/S (95% CI 1.038-9.220, P-value = 0.043). The odds of cases are 14.675 times greater for ba- bies admitted to NICU (95% CI 13.774- 57.073, P < 0.001). In addition, the odds of cases are 12.024 times greater for babies born postdate (95% CI 4.686-30.854, P- value < 0.001). Furthermore, the odds of cases are 21.068 times greater for babies with fetal distress (95% CI 4.686-30.854, P- value < 0.001). 16 In order to determine the degree of asso- ciation between a range of risk factors and the case-control groups, a logistic re- gression analysis was conducted. Table 3 shows the findings of this analysis. As il- lustrated in the table, Nagelkerke R² is 0.513, which indicates that 51% of the variance is explained by the model. The data analysis shows no evidence of an effect of the level of education, smoking, parity, anemia, and access to antenatal care on the case and control groups. The B coefficients for C/S, NICU admission, postdate, and fetal distress are 1.129, Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3. Logistic regression analysis of risk factors and case control groups Variable B Coefficient Wald Odds ratio (95% CI) P value Intercept -21.093 34.929 <0.001 Educational level Educational level - 6.011 - 0.111 Illiterate -0.879 0.965 0.415 (0.072 to 2.398) 0.326 Elementary -0.410 0.173 0.664 (0.096 to 4.585) 0.678 High school/ diploma 1.345 1.062 3.837 (0.297 to 49.536) 0.303 Smoking 2.108 3.161 0.566 (0.27 to 1.18) 0.075 Parity Parity - 4.951 - 0.084 Multipara -1.204 4.239 0.300 (0.095 to 0.944) 0.040 Grand multip- arous -0.742 1.735 0.476 (0.158 to 1.436) 0.188 Access to prenatal care -0.449 2.192 0.638 (0.352 to 1.157) 0.139 Cesarean section 1.129 4.109 3.094 (1.038 to 9.220) 0.043 Admitted to NICU 2.686 15.027 14.675 (3.774 to 57.073) <0.001 Post date 2.487 26.756 12.024 (4.686 to 30.854) <0.001 Fetal distress 3.048 20.667 21.068 (5.662 to 78.393) <0.001 Anemia 0.783 3.757 2.187 (0.991to 4.826) 0.053 Overall % of correct classification 81.0 Nagelkerke R2 0.513 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article 4.1% in the control group, and this is statis- tically highly significant at P-value < 0.001. This result was in agreement with the study performed by Padmapriya in 2023 at Dharmapuri, which showed that 26% of patients were at a gestational age of more than 40 weeks (10). The current study re- vealed that fetal distress is significantly associated with meconium-stained amni- otic fluid. This finding was supported by the study conducted in Northwest Ethiopia by Abate in 2021, which showed that fetal distress was nearly 22 times more likely to result in meconium-stained liquor (2). In addition, there was a statistically signifi- cant association between the case-control groups and anemia (P=0.021). Around 19% of the cases had anemia compared to 9.9% in the control group (P=0.021). A similar study performed by Seife and Elias in 2022 showed that 38.6% of the cases had ane- mia compared to only 31.3% in the control group (11). Spontaneous labor, induction of labor, prolonged labor, polyhydramnios, oligohydramnios, preeclampsia, premature rupture of membranes, PIH, gestational diabetes, IUGR, chorioamnionitis, and chronic hypertension were not significant in the current study. This finding was con- sistent with a study done in Southest Ethi- opia by Sorsa. It revealed that preeclamp- sia and oligohydramnios were not signifi- cant (12). Another study, reported from Northern Ethiopia, contradicted this find- ing, showing that induced labor, prolonged labor, and premature rupture of mem- branes were significantly associated with meconium-stained amniotic fluid (13). The findings of the present study showed that the majority 52.6% of the cases and 63.7% of the control group were multipa- rous. There was a significant statistically association between the case-control groups and parity. This finding did not agree with a study done in Kerala, India, which showed that 64.1% of the cases were primigravida and 66.7% of the con- trols were primigravida. Therefore, parity was not statistically significant (7). Addi- tionally, there was a statistically significant association between the case-control groups and access to prenatal care. This finding was not consistent with a study conducted in Ethiopia in 2024, which showed that the highest percentage of women attended antenatal checkups (8). Another finding was that the majority of cases had C/S compared to a low percent- age in the control group, and this is statis- tically highly significant. A similar study done in Kerala, India in 2022 illustrated a higher incidence of caesarean section, with 50% delivered by caesarean section in the case group, whereas in the control group it was 44%. The indication for cae- sarean section in the study group was fetal distress, associated with abnormal FHR (9). In addition, regarding those babies who were admitted to NICU, around 30% of the cases were admitted to NICU com- pared to only 1.8% in the control group. This is statistically highly significant at P- value < 0.001. A similar study in Northwest Ethiopia in 2021 revealed that the need for NICU care was higher in the Meconium -stained amniotic fluid group babies than in the control group (2). The result of the current study shows that the association between risk factors and case-control groups was illustrated. The analysis reveals a significant association between postdate and case-control groups, as 28.1% of the cases were postdate compared to only 17 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Discussion https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article [3] Smruthi, C., Bhat, S., Ashwini, M.S., Kanta, S.R. and Lepakshi, B.G., A Clinical Study of Risk factors and Pregnancy outcome in women with Meconium-Stained Amniotic Fluid in labour in a Tertiary care centre. 2022. Journal of Cardiovascular Disease Re- search. 13 (5). Available from: DOI: Down- loads\Documents\629f3819706506.2592326 5_2.pdf [4] Gallo DM, Romero R, Bosco M, Gotsch F, Jaiman S, Jung E., et al. Meconium-stained amniotic fluid. American journal of obstetrics and gynecology. 2023 May 1;228(5): S1158- 78. Available from: DOI: https:// doi.org/10.1016/j.ajog.2022.11.1283 [5] Beyene, B.N., Hirbaye, M., Kebede, A. and Balina, S., 2024. Meconium-stained amniotic fluid and associated factors among mothers who gave birth at West Guji Zone public hos- pitals, Oromia region, Ethiopia: A cross- sectional study. Clinical Epidemiology and Global Health. 29 (10). Available from: DOI: 10.1016/j.cegh.2024.101669. [6] Nirmala C, Thomas L, Sujatha Y. Risk factors of meconium stained amniotic fluid-a case control study. International Journal of Clini- cal Obstetrics and Gynaecology. 2020;4 (2):157-60. Available from: DOI: https:// doi.org/10.33545/gynae.2020.v4.i2c.521. [7] Sori D, Belete A, Wolde M. Meconium stained amniotic fluid: factors affecting ma- ternal and perinatal outcomes at Jimma Uni- versity specialized teaching hospital, South West Ethiopia. Gynecology and obstetrics journal (Sunnyvale). 2016;6(394):2161-0932. DOI: 10.4172/2161-0932.1000394. [8] Tefera M, Birhanu D, Mihretie A, Belete E, Demis A, Alemaw L. Magnitude of meconi- um stained amniotic fluid and associated factors among women who gave birth in North Shoa Zone hospitals, Amhara Region, Ethiopia 2024. PLoS ONE. 19(2): e0297654. https://doi.org/10.1371/ journal.pone.0297654. [9] Sebastian G, Ulahannan RT. Pregnancy out- come of meconium-stained amniotic fluid in uncomplicated term pregnancies: a case control study. International Journal of Aca- demic Medicine and Pharmacy. 022;4(5):432 -5. Available from: DOI: 10.47009/ jamp.2022.4.5.89. [10] Padmapriya R, Shanmugapriya N, Shanmu- gapriya K, Sukanya E. Study on maternal risk factors and fetal outcome in deliveries with meconium-stained amniotic fluid. To conclude, 26% of the cases had thick meconium and more than a quarter of the cases (27.2%) were detected during the active phase of the labour. The majority of the study sample were post-date and had fetal distress in the case group compared to a low percentage in the control group. This means that the main risk factors were post-date and fetal distress, which were found to be highly significantly associated with meconium-stained liquor. Maternal conditions like anemia were significantly associated with meconium-stained amni- otic fluid (MSAF). We should aim at treating anaemia in ado- lescent girls and women of reproductive age group before conceiving. During our antenatal checkups we should detect IUGR and amniotic fluid volume while palpating. It is also recommended to detect maternal infections at term, such as vaginitis and UTIs, as they are risk factors for MSAF. We should use a partogram or labor care guide by WHO to assess whether labor is progressing at the required rate and de- tect prolonged labor at the earliest, as pro- longed labor is a risk factor for MSAF. [1] Shekari, M., Jahromi, M.S., Ranjbar, A. The incidence and risk factors of meconium am- niotic fluid in singleton pregnancies: an ex- perience of a tertiary hospital in Iran. BMC Pregnancy Childbirth. 2, 930 (2022). Availa- ble from: DOI: https://doi.org/10.1186/ s12884-022-05285. [2] Abate E, Alamirew K, Admassu E, Derbie A. Prevalence and Factors Associated with Me- conium-Stained Amniotic Fluid in a Tertiary Hospital, Northwest Ethiopia: A Cross- Sectional Study. Obstetric Gynecology Inter- national Journal. 021;2021:5520117. Availa- ble from: DOI: https:// doi.org/10.1155/2021/5520117. 18 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. CONCLUSION RECOMMENDATIONS References https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2025.02 Erbil j. nurs. midwifery, Vol. 8, No. (1), May 2025 Original Article International Journal of Academic Medicine and Pharmacy. 2023;5(4):696-8. Available from: DOI: 10.47009/jamp.2023.5.4.138. [11] Awqchew S., Ezo E., Determinants of meco- nium aspiration syndrome among neonates admitted to neonatal intensive care unit at Nigist Eleni Mohammed Memorial Compre- hensive Specialized Hospital, South Ethiopia: Unmatched case–control study. Sage Open Medicine Journal. 2022. 10 (1). Available from: DOI: https:// doi.org/10.1177/20503121221124693. [12] Sorsa R, Adugna T, Kene K, Abera D, Dereje D, Leta B, et al. Determinants of meconium- stained amniotic fluid among women deliv- ered at southwestern referral hospitals, Southwest Ethiopia: a multi-center case- control study. BMC Pregnancy and Child- birth. 2024 Oct 14;24(1):672. Available from: DOI: https://doi.org/10.1186/s12884-024- 06867-4. [13] Gebregziabher GT, Hadgu FB, Abebe HT. Prevalence and associated factors of perina- tal asphyxia in neonates admitted to Ayder Comprehensive Specialized Hospital, North- ern Ethiopia: a cross-sectional study. Interna- tional Journal of Pediatric. 2020;2020 (1):4367248. Available from: DOI: 10.1155/2020/4367248 19 Copyright ©2025 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. https://creativecommons.org/licenses/by-nc-sa/4.0/