Meconium-stained amniotic fluid (MSAF) is the result of waste material from the fetal colon passing into the mother's amniotic cavity. Its incidence increases in post-term pregnancies. Pregnant women with MSAF are more likely to develop maternal complications including inflammation of the fetal membranes caused by a bacterial infection (chorioamnionitis), postpartum inflammation of the lining of the uterus (endometritis) and neonatal complications such as neonatal sepsis and the need for admission to a neonatal intensive care unit (NICU). Fetal stress or hypoxia may trigger gasping fetal respirations, which results in the aspiration of meconium.
Our review was based on two identified randomised controlled study (involving 362 women) and found that prophylactic antibiotics may reduce the risk of intra-amniotic infection in women with MSAF (moderate quality evidence). Antibiotics use did not clearly reduce neonatal sepsis (low quality evidence), NICU admission (low quality evidence) or postpartum endometritis (low quality evidence). Studies with much larger numbers of pregnant women with MSAF would be needed to examine these issues.