BACKGROUND: The expulsion of meconium during labor increases the likelihood of adverse birth outcomes, with its detrimental effects being more pronounced in resource-constrained countries.

METHODS: A cross-sectional study was conducted between March and May 2022 to assess the prevalence of meconium-stained amniotic fluid (MSAF), associated risk factors, and related neonatal outcomes among 281 laboring mothers who delivered at Hawassa University Comprehensive Specialized Referral Hospital, Ethiopia. Study participants were selected using a systematic random sampling technique. Data were collected using a pretested questionnaire administered by trained BSc midwives, along with a checklist derived from medical records. Data entry and analysis were performed using SPSS version 23. Both descriptive and analytical statistics were computed. Statistical significance was set at P < 0.05, and the strength of association was assessed using adjusted odds ratios (AOR).

RESULTS: In this study, MSAF occurred in 57 (20.3%) of pregnancies. Low Apgar scores at the fifth minute, meconium aspiration syndrome, perinatal asphyxia, and neonatal intensive care unit admission were identified as the major adverse neonatal outcomes associated with MSAF. Factors such as maternal age, rural residence, gestational age greater than 42 weeks, prolonged labor duration, and obstructed labor were identified as potential risk factors for the development of MSAF.

CONCLUSIONS: Healthcare providers should evaluate women in labor for these risk factors and remain vigilant in the early identification of MSAF to improve outcomes for both the fetus and the mother.

KEYWORDS: Meconium-stained amniotic fluid, adverse neonatal outcomes, risk factors, Southern Ethiopia.