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A substantive amendment to this systematic review was last made on 05
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October 2001. Cochrane reviews are regularly checked and updated if
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necessary.
Background: Amnioinfusion aims to prevent or relieve umbilical cord
compression during labour by infusing a solution into the uterine
cavity. It is also thought to dilute meconium when present in the
amniotic fluid and so reduce the risk of meconium aspiration. However,
it may be that the mechanism of effect is that it corrects
oligohydramnios (reduced amniotic fluid), for which thick meconium
staining is a marker.
Objectives: The objective of this review was to assess the effects of
amnioinfusion for meconium-stained liquor on perinatal outcome.
Search strategy: The Cochrane Pregnancy and Childbirth Group trials
register (October 2001) and the Cochrane Controlled Trials Register
(Issue 3, 2001) were searched.
Selection criteria: Randomised trials comparing amnioinfusion with no
amnioinfusion for women in labour with moderate or thick
meconium-staining of the amniotic fluid.
Data collection and analysis: Eligibility and trial quality were
assessed by one reviewer.
Main results: Twelve studies, most involving small numbers of
participants, were included. Under standard perinatal surveillance,
amnioinfusion was associated with a reduction in the following: heavy
meconium staining of the liquor (relative risk 0.03, 95% confidence
interval 0.01 to 0.15); variable fetal heart rate deceleration (relative
risk 0.65, 95% confidence interval 0.49 to 0.88); and reduced caesarean
section overall (relative risk 0.82, 95% confidence interval 0.69 to
1.97). No perinatal deaths were reported. Under limited perinatal
surveillance, amnioinfusion was associated with a reduction in the
following: meconium aspiration syndrome (relative risk 0.24, 95%
confidence interval 0.12 to 0.48); neonatal hypoxic ischaemic
encephalopathy (relative risk 0.07, 95% confidence interval 0.01 to
0.56) and neonatal ventilation or intensive care unit admission
(relative risk 0.56, 95% confidence interval 0.39 to 0.79); there was a
trend towards reduced perinatal mortality (relative risk 0.34, 95%
confidence interval 0.11 to 1.06).
Reviewers' conclusions: Amnioinfusion is associated with improvements in
perinatal outcome, particularly in settings where facilities for
perinatal surveillance are limited. The trials reviewed are too small
to address the possibility of rare but serious maternal adverse effects
of amnioinfusion.
Citation: Hofmeyr GJ. Amnioinfusion for meconium-stained liquor in
labour (Cochrane Review). In: The Cochrane Library, 1, 2002. Oxford:
Update Software.
-------------------------------------------------------------------------------I
do amnioinfusion in selected cases - sometimes it "works" - improves FHR
-------------------------------------------------------------------------------I
tracing - "routine" is a word that I particulary dislike but I know what
-------------------------------------------------------------------------------I
you mean - if you think that the fetus is acidotic it would be idiotic
to try to reverse acidosis with amnioinfusion -- IMHO
Good luck
-
At Tue, 29 Jan 2002, Dr.Jimi Taria wrote:
>
>Hi,I work in a Unit that routinely does amnioinfusion on cases of
>meconium stained amniotic fluid.I guess there's enough evidence in the
>literature for this.I'm currently looking for evidence if the
>'advantages' hold in cases where there is already evidence of fetal
>anoxia(eg.late decelerations on CTG).A school of thought, is of the
>opinion that amnioinfusion at this stage is unhelpful and to some, even
>contraindicated. Then there is the other school that claim that those
>cases that have amnioinfusion do heaps better(perinatal morbidity /
>mortality) than those that do not get it!
>I'd appreciate any experiences and/or reference areas that could help me
>here.
> Thanks.
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move together..." David Whyte
