Utility of amnioinfusion in deliveries complicated by meconium stained liquor: a randomized controlled trial
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20164634Keywords:
Amnioinfusion, Cesarean section, Fetal distress, Meconium aspiration syndrome, Meconium stained liquorAbstract
Background: Meconium stained amniotic fluid could be seen in 12-16 % of deliveries. Meconium is toxic to the newborn lung. Its presence during labour increases the risk to develop neonatal respiratory distress by about 100 times more. Meconium aspiration syndrome (MAS) occurs in about 5% of deliveries with meconium-stained amniotic fluid and death occurs in about 12% of infants with MAS. Intrapartum amnioinfusion was described as a way to dilute meconium or act as a mechanical cushioning of the umbilical cord to prevent its compression .The aim of this study is to perform a randomized controlled clinical trial to test the hypothesis that amnioinfusion can reduce the incidence of caesarean deliveries and perinatal morbidity associated with meconium stained amniotic fluid.
Methods: An interventional randomized study was conducted in Hai Jamaa hospital. 360 patients were enrolled in the study. The patients were in labour with meconium stained liquor above 37 weeks. They were randomly allocated in two groups. Group 1: amnioinfusion group and Group 2: non amnioinfusion group.
Results: Significant reduction of cesarean section rate due to fetal distress. Also significant reduction of prevalence of variable fetal heart rate decelerations, and significant reduction of incidence of MAS in patients received amnioinfusion.
Conclusions: Amnioinfusion is an easy, safe and inexpensive procedure useful in patients with meconium stained liquor.
Metrics
References
Hiersch L, Krispin E, Aviram A, Wiznitzer A, Yogev Y, Ashwal E. Effect of Meconium-Stained Amniotic Fluid on Perinatal Complications in Low-Risk Pregnancies at Term. Am J Perinatol. 2016;33(4):378-84.
Lindenskov PH, Castellheim A, Saugstad OD, Mollnes TE. Meconium aspiration syndrome: possible pathophysiological mechanisms and future potential therapies. Neonatology. 2015;107(3):225-30.
Espinheira MC, Grilo M, Rocha G, Guedes B, Guimaraes H. Meconium aspiration syndrome - the experience of a tertiary center. Revista portuguesa de pneumologia. 2011;17(2):71-6.
Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev. 2014;35(10):417-28; quiz 429.
Flores Nava G, Joachin Roy H, Lopez Padilla MG, Corzo Pineda JA, Ramirez Garcia LA. Perinatal risk factors for mortality in the high-risk newborn. Ginecologia y obstetricia de Mexico. 1998;66:440-3.
Raju U, Sondhi V, Patnaik SK. Meconium Aspiration Syndrome: An Insight. Medical journal, Armed Forces India. 2010;66(2):152-7.
7. Osava RH, Silva FM, Vasconcellos de Oliveira SM, Tuesta EF, Amaral MC. Meconium-stained amniotic fluid and maternal and neonatal factors associated. Revista de saude publica. 2012;46(6):1023-9.
Carson BS, Losey RW, Bowes WA, Jr., Simmons MA. Combined obstetric and pediatric approach to prevent meconium aspiration syndrome. Am J Obstet Gynecol. 1976;126(6):712-5.
Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Lancet (London, England). 2004;364(9434):597-602.
Wenstrom KD, Parsons MT. The prevention of meconium aspiration in labor using amnioinfusion. Obstet Gynecol. 1989;73(4):647-51.
Bansal N, Gupta V, Nanda A, Chaudhary P, Tandon A, Behl N. Intrapartum amnioinfusion in meconium-stained liquor: a case-control study. Journal of obstetrics and gynaecology of India. 2013;63(3):164-7.
Bhatia P, Reena K, Nangia S. Role of intrapartum transcervical amnioinfusion in patients with meconium-stained amniotic fluid. Journal of obstetrics and gynaecology of India. 2013;63(1):59-63.
Choudhary D, Bano I, Ali SM. Does amnioinfusion reduce caesarean section rate in meconium-stained amniotic fluid. Arch Gynecol Obstet. 2010;282(1):17-22.
Darmstadt GL, Yakoob MY, Haws RA, Menezes EV, Soomro T, Bhutta ZA. Reducing stillbirths: interventions during labour. BMC pregnancy and childbirth. 2009;9 Suppl 1:S6.
Das AK, Jana N, Dasgupta S, Samanta B. Intrapartum transcervical amnioinfusion for meconium-stained amniotic fluid. Int J Gynaecol Obstet. 2007;97(3):182-6.
Fraser W, Marcoux S, Prendiville W, et al. Multicenter randomized trial of amnioinfusion. Journal de gynecologie, obstetrique et biologie de la reproduction. 2000;29(3):312-5.
Fanaroff AA, Richard J, Martin. The respiratory system. Neonatal Perinatal Medicine. St. Louis, Missouri: Mosby Year Book. 1992;2:834-5.
Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol. Oct 1976;33(10):696-705.
O'Driscoll K, Coughlan M, Fenton V, Skelly M. Active management of labour: care of the fetus. Br Med J. 1977;2(6100):1451-3.
American Heart A. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support. Pediatrics. 2006;117(5):e989-1004.
Hofmeyr GJ, Xu H, Eke AC. Amnioinfusion for meconium-stained liquor in labour. The Cochrane database of systematic reviews. 2014(1):CD000014.
Khosla AH, Sangwan K, Ahuja SD. Prophylactic amnioinfusion during labor complicated by meconium. The Australian and New Zealand journal of obstetrics and gynaecology.1997;37(3):294-6.
Hofmeyr GJ. Amnioinfusion for meconium-stained liquor in labour. The Cochrane database of systematic reviews. 2002(1):CD000014.
Rathor AM, Singh R, Ramji S, Tripathi R. Randomised trial of amnioinfusion during labour with meconium stained amniotic fluid. BJOG : an international journal of obstetrics and gynaecology. 2002;109(1):17-20.
Mahomed K, Mulambo T, Woelk G, Hofmeyr GJ, Gulmezoglu AM. The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 2. Zimbabwe. Br J Obstet Gynaecol. 1998;105(3):309-13.
Cialone PR, Sherer DM, Ryan RM, Sinkin RA, Abramowicz JS. Amnioinfusion during labor complicated by particulate meconium-stained amniotic fluid decreases neonatal morbidity. Am J Obstet Gynecol. 1994;170(3):842-9.
Sadovsky Y, Amon E, Bade ME, Petrie RH. Prophylactic amnioinfusion during labor complicated by meconium: a preliminary report. Am J Obstet Gynecol. 1989;161(3):613-7.
Rogers MS, Lau TK, Wang CC, Yu KM. Amnioinfusion for the prevention of meconium aspiration during labour. The Australian and New Zealand journal of obstetrics and gynaecology. 1996;36(4):407-10.
Surbek DV, Hosli IM, Pavic N, Almendral A, Holzgreve W. Transcervical intrapartum amnioinfusion: a simple and effective technique. Eur J Obstet Gynecol Reprod Biol. 1997;75(2):123-6.
Puertas A, Paz Carrillo M, Molto L, Alvarez M, Sedeno S, Miranda JA. Meconium-stained amniotic fluid in labor: a randomized trial of prophylactic amniofusion. Eur J Obstet Gynecol Reprod Biol. 2001;99(1):33-7.
Abdel-Aleem H, Amin AF, Shokry M, Radwan RA. Therapeutic amnioinfusion for intrapartum fetal distress using a pediatric feeding tube. Int J Gynaecol Obstet. 2005;90(2):94-8.
Eriksen NL, Hostetter M, Parisi VM. Prophylactic amnioinfusion in pregnancies complicated by thick meconium. Am J Obstet Gynecol. 1994;171(4):1026-30.
Uhing MR, Bhat R, Philobos M, Raju TN. Value of amnioinfusion in reducing meconium aspiration syndrome. Am J Perinatol. 1993;10(1):43-5.