We also assessed the effect of the intervention on the risk of cesarean delivery and other major indicators of neonatal and maternal disorders. The objective of this international, randomized, controlled trial was to determine whether amnioinfusion reduces the risk of the composite outcome of perinatal death, moderate or severe meconium aspiration syndrome, or both. The combined sample size of all previous trials is too small to assess adequately the possibility of rare but serious complications such as umbilical-cord prolapse, amniotic-fluid embolism, and uterine rupture. 8,12 The largest study, which showed a clear benefit associated with amnioinfusion, was carried out in a setting where routine intrapartum fetal heart-rate monitoring and neonatal resuscitation were not available. 8 However, most previous trials had small sample sizes, and in some, outcome measures were not clearly defined. Potential mechanisms include dilution of meconium, thus reducing its mechanical and inflammatory effects, and cushioning of the umbilical cord, thus correcting recurrent umbilical-cord compressions that lead to fetal acidemia (a condition predisposing to the meconium aspiration syndrome).Ī systematic review of randomized trials found that amnioinfusion was associated with an overall reduction in the meconium aspiration syndrome and cesarean section. ![]() 4Īmnioinfusion, or transcervical infusion of saline into the amniotic cavity, has been proposed as a method to reduce the risk of the meconium aspiration syndrome. Prophylactic pharyngeal suctioning and tracheal aspiration have not been shown to reduce the risk of the meconium aspiration syndrome. 4,9-11 The meconium aspiration syndrome is believed to result from aspiration of meconium during intrauterine gasping or at the first breath. ![]() 3-8 The case fatality rate of the meconium aspiration syndrome is reported to range from 5 to 40 percent. Meconium-stained amniotic fluid occurs in 7 to 22 percent of term deliveries, 1,2 and the meconium aspiration syndrome complicates 1.7 to 35.8 percent of these deliveries. Conclusionsįor women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal disorders. The rate of cesarean delivery was 31.8 percent in the amnioinfusion group and 29.0 percent in the control group (relative risk, 1.10 95 percent confidence interval, 0.96 to 1.25). Five perinatal deaths occurred in the amnioinfusion group and five in the control group. Perinatal death, moderate or severe meconium aspiration syndrome, or both occurred in 44 infants (4.5 percent) of women in the amnioinfusion group and 35 infants (3.5 percent) of women in the control group (relative risk, 1.26 95 percent confidence interval, 0.82 to 1.95). The composite primary outcome measure was perinatal death, moderate or severe meconium aspiration syndrome, or both. We performed a multicenter trial in which 1998 pregnant women in labor at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid were stratified according to the presence or absence of variable decelerations in fetal heart rate and then randomly assigned to amnioinfusion or to standard care. It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death, moderate or severe meconium aspiration syndrome, or both. The most trusted, influential source of new medical knowledge and clinical best practices in the world. Information and tools for librarians about site license offerings. Valuable tools for building a rewarding career in health care. The authorized source of trusted medical research and education for the Chinese-language medical community. The most advanced way to teach, practice, and assess clinical reasoning skills. Information, resources, and support needed to approach rotations - and life as a resident. ![]() The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams. NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.Ĭoncise summaries and expert physician commentary that busy clinicians need to enhance patient care. NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
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