It has been unclear whether amnioinfusion (i.e., transcervical
infusion of saline into the amniotic cavity) in women with meconium-stained amniotic fluid during labor
reduces risk for meconium aspiration syndrome.
Results from one randomized trial suggested a beneficial effect, but
routine fetal heart-rate monitoring and neonatal resuscitation were
unavailable in that clinical setting (BJOG 1998; 105:309). In
the current international, multicenter study, 1998
women who were in labor with full-term singleton gestations and had meconium-stained amniotic fluid were randomized to receive
amnioinfusion or standard care; continuous
electronic fetal heart-rate monitoring was performed in both groups.
Baseline demographic and obstetric characteristics did not differ
significantly between the groups.
Incidence of the primary endpoint — a
composite of perinatal death, moderate or
severe meconium aspiration syndrome, or both —
did not differ significantly between the amnioinfusion
and standard-care groups (4.5% and 3.5%, respectively). In particular,
moderate or severe meconium aspiration syndrome
(assessed according to clinical criteria) occurred in 43 and 31
infants, respectively, and there were five perinatal deaths in each group.
Comment: In this large trial, amnioinfusion
did not reduce risk for meconium
aspiration syndrome or perinatal death. Perhaps many,
if not most, infants with meconium aspiration
syndrome have meconium in their pulmonary
tree prior to labor. The authors conclude that amnioinfusion
should not be recommended for the prevention of meconium
aspiration syndrome in settings where standard peripartum
surveillance is available.
— Ann J. Davis, MD
Published in Journal Watch Women's Health October 18, 2005
Source
Fraser WD et al. Amnioinfusion for the
prevention of the meconium aspiration syndrome.