The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa.

OBJECTIVE

To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labout.

DESIGN

Multicentre randomised controlled trial.

SETTING

Four urban academic hospitals in South Africa. Obstetric surveillance included the use of electronic fetal heart rate monitoring in most cases.

PARTICIPANTS

Women in labour at term with moderate or thick meconium staining of the amniotic fluid.

INTERVENTIONS: Transcervical amnioinfusion of 800 mL saline at 15 mL per minute, followed by a maintenance infusion at 3 mL per minute. The control group received routine care. Blinding of the intervention was not possible.

MAIN OUTCOME MEASURES: Caesarean section, meconium aspiration syndrome and perinatal mortality.

RESULTS

Caesarean section rates were similar (amnioinfusion group 70/167 vs control group 68/159; RR 0.98, 95% CI 0.76-1.26). The incidence of meconium aspiration syndrome was lower than expected on the basis of previous studies (4/162 vs 6/163; RR 0.67, 95% CI 0.19-2.33). There were no perinatal deaths. There were no significant differences between any of the subsidiary outcomes.

CONCLUSIONS

This study concurred with three previous trials which found no effect of amnioinfusion for meconium-stained amniotic fluid on caesarean section rate, though the pooled data from all identified trials to date show a significant reduction. The findings with respect to meconium aspiration syndrome were inconclusive in this study alone because of the small number of babies affected, but the point estimate of the relative risk was consistent with the finding of a significant reduction in previous studies and with the Zimbabwe arm (CRAMP 2) of this study. Pooled data clearly support the use of amnioinfusion for meconium stained amniotic fluid to reduce the incidence of meconium aspiration syndrome.