BJOG : an international journal of obstetrics and gynaecology · 2002
Randomised trial of amnioinfusion during labour with meconium stained amniotic fluid.
Клиническое исследованиеСтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Rathor Asmita Muthal, Singh Ruchira, Ramji S, Tripathi Reva
Аннотация
OBJECTIVE: To assess the effect of amnioinfusion during labour with meconium stained amniotic fluid on caesarean section rate and perinatal outcome.
DESIGN: Prospective randomised controlled study.
SETTING: A tertiary care teaching hospital in India.
POPULATION: Women in labour at term with meconium stained amniotic fluid.
METHODS: Two hundred women in labour with > or = 37 weeks gestation, single cephalic presentation with moderate or thick meconium were randomised to control and amnioinfusion groups at a 1:1 ratio. Amnioinfusion was performed using 500 mL of normal saline over a period of 30 minutes in a study group. The control group received routine care. Both groups had intermittent auscultation of fetal heart rate during labour.
MAIN OUTCOME MEASURES: The primary outcome measure was caesarean section rate. Secondary outcome measures were meconium aspiration syndrome, 1 minute and 5 minute apgar < 7, hypoxic ischaemic encephalopathy, neonatal intensive care unit admission, meconium at the level of vocal cords.
RESULTS: The caesarean section rate in the amnioinfusion group was less than the control group (RR 0.47; 95% CI 0.24-0.93). Amnioinfusion was associated with a significant decrease in the incidence of meconium at the vocal cords (P = 0.001); improvement in 1 minute apgar scores (P < 0.05), respiratory distress (P = 0.002) and fewer admissions to nursery compared with the controls. This sample size was inadequate to study the impact on meconium aspiration syndrome.
CONCLUSION: Amnioinfusion in an under resourced labour ward decreases caesarean section rates and fetal morbidity.
DESIGN: Prospective randomised controlled study.
SETTING: A tertiary care teaching hospital in India.
POPULATION: Women in labour at term with meconium stained amniotic fluid.
METHODS: Two hundred women in labour with > or = 37 weeks gestation, single cephalic presentation with moderate or thick meconium were randomised to control and amnioinfusion groups at a 1:1 ratio. Amnioinfusion was performed using 500 mL of normal saline over a period of 30 minutes in a study group. The control group received routine care. Both groups had intermittent auscultation of fetal heart rate during labour.
MAIN OUTCOME MEASURES: The primary outcome measure was caesarean section rate. Secondary outcome measures were meconium aspiration syndrome, 1 minute and 5 minute apgar < 7, hypoxic ischaemic encephalopathy, neonatal intensive care unit admission, meconium at the level of vocal cords.
RESULTS: The caesarean section rate in the amnioinfusion group was less than the control group (RR 0.47; 95% CI 0.24-0.93). Amnioinfusion was associated with a significant decrease in the incidence of meconium at the vocal cords (P = 0.001); improvement in 1 minute apgar scores (P < 0.05), respiratory distress (P = 0.002) and fewer admissions to nursery compared with the controls. This sample size was inadequate to study the impact on meconium aspiration syndrome.
CONCLUSION: Amnioinfusion in an under resourced labour ward decreases caesarean section rates and fetal morbidity.