Meconium-stained amniotic fluid is ...

Meconium-stained amniotic fluid is reported in 7 to 22 percent of season deliveries. Amnioinfusion is used to model meconium aspiration syndrome, a leading cause of neonatal morbidity and mortality. A Cochrane review of randomized trials proposes that amnioinfusion decreases the proceeding of this syndrome, but the trials used for this review had limitations, principally notably size. To address this, Fraser and colleagues careered a large, multicenter, randomized controll trial to determine the efficacy of amnioinfusion for thick meconium amniotic fluid staining.

Enrollment criteria included active labor, gestation of 36 weeks or greater, ruptur membranes, thick meconium amniotic fluid staining, cervical dilation between 2 and 7 cm and no clinical signs indicating cogent delivery. A total of 1998 women were randomized to amnioinfusion or usual care, and 1975 were eligible to participate in the final analysis of the research Block randomization according to the port or absence of variable decelerations in succession fetal monitoring occurred before treatment randomization. Oropharyngeal and nasal suctioning were performed after delivery of the fetal head. Because prophylactic pharyngeal suctioning and intubation and suctioning have not been shown to shorten meconium aspiration syndrome, these interventions were used solitary for infants in respiratory distress. The primary consequence measure for this trial was a composite of perinatal death, moderate to hard meconium aspiration syndrome, or both

The average maternal age was 26 years, and principally patients were term (53 percent) or postterm (41 percent); 55 percent were nulliparous. The composite consequence occurred in 44 infants (45 percent) in the amnioinfusion cluster and 35 infants (3.5 percent) in the command group. Moderate to severe meconium aspiration syndrome was diagnosed in 43 intervention infants (44 percent) and 31 superintend infants (3.1 percent). Five deaths occurr in each form into groups Mild respiratory distress occurred with equal frequent occurrence in both groups. Analysis showed no significant difference between the clusters based on the intervention or according to the shut up randomization for variable decelerations. There also was no significant difference in neonatal respiratory interventions of the like kind as oxygen, bag ventilation, or intubation.

The authors terminate that amnioinfusion for thick meconium staining does not decrease the risk of meconium aspiration syndrome or perinatal death. They commend against using it for these purposes

tap [i]or[/i] pat CARTER, M.D.

Fraser WD et al. Amnioinfusion for the prevention of the meconium aspiration syndrome N Engl J M September 1 2005;353:909-17

COPYRIGHT 2006 American Academy of Family Physicians

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