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A Prospective Randomized Study On Maternal And Infant Outcomes Of Intrapartum Transcervical Amnioinfusion Versus Standard Obstetric Care For Parturients With Meconium Stained Amniotic Fluid: A Preliminary Report

Ira Dominique T. Alatraca-Malonzo, MD; Ma. Cristina G. Pelaez-Crisologo, MD, FPOGS, FPSMFM
Department of Obstetrics and Gynecology, Philippine General Hospital

Background: Amnioinfusion, or transcervical infusion of saline into the amniotic cavity, has been proposed as a method for reducing the risk of meconium aspiration syndrome.

Objective: This study aims to assess the effect of intrapartal amnioinfusion with meconium stained amniotic fluid on cesarean section rate, incidence of meconium aspiration syndrome, neonatal ICU admission, perinatal death and adverse maternal outcomes.

Methods: This study is a randomized controlled trial from June to September 2013, conducted in the service wards of a university hospital. The study population consists of parturients 19-45 years old with singleton term low-risk pregnancies, in cephalic presentation, with cervical dilatation at 2-6 cm, with ruptured membranes showing meconium stained amniotic fluid.

Results: Meconium aspiration syndrome occurred in one infant in the amnioinfusion group and in three infants in the control group (9% vs. 25%). There was a lower rate of neonatal pneumonia and neonatal sepsis in the treatment arm (0% vs. 8% and 9% vs. 17%, respectively). There were no perinatal deaths in both groups. Neonatal ICU admission was seen less in the treatment arm (9% vs. 25%) The cesarean section rate did not differ significantly in both groups (9% vs. 8%). Maternal morbidity was seen less in the treatment group. None of the patients in the amnioinfusion arm had fever while two patients in the control group had pyrexia (0% vs. 17%). Hospital stay was also shorter for patients in the treatment group with an average duration of 3 days, as opposed to 4 days in the control arm.

Conclusion: Amnioinfusion is a relatively simple technique of reducing perinatal and maternal morbidity in patients with meconium stained amniotic fluid. Although this study did not show any significant difference between the two groups, there is a trend towards better neonatal outcomes and decreased maternal morbidity with amnioinfusion.