Intrapartum transcervical amnioinfusion for meconium-stained amniotic fluid

Abstract

Objective To assess the rates of cesarean deliveries and perinatal outcome following intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid (MSAF) in a setting with no electronic fetal monitoring or specialized neonatal care. Materials and methods In this prospective comparative study with 150 women who were in labor and had MSAF, 50 of the women received a transcervical amnioinfusion and the remaining 100 women received standard care. The inclusion criteria were a pregnancy of at least 37 weeks' duration, a single live fetus in cephalic presentation, no major medical or obstetric complications, and no known fetal malformation. The amnioinfusion was performed with 1000 mL of normal saline solution through a red rubber catheter. Results Amnioinfusion was associated with a significant decrease in the incidence of low Apgar score (< 7) at 1 min (12% vs. 47%; relative risk [RR], 0.26; 95% confidence interval [CI], 0.12–0.56); low Apgar score at 5 min (4% vs. 23%; RR, 0.17; 95% CI, 0.04–0.71); and meconium aspiration syndrome (4% vs. 18%; RR, 0.22; 95% CI, 0.05–0.92). There was also a trend towards a lesser incidence of cesarean deliveries (18% vs. 30%; RR, 0.6; 95% CI, 0.31–1.16) and perinatal deaths (4% vs. 13%; RR, 0.31; 95% CI, 0.07–1.31). The incidence of maternal hospital stays longer than 3 days was significantly lower in the amnioinfusion than in the control group (24% vs. 48%; RR, 0.5; 95% CI, 0.29–0.85). There were no major complications related to amnioinfusion. Conclusions Intrapartum amnioinfusion for MSAF is a simple, safe, effective, and inexpensive procedure feasible in settings where intrapartum monitoring is limited. It is associated with improved perinatal outcome and could lower cesarean delivery rates in low-resource countries.