Amnioinfusion In Women Research Articles

Intrapartum amnioinfusion in women with oligohydramniosis, A prospective randomized trial

To evaluate the effects of amnioinfusion in oligohydramniosis. During a 20-month period, patients at term with oligohydramniosis (amniotic fluid index less than 5 cm) at Huddinge University and Norrköping Hospitals were recruited for a prospective randomized study to evaluate amnioinfusion. Informed consent was obtained from 112 patients who met the entry criteria. Sixty subjects were randomized to amnioinfusion and 52 to the control group. Outcome parameters included fetal heart rate abnormalities, mode of delivery, Apgar score, pH in umbilical artery blood and need for neonatal intensive care. The cesarean section rate was significantly reduced in the amnio-infusion group (29% versus 13%, p=0.043). No difference in time from randomization to delivery was detected between the two groups. The frequency of ominous fetal heart rate tracings with a cervical dilatation of 0-3 cm was the same in the two groups. The frequency of such heart rate patterns after amnioinfusion was significantly lower than in the control group. Neonatal outcome, pH in the umbilical artery blood and need for neonatal intensive care did not differ between the two groups. The present study confirms the findings of other authors that amnioinfusion effectively reduces the number of cesarean sections in cases of oligohydramniosis.

Intrapartum amnioinfusion in women with oligohydramniosis, A prospective randomized trial

Intrapartum amnioinfusion in women with oligohydramniosis, A prospective randomized trial

Amnioinfusion for umbilical cord compression in labour.

Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. The objective of this review was to assess the effects of amnioinfusion on maternal and perinatal outcome for potential or suspected umbilical cord compression or potential amnionitis. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Randomised trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression; and women at risk of intrauterine infection. Eligibility and trial quality were assessed by the reviewer. Twelve studies were included. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: fetal heart rate decelerations (relative risk 0.54, 95% confidence interval 0.43 to 0.68); caesarean section for suspected fetal distress (relative risk 0.35, 95% confidence interval 0.24 to 0.52); neonatal hospital stay greater than 3 days (relative risk 0.40, 95% confidence interval 0. 26 to 0.62); maternal hospital stay greater than 3 days (relative risk 0.46, 95% 0.29 to 0.74). Transabdominal amnioinfusion showed similar results. Transcervical amnioinfusion to prevent infection in women with membranes ruptured for more than 6 hours was associated with a reduction in puerperal infection (relative risk 0.50, 95% confidence interval 0.26 to 0.97). Amnioinfusion appears to reduce the occurrence of variable heart rate decelerations and lower the use of caesarean section. However the studies were done in settings where fetal distress was not confirmed by fetal blood sampling. The results may therefore only be relevant where caesarean sections are commonly done for abnormal fetal heart rate alone. The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

Amnioinfusion for preterm rupture of membranes.

Preterm rupture of membranes places a fetus at risk of cord compression and amnionitis. Amnioinfusion aims to prevent or relieve umbilical cord compression by infusing a solution into the uterine cavity. The objective of this review was to assess the effects of amnioinfusion for preterm rupture of membranes on maternal and perinatal outcomes. The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Randomised trials of amnioinfusion compared to no amnioinfusion in women with preterm rupture of membranes. Eligibility and trial quality were assessed by the reviewer. One trial of 66 women was included. It had some methodological flaws. No significant differences between amnioinfusion and no amnioinfusion were detected for caesarean section (relative risk 0.32, 95% confidence interval 0.07 to 1.40); low Apgar scores (relative risk 0.28, 95% confidence interval 0.03 to 2.33) or neonatal death (relative risk 0.55, 95% confidence interval 0.05 to 5.77). In the amnioinfusion group, the number of severe fetal heart rate decelerations per hour during the first stage of labour were reduced (weighted mean difference -1.20, 95% confidence interval -1.83 to -0.57). These outcomes are consistent with those found in the Cochrane review on amnioinfusion for cord compression. There is not enough evidence concerning the use of amnioinfusion for preterm rupture of membranes.

Prophylactic versus therapeutic amnioinfusion for oligohydramnios in labour.

Amnioinfusion aims to relieve umbilical cord compression during labour by infusing a liquid into the uterine cavity. The objective of this review was to assess the effects of prophylactic amnioinfusion for oligohydramnios compared with therapeutic amnioinfusion only if fetal heart rate decelerations or thick meconium-staining of the liquor occur. The Cochrane Pregnancy and Childbirth Group trials register and Cochrane Controlled Trials Register were searched. Date of last search: October 1997. Randomised trials comparing prophylactic with therapeutic amnioinfusion in women with oligohydramnios but not fetal heart rate deceleration in labour. The reviewer assessed trial quality and extracted data. Two studies of 285 women were included. No differences were found in the rate of caesarean section (relative risk 0.98, 95% confidence interval 0.58 to 1.66), or forceps delivery. There were no difference in Apgar scores, cord arterial pH, oxytocin augmentation, meconium aspiration, neonatal pneumonia or postpartum endometritis. Prophylactic amnioinfusion was associated with increased intrapartum fever (relative risk 3.48, 95% confidence interval 1.21 to 10.05). There appears to be no advantage of prophylactic amnioinfusion over therapeutic amnioinfusion carried out only when fetal heart rate decelerations or thick meconium-staining of the liquor occur.

Amnioinfusion in women with previous cesarean births: A preliminary report

OBJECTIVE: Our purpose was to evaluate the use of intrapartum amnioinfusion in women undergoing a trial of labor after a previous cesarean delivery. STUDY DESIGN: Labor and delivery records of women undergoing intrapartum amnioinfusion over a 1-year period were reviewed retrospectively. Neonatal data were obtained by chart review. RESULTS: During the study period 936 women underwent intrapartum amnioinfusion for the following indications: oligohydramnios (76.6%), meconium-stained amniotic fluid (12.8%), and variable decelerations (7.5%). Among these, 122 (13%) had previous cesarean births. Seventy-one (58.2%) women were delivered vaginally; the remaining 51 (41.8%) were delivered by repeat cesarean. Among women undergoing intrapartum amnioinfusion there were no statistically significant differences ( p < 0.05) between those with previous cesarean births and those with unscarred uteri with respect to the following: cesarean section for fetal distress (1.6% vs 1.4%), meconium aspiration (0% vs 0.9%), or low 5-minute Apgar scores (2.5% vs 0.9%). There were no perinatal or maternal deaths in either group. One uterine rupture occurred in a woman with one previous cesarean birth. CONCLUSIONS: Amnioinfusion appears to be an acceptable procedure in women with previous cesarean births. The incidence of uterine rupture (0.8%) noted was similar to the 10-year institutional rate at Los Angeles County - University of Southern California Women's Hospital (0.7%). (A M J O BSTET G YNECOL 1996;174:783-6.)

Amnioinfusion in women with previous cesarean births: [formula omitted], x David A Miller MD, Richard H Paul MD University of Southern California School of Medicine, Los Angeles, CA

Amnioinfusion in women with previous cesarean births: [formula omitted], x David A Miller MD, Richard H Paul MD University of Southern California School of Medicine, Los Angeles, CA

Amnioinfusion and the intrauterine prevention of meconium aspiration

We evaluated the published literature on the effectiveness of amnioinfusion in reducing meconium below the vocal cords and meconium aspiration syndrome among infants born to women presenting with more than trace meconium-stained fluid. A literature search was conducted to evaluate clinical trials of amnioinfusion and meconium aspiration. Trials meeting certain basic design criteria (n = 5), which included a prospective study design and blinded assessment of newborn outcome, were selected for statistical analyses estimating the average effect's size and direction. In total, 247 women with meconium-stained fluid receiving amnioinfusion and 260 women with meconium-stained fluid not receiving amnioinfusion were represented by these trials. Infants born to women with meconium-stained fluid receiving amnioinfusion were less likely to have meconium below the vocal cords (odds ratio 0.13, 95% confidence interval 0.08 to 0.20) and were less likely to have meconium aspiration syndrome (odds ratio 0.20, 95% confidence interval 0.08 to 0.48) than were infants born to women with meconium-stained fluid not receiving amnioinfusion. Amnioinfusion appears to be an effective intrauterine intervention for the prevention of meconium aspiration. Clinicians should consider implementing amnioinfusion in women presenting with thick meconium to prevent intrapartal meconium aspiration in newborns.