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Meta-Analysis
. 2012 Jan 18;1(1):CD000013.
doi: 10.1002/14651858.CD000013.pub2.

Amnioinfusion for potential or suspected umbilical cord compression in labour

G Justus Hofmeyr  1 , Theresa A Lawrie
Affiliations
Meta-Analysis

Amnioinfusion for potential or suspected umbilical cord compression in labour

G Justus Hofmeyr et al. Cochrane Database Syst Rev. .

Abstract

Background: Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity.

Objectives: To assess the effects of amnioinfusion for potential or suspected umbilical cord compression on maternal and perinatal outcome .

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011).

Selection criteria: Randomised trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression in labour.

Data collection and analysis: The original review had one author only (Justus Hofmeyr (GJH)). For this update, two authors (GJH and T Lawrie) assessed 13 additional trial reports for eligibility and quality. We extracted data and checked for accuracy.

Main results: We have included 19 studies, with all but two studies having fewer than 200 participants. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: caesarean section overall (13 trials, 1493 participants; average risk ratio (RR) 0.62, 95% confidence interval (CI) 0.46 to 0.83); fetal heart rate (FHR) decelerations (seven trials, 1006 participants; average RR 0.53, 95% CI 0.38 to 0.74); Apgar score less than seven at five minutes (12 trials, 1804 participants; average RR 0.47, 95% CI 0.30 to 0.72); meconium below the vocal cords (three trials, 674 participants, RR 0.53, 95% CI 0.31 to 0.92); postpartum endometritis (six trials, 767 participants; RR 0.45, 95% CI 0.25 to 0.81) and maternal hospital stay greater than three days (four trials, 1051 participants; average RR 0.45, 95% CI 0.25 to 0.78). Transabdominal amnioinfusion showed similar trends, though numbers studied were small.Mean cord umbilical artery pH was higher in the amnioinfusion group (seven trials, 855 participants; average mean difference 0.03, 95% CI 0.00 to 0.06) and there was a trend toward fewer neonates with a low cord arterial pH (less than 7.2 or as defined by trial authors) in the amnioinfusion group (eight trials, 972 participants, average RR 0.58, 95% CI 0.29 to 1.14).

Authors' conclusions: The use of amnioinfusion for potential or suspected umbilical cord compression may be of considerable benefit to mother and baby by reducing the occurrence of variable FHR decelerations, improving short-term measures of neonatal outcome, reducing maternal postpartum endometritis and lowering the use of caesarean section, although there were methodological limitations to the trials reviewed here. In addition, the trials are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion. More research is needed to confirm the findings, assess longer-term measures of fetal outcome, and to assess the impact on caesarean section rates when the diagnosis of fetal distress is more stringent. Trials should assess amnioinfusion in specific clinical situations, such as FHR decelerations, oligohydramnios or prelabour rupture of membranes.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Funnel plot of comparison: 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM), outcome: 1.11 Caesarean section, overall.
2
2
Funnel plot of comparison: 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM), outcome: 1.2 Caesarean for suspected fetal distress.
3
3
Funnel plot of comparison: 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM), outcome: 1.14 Apgar score < 7 at 1 minute.
4
4
Funnel plot of comparison: 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, outcome: 1.12 Apgar score < 7 at 5 minutes.
5
5
Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.
6
6
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 1 Caesarean section, overall.
1.2
1.2. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 2 Caesarean for suspected fetal distress.
1.3
1.3. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 3 Forceps/vacuum‐suspected fetal distress.
1.4
1.4. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 4 Forceps or vacuum delivery, overall.
1.5
1.5. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 5 Persistent variable decelerations.
1.6
1.6. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 6 Variable FHR decelerations during second stage of labour.
1.7
1.7. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 7 Meconium‐stained amniotic fluid.
1.8
1.8. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 8 Umbilical cord prolapse.
1.9
1.9. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 9 Rupture of membranes to delivery interval (hours).
1.10
1.10. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 10 Intrapartum maternal temperature > 38ºC.
1.11
1.11. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 11 Apgar score < 7 at 1 minute.
1.12
1.12. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 12 Apgar score < 7 at 5 minutes.
1.13
1.13. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 13 'Mild' or 'severe' birth asphyxia.
1.14
1.14. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 14 Low cord arterial pH (< 7.2 or as defined by trial authors).
1.15
1.15. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 15 Neonatal sepsis.
1.16
1.16. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 16 Perinatal death.
1.17
1.17. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 17 Postpartum endometritis.
1.18
1.18. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 18 Umbilical cord arterial pH.
1.19
1.19. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 19 Meconium aspiration syndrome.
1.20
1.20. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 20 Admission to ICU/high‐care nursery.
1.21
1.21. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 21 Meconium below vocal cords.
1.22
1.22. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 22 Maternal hospital stay > 3 days.
1.23
1.23. Analysis
Comparison 1 Transcervical amnioinfusion for intrapartum umbilical cord compression (potential, or diagnosed by EFM)*, Outcome 23 Neonatal hospital stay > 3 days.
2.1
2.1. Analysis
Comparison 2 Transabdominal amnioinfusion for cord compression (potential, or diagnosed by fetal heart rate monitor), Outcome 1 Suspicious/ominous fetal heart rate pattern.
2.2
2.2. Analysis
Comparison 2 Transabdominal amnioinfusion for cord compression (potential, or diagnosed by fetal heart rate monitor), Outcome 2 Meconium‐stained liquor.
2.3
2.3. Analysis
Comparison 2 Transabdominal amnioinfusion for cord compression (potential, or diagnosed by fetal heart rate monitor), Outcome 3 Caesarean for suspected fetal distress.
2.4
2.4. Analysis
Comparison 2 Transabdominal amnioinfusion for cord compression (potential, or diagnosed by fetal heart rate monitor), Outcome 4 Caesarean section, overall.
2.5
2.5. Analysis
Comparison 2 Transabdominal amnioinfusion for cord compression (potential, or diagnosed by fetal heart rate monitor), Outcome 5 Forceps/vacuum delivery, overall.
2.6
2.6. Analysis
Comparison 2 Transabdominal amnioinfusion for cord compression (potential, or diagnosed by fetal heart rate monitor), Outcome 6 Apgar score < 7 at 5 minutes.
2.7
2.7. Analysis
Comparison 2 Transabdominal amnioinfusion for cord compression (potential, or diagnosed by fetal heart rate monitor), Outcome 7 Low cord pH (< 7.20 or as defined by trialists).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Regi 2009 {published and unpublished data}
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References to studies excluded from this review

McDermot 1998 {published data only}
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Hofmeyr 1995
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