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Meta-Analysis
. 2014 Jan 23;2014(1):CD000014.
doi: 10.1002/14651858.CD000014.pub4.

Amnioinfusion for meconium-stained liquor in labour

G Justus Hofmeyr  1 , Hairong Xu, Ahizechukwu C Eke
Affiliations
Meta-Analysis

Amnioinfusion for meconium-stained liquor in labour

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

Abstract

Background: Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration.

Objectives: To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013).

Selection criteria: Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium staining of the amniotic fluid.

Data collection and analysis: Three review authors independently assessed eligibility and trial quality, and extracted data.

Main results: Fourteen studies of variable quality (4435 women) are included.Subgroup analysis was performed for studies from settings with limited facilities to monitor the baby's condition during labour and intervene effectively, and settings with standard peripartum surveillance.Settings with standard peripartum surveillance: there was considerable heterogeneity for several outcomes. There was no significant reduction in the primary outcomes meconium aspiration syndrome, perinatal death or severe morbidity, and maternal death or severe morbidity. There was a reduction in caesarean sections (CSs) for fetal distress but not overall. Meconium below the vocal cords diagnosed by laryngoscopy was reduced, as was neonatal ventilation or neonatal intensive care unit admission, but there was no significant reduction in perinatal deaths or other morbidity. Planned sensitivity analysis excluding trials with greater risk of bias resulted in an absence of benefits for any of the outcomes studied.Settings with limited peripartum surveillance: three studies were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (three studies, 1144 women; risk ratio (RR) 0.17, 95% confidence interval (CI) 0.05 to 0.52); perinatal mortality (three studies, 1151 women; RR 0.24, 95% CI 0.11 to 0.53) and neonatal ventilation or neonatal intensive care unit admission. In one of the studies, meconium below the vocal cords was reduced and, in the other, neonatal encephalopathy was reduced.

Authors' conclusions: Amnioinfusion is associated with substantive improvements in perinatal outcome only in settings where facilities for perinatal surveillance are limited. It is not clear whether the benefits are due to dilution of meconium or relief of oligohydramnios.In settings with standard peripartum surveillance, some non-substantive outcomes were improved in the initial analysis, but sensitivity analysis excluding trials with greater risk of bias eliminated these differences. Amnioinfusion is either ineffective in this setting, or its effects are masked by other strategies to optimise neonatal outcome.The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.

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Conflict of interest statement

G J Hofmeyr is an author of studies considered for inclusion in the review and has not participated in decisions regarding these studies.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 1 Meconium aspiration syndrome.
1.2
1.2. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 2 Perinatal death or serious morbidity (post hoc).
1.3
1.3. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 3 Maternal death or serious morbidity (post hoc).
1.4
1.4. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 4 Heavy meconium staining.
1.5
1.5. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 5 Variable decelerations.
1.6
1.6. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 6 Caesarean for fetal distress.
1.7
1.7. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 7 Caesarean overall.
1.8
1.8. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 8 1‐minute Apgar < 4.
1.9
1.9. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 9 1‐minute Apgar < 7.
1.10
1.10. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 10 5‐minute Apgar < 7.
1.11
1.11. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 11 Umbilical artery pH < 7.20.
1.12
1.12. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 12 Meconium below vocal cords.
1.13
1.13. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 13 Neonatal ventilation/neonatal intensive care unit admission.
1.14
1.14. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 14 Neonatal encephalopathy.
1.15
1.15. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 15 Perinatal death.
1.16
1.16. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 16 Puerperal pyrexia.
1.17
1.17. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 17 Puerperal endometritis.
1.18
1.18. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 18 Oxytocin augmentation.
1.19
1.19. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 19 Narcotic analgesic.
1.20
1.20. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 20 Epidural analgesia.
1.21
1.21. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 21 First stage labour (minutes).
1.22
1.22. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 22 Instrumental vaginal delivery for fetal distress.
1.23
1.23. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 23 Instrumental vaginal delivery.
1.25
1.25. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 25 Respiratory Distress (post hoc).
1.26
1.26. Analysis
Comparison 1 Amnioinfusion for meconium‐stained liquor in labour, Outcome 26 Mean maternal hospital stay (post hoc).
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Update of

References

References to studies included in this review

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