The impact of a policy of amnioinfusion for meconium-stained amniotic fluid.
OBJECTIVE
To evaluate the impact of an amnioinfusion (AI) policy for thick or moderate meconium-stained amniotic fluid (AF) on neonatal outcome, specifically meconium-aspiration syndrome and its complications.


METHODS
We reviewed maternal and neonatal charts of 937 vertex, singleton pregnancies complicated by moderate or thick meconium-stained AF during a 3-year period. The patients were divided into groups according to whether AI was performed. Demographic characteristics, risk factors, mode of delivery, pregnancy outcome, and neonatal complications, including meconium-aspiration syndrome, were analyzed.


RESULTS
Four hundred forty patients (47%) received AI (AI group); 497 (53%) did not, for the following reasons: imminent delivery (310 patients), occult meconium (141), or emergency cesarean delivery (46) (no-AI group). Our study did not show any reduction in the incidence of 5-minute Apgar scores of 7 or less (8 versus 7%), meconium below the vocal cords (28 versus 29%), meconium aspiration syndrome (4.5 versus 3.8%), ventilation requirement (4.3 versus 2.4%), or neonatal death (0.7 versus 0.2%) in the AI and no-AI groups, respectively. The AI group had a higher incidence of fetal heart rate abnormalities in labor (48 versus 31%, P < .05), instrumental delivery (15 versus 8%, P < .05), cesarean delivery (28 versus 17%, P < .001), and endometritis (21 versus 13%, P = .004).


CONCLUSIONS
With the policy of routine AI for moderate or thick meconium-stained AF, AI was not clinically feasible in 53% of the cases. We were unable to demonstrate any improvement in neonatal outcome in those who received AI for moderate or thick meconium.
Usta
I M
IM
Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
Mercer
B M
BM
Aswad
N K
NK
Sibai
B M
BM
D000328:Adult; D000653:Amniotic Fluid; D001034:Apgar Score; D036861:Delivery, Obstetric; D005260:Female; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D007263:Infusions, Parenteral; D008471:Meconium Aspiration Syndrome / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012121:Respiration, Artificial; D012965:Sodium Chloride / Q000008:administration & dosage
D012965:Sodium Chloride