Amnioinfusion for the prevention of the meconium aspiration syndrome.
BACKGROUND
It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death, moderate or severe meconium aspiration syndrome, or both.


METHODS
We performed a multicenter trial in which 1998 pregnant women in labor at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid were stratified according to the presence or absence of variable decelerations in fetal heart rate and then randomly assigned to amnioinfusion or to standard care. The composite primary outcome measure was perinatal death, moderate or severe meconium aspiration syndrome, or both.


RESULTS
Perinatal death, moderate or severe meconium aspiration syndrome, or both occurred in 44 infants (4.5 percent) of women in the amnioinfusion group and 35 infants (3.5 percent) of women in the control group (relative risk, 1.26; 95 percent confidence interval, 0.82 to 1.95). Five perinatal deaths occurred in the amnioinfusion group and five in the control group. The rate of cesarean delivery was 31.8 percent in the amnioinfusion group and 29.0 percent in the control group (relative risk, 1.10; 95 percent confidence interval, 0.96 to 1.25).


CONCLUSIONS
For women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal disorders.
Fraser
William D
WD
Department of Obstetrics and Gynecology, Hôpital Sainte-Justine, Université de Montréal, Montreal, QC, Canada. william.fraser@umontreal.ca
Hofmeyr
Justus
J
Lede
Roberto
R
Faron
Gilles
G
Alexander
Sophie
S
Goffinet
François
F
Ohlsson
Arne
A
Goulet
Céline
C
Turcot-Lemay
Lucile
L
Prendiville
Walter
W
Marcoux
Sylvie
S
Laperrière
Louise
L
Roy
Chantal
C
Petrou
Stavros
S
Xu
Hai-Rong
HR
Wei
Bin
B
D000653:Amniotic Fluid; D005260:Female; D005316:Fetal Distress; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control; D007263:Infusions, Parenteral; D008471:Meconium Aspiration Syndrome / Q000517:prevention & control*; D007744:Obstetric Labor Complications / Q000628:therapy*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012965:Sodium Chloride / Q000627:therapeutic use*; D017211:Treatment Failure
D012965:Sodium Chloride