WITHDRAWN: Amnioinfusion for meconium-stained liquor in labour.
BACKGROUND
Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. It is also thought to dilute meconium when present in the amniotic fluid and so reduce the risk of meconium aspiration. However, it may be that the mechanism of effect is that it corrects oligohydramnios (reduced amniotic fluid), for which thick meconium staining is a marker.


OBJECTIVE
The objective of this review was to assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome.


METHODS
The Cochrane Pregnancy and Childbirth Group trials register (October 2001) and the Cochrane Controlled Trials Register (Issue 3, 2001) were searched.


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


METHODS
Eligibility and trial quality were assessed by one reviewer.


RESULTS
Twelve studies, most involving small numbers of participants, were included. Under standard perinatal surveillance, amnioinfusion was associated with a reduction in the following: heavy meconium staining of the liquor (relative risk 0.03, 95% confidence interval 0.01 to 0.15); variable fetal heart rate deceleration (relative risk 0.65, 95% confidence interval 0.49 to 0.88); and reduced caesarean section overall (relative risk 0.82, 95% confidence interval 0.69 to 1.97). No perinatal deaths were reported. Under limited perinatal surveillance, amnioinfusion was associated with a reduction in the following: meconium aspiration syndrome (relative risk 0.24, 95% confidence interval 0.12 to 0.48); neonatal hypoxic ischaemic encephalopathy (relative risk 0.07, 95% confidence interval 0.01 to 0.56) and neonatal ventilation or intensive care unit admission (relative risk 0.56, 95% confidence interval 0.39 to 0.79); there was a trend towards reduced perinatal mortality (relative risk 0.34, 95% confidence interval 0.11 to 1.06).


CONCLUSIONS
Amnioinfusion is associated with improvements in perinatal outcome, particularly in settings where facilities for perinatal surveillance are limited. The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion.
Hofmeyr
G Justus
GJ
Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, East London, Eastern Cape, South Africa, 5200. gjh@global.co.za
D000650:Amnion; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007267:Injections; D008470:Meconium; D008471:Meconium Aspiration Syndrome / Q000517:prevention & control*; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic