Table 9 Impact of amnioinfusion on stillbirth and perinatal outcomes

Hofmeyr 2002 [124]

South Africa, Zimbabwe, USA.

Meta-analysis (Cochrane). 8 RCTs included (N = 1,481 women).

To assess the effects of amnioinfusion for meconium-stained liquor (intervention) vs. no amnioinfusion (controls) on perinatal outcome.

PMR: RR = 0.34 (95% CI: 0.11 – 1.06) [NS].

[4/727 vs. 12/754 in intervention and control groups, respectively].

Hofmeyr 1998 [125]

USA.

Meta-analysis (Cochrane). 8 RCTs included (N = 584 women).

To assess the effects of amnioinfusion (intervention) vs. no amnioinfusion (controls) on maternal and perinatal outcome for potential or suspected umbilical cord compression or potential amnionitis.

PMR: RR = 0.51 (95% CI: 0.11 – 2.24) [NS].

[2/301 vs. 4/283 in intervention and control groups, respectively].

Intervention studies

Ashfaq 2004 [130]

Pakistan (Karachi). Jinnah Postgraduate Medical Centre.

Matched case control study. N = 400 patients between 1^st January 1998 to 31^st December 2000 (N = 200 intervention group, N = 200 controls) with meconium staining of liquor.

Compared the impact on fetal outcome of amnioinfusion (intervention) vs. no amnioinfusion (controls) in cases of meconium staining.

SBR: 0/200 vs. 8/200 (4%) in intervention and control groups, respectively.

PMR/perinatal morbidity: 6% vs. 14% in intervention and control groups, respectively (statistically significant).

Das et al. 2007 [133]

India (West Bengal).

Prospective comparative study. Women (N = 150) who were in labour and had meconium-stained amniotic fluid (N = 50 intervention group, N = 100 controls).

Compared the impact of transcervical amnioinfusion (intervention) vs. standard care (controls).

PMR: RR = 0.31 (95% CI: 0.07 – 1.31) [NS].

[2/50 (4%) vs. 13/100 (13%) in intervention and control groups, respectively].

Fraser et al. 2005 [129]

13 countries. Multicentered (56 centers).

RCT. Pregnant women (N = 1998) in labour at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid. (81.3% of these women did not have recurrent variable decelerations in fetal heart rate on monitoring). N = 995 intervention group, N = 1003 controls).

Compared the impact of transcervical amnioinfusion (800 ml saline over 40 min, followed by 2 ml/min to 1500 ml max; intervention) vs. standard care (no amnioinfusion) (controls). Women were assessed by continuous monitoring of intrauterine pressure or by uterine palpation at 15-minute intervals for signs of uterine overdistention or hypertonic contractions. Continuous electronic fetal heart-rate monitoring was performed in both groups.

PMR: RR = 1.00 (95% CI: 0.29 – 3.45) [NS].

[N = 5 (0.5%) vs. N = 5 (0.5%) in intervention and control groups, respectively].

PMR, moderate or severe meconium aspiration syndrome, or both: RR = 1.26 (95% CI: 0.82 – 1.95) [NS].

[44/986 (4.5%) vs. 35/989 (3.5%) in intervention and control groups, respectively].

Kirubamani 2000. [132]

India.

RCT. N = 50 labouring women with clinically analysed meconium (light, moderate, thick) (N = 30 intervention group, N = 20 controls).

Compared the impact on perinatal mortality of amnioinfusion with warm saline at room temperature, along with standard obstetric care (intervention) vs. standard care only without amnioinfusion (controls).

PMR: 0/30 vs. 1/20 in intervention and control groups, respectively.

Mukhopadhyay et al. 2006 [153]

India.

Quasi-RCT. N = 200 women (N = 100 in each group).

Compared the impact on perinatal mortality of intraamniotic infusion of normal saline (intervention) vs. no amnioinfusion (controls).

PMR: 2/93 (2.1%) vs. 3/93 (3.2%) in intervention and control groups, respectively; P = 0.9748.

Rathore et al. 2002 [134]

India.

RCT. Women (N = 200) during labour with meconium stained amniotic fluid (N = 100 in each group).

Assessed the effect on perinatal deaths of amnioinfusion (intervention) vs. no amnioinfusion (controls).

PMR: 2 vs. 5 deaths in intervention and control groups, respectively.

SBR: 1 death in each group.

Early NMR (excluding malformations): 0 vs. 1 death in intervention and control groups, respectively.

Observational studies

Chhabra et al. 2007 [128]

India.

Case-control study. Pregnant women (N = 100) with oligohydramnios (N = 50 study group, N = 50 controls).

Compared the impact of antepartum transabdominal amnioinfusion (cases) vs. conservative treatment without amnioinfusion (controls).

PMR: 4% vs. 18% in cases and controls, respectively (statistically significant).

Das 2001 [154]

India.

Prospective case control study. Women (N = 290); (N = 100 amnioinfusion group, N = 190 controls).

Compared the impact on perinatal mortality of amnioinfusion (intervention) vs. no amnioinfusion (controls).

PMR: 1/100 vs. 16/190 in amnioinfusion and control groups, respectively; P = 0.01.

De Santis et al. 2003 [127]

Italy. Tertiary care center.

Quasi-RCT. Women (N = 71) with pre-term premature rupture of membranes (pPROM) at <26 weeks of gestational age (N = 37 amnioinfusion group, N = 34 controls).

Compared the impact on fetal survival of serial transabdominal amnioinfusion with saline every 7 days in case of persistent oligohydramnios (intervention) vs. expectant management (controls).

Intrauterine fetal survival: 24/37 (64.8%) vs. 11/34 (32.3%) in intervention and control groups, respectively, p < 0.01.

Halvax 2002 [155]

Hungary. Tertiary referral hospital (University of Pecs).

Retrospective analysis. N = 228 women (N = 118 amnioinfusion group, N = 110 controls).

Compared the impact of simultaneous use of fetal pulse oximetry and amnioinfusion in meconium stained amniotic fluid (intervention) vs. no amnioinfusion (controls). All monitored with cardiotocography.

Meconium below the vocal cords: 0% vs. 10.1% in intervention and control groups, respectively; P < 0.01.

Operative delivery rate: 22.0% vs. 30.9% in intervention and control groups, respectively; P < 0.05.

Sahu 2003 [131]

India.

Prospective case-control study. Women (N = 250) having meconium stained amniotic fluid during labour (N = 100 amnioinfusion group, N = 150 controls.

Compared the impact on perinatal mortality of amnioinfusion (study group) vs. no amnioinfusion (controls).

PMR: 1/100 (1%) vs. 12/150 (8%) in the study and control groups, respectively; P = 0.01.