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G J Hofmeyr - One of the best experts on this subject based on the ideXlab platform.
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withdrawn Amnioinfusion for meconium stained liquor in labour
Cochrane Database of Systematic Reviews, 2009Co-Authors: G J HofmeyrAbstract: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. OBJECTIVES The objective of this review was to assess the effects of Amnioinfusion for meconium-stained liquor on perinatal outcome. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register (October 2001) and the Cochrane Controlled Trials Register (Issue 3, 2001) were searched. 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 Eligibility and trial quality were assessed by one reviewer. MAIN 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). AUTHORS' 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.
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external cephalic version facilitation for breech presentation at term
Cochrane Database of Systematic Reviews, 2001Co-Authors: G J HofmeyrAbstract:Background Tocolytic drugs to relax the uterus as well as other methods have been also used in an attempt to facilitate external cephalic version at term. Objectives The objective of this review is to assess the effects of routine tocolysis, fetal acoustic stimulation, epidural or spinal analgesia and transabdominal Amnioinfusion for external cephalic version at term on successful version and measures of pregnancy outcome. Search strategy The Cochrane Pregnancy and Childbirth Group Trials Register and the Cochrane Controlled Trials Register were searched. Date of last search: April 2001. Selection criteria Randomised and quasi-randomised trials comparing routine versus selective tocolysis; fetal acoustic stimulation in midline fetal spine positions versus dummy or no stimulation; epidural or spinal analgesia versus no regional analgesia; or transabdominal Amnioinfusion versus no Amnioinfusion for external cephalic version at term. Data collection and analysis Eligibility and trial quality were assessed by the reviewer. Main results In seven trials, routine tocolysis was associated with fewer failures of external cephalic version (relative risk 0.74, 95% confidence interval 0.64 to 0.87). There were no significant differences between non-cephalic presentations at birth. Caesarean sections were reduced (relative risk 0.85, confidence interval 0.72-0.99). Fetal acoustic stimulation in midline fetal spine positions was associated with fewer failures of external cephalic version at term (relative risk 0.17, 95% confidence interval 0.05 to 0.60). With epidural or spinal analgesia, external cephalic version failure, non-cephalic births and caesarean sections were reduced in one trial but not the other. The overall differences were not statistically significant. No randomised trials of transabdominal Amnioinfusion for external cephalic version at term were located. Reviewer's conclusions Routine tocolysis appears to reduce the failure rate of external cephalic version at term. Although promising, there is not enough evidence to evaluate the use of fetal acoustic stimulation in midline fetal spine positions, nor of epidural or spinal analgesia. Large volume intravenous preloading may have contributed to the effectiveness demonstrated in one of the latter trials. No randomised trials of transabdominal Amnioinfusion for external cephalic version at term were found.
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Amnioinfusion for umbilical cord compression in labour
Cochrane Database of Systematic Reviews, 2000Co-Authors: G J HofmeyrAbstract:Background Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. Objectives The objective of this review was to assess the effects of Amnioinfusion on maternal and perinatal outcome for potential or suspected umbilical cord compression or potential amnionitis. Search strategy The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Selection criteria Randomised trials of Amnioinfusion compared with no Amnioinfusion in women with babies at risk of umbilical cord compression; and women at risk of intrauterine infection. Data collection and analysis Eligibility and trial quality were assessed by the reviewer. Main results Twelve studies were included. Transcervical Amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: fetal heart rate decelerations (relative risk 0.54, 95% confidence interval 0.43 to 0.68); caesarean section for suspected fetal distress (relative risk 0.35, 95% confidence interval 0.24 to 0.52); neonatal hospital stay greater than 3 days (relative risk 0.40, 95% confidence interval 0. 26 to 0.62); maternal hospital stay greater than 3 days (relative risk 0.46, 95% 0.29 to 0.74). Transabdominal Amnioinfusion showed similar results. Transcervical Amnioinfusion to prevent infection in women with membranes ruptured for more than 6 hours was associated with a reduction in puerperal infection (relative risk 0.50, 95% confidence interval 0.26 to 0.97). Reviewer's conclusions Amnioinfusion appears to reduce the occurrence of variable heart rate decelerations and lower the use of caesarean section. However the studies were done in settings where fetal distress was not confirmed by fetal blood sampling. The results may therefore only be relevant where caesarean sections are commonly done for abnormal fetal heart rate alone. The trials reviewed are too small to address the possibility of rare but serious maternal adverse effects of Amnioinfusion.
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the collaborative randomised Amnioinfusion for meconium project cramp 2 zimbabwe
British Journal of Obstetrics and Gynaecology, 1998Co-Authors: K Mahomed, G J Hofmeyr, T Mulambo, G Woelk, A M GulmezogluAbstract:The presence of meconium in the amniotic fluid is associated with increased perinatal morbidity and mortality. Saline Amnioinfusion during labor has been shown in several clinical trials to reduce the incidence of cesarean section and meconium aspiration syndrome. A randomized controlled trial conducted at Harare Maternity Hospital in Zimbabwe sought to confirm the benefits of Amnioinfusion for meconium-stained amniotic fluid during labor for perinatal outcome. In the intervention group (n = 325) 500 ml of saline was transcervically amnioinfused over a 30-minute period followed by 500 ml at 30 drops per minute for the duration of labor. The control group (n = 336) received routine obstetric care. The cesarean section rate was 9.5% in the intervention group and 12.3% in the control group (relative risk (RR) 0.84; 95% confidence interval (CI) 0.53-1.32). Meconium aspiration syndrome was significantly less frequent in the Amnioinfusion group (3.1%) than the control group (12.8%) (RR 0.24; 95% CI 0.12-0.48). The perinatal death rate was 1.2% in the Amnioinfusion group and 3.6% among controls (RR 0.34; 95% CI 0.11-1.06). Also recorded in the Amnioinfusion group were significant reductions in the following perinatal morbidity measures: 5-minute Apgar score below 7 neonatal intensive care admissions neonatal ventilation and hypoxic ischemic encephalopathy. The striking improvements in perinatal outcome recorded among women in the Amnioinfusion group suggest the feasibility of more widespread use of this simple procedure in developing country settings without routine electronic fetal monitoring facilities.
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the collaborative randomised Amnioinfusion for meconium project cramp 1 south africa
British Journal of Obstetrics and Gynaecology, 1998Co-Authors: G J Hofmeyr, A M Gulmezoglu, E J Buchmann, G R Howarth, A Shaw, V C Nikodem, H Cronje, M De Jager, K MahomedAbstract:Numerous clinical trials have indicated that Amnioinfusion for potential or suspected umbilical cord compression reduces the frequency of fetal heart rate decelerations and cesarean section. The present study conducted at four urban teaching hospitals in South Africa further evaluated the benefits of transcervical Amnioinfusion for meconium-stained amniotic fluid during labor on perinatal outcome. In the intervention group (n = 176) 800 ml of saline was amnioinfused at 15 ml/minute followed by a maintenance dose of 3 ml/minute for the duration of labor. The control group (n = 176) received routine obstetric care. There were 70 cesarean sections in the Amnioinfusion group and 68 in the control group (relative risk (RR) 0.98; 95% confidence interval (CI) 0.76-1.26). The prevalence of meconium aspiration syndrome was unexpectedly low: 4 cases in the intervention group and 6 cases in the control group (RR 0.67; 95% CI 0.19-2.33). There were no perinatal deaths in either group. Subsidiary outcomes (e.g. Apgar score assisted delivery cord pH neonatal ventilation) did not differ between groups. These findings provide preliminary support for use of Amnioinfusion in women whose fetuses are considered at risk of meconium aspiration syndrome. A similar study conducted in Zimbabwe demonstrated larger effects of Amnioinfusion on reductions in cesarean section meconium aspiration syndrome and perinatal mortality.
Richard H Paul - One of the best experts on this subject based on the ideXlab platform.
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Amnioinfusion in women with previous cesarean births a preliminary report
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Joseph G Ouzounian, David A Miller, Richard H PaulAbstract:Abstract OBJECTIVE: Our purpose was to evaluate the use of intrapartum Amnioinfusion in women undergoing a trial of labor after a previous cesarean delivery. STUDY DESIGN: Labor and delivery records of women undergoing intrapartum Amnioinfusion over a 1-year period were reviewed retrospectively. Neonatal data were obtained by chart review. RESULTS: During the study period 936 women underwent intrapartum Amnioinfusion for the following indications: oligohydramnios (76.6%), meconium-stained amniotic fluid (12.8%), and variable decelerations (7.5%). Among these, 122 (13%) had previous cesarean births. Seventy-one (58.2%) women were delivered vaginally; the remaining 51 (41.8%) were delivered by repeat cesarean. Among women undergoing intrapartum Amnioinfusion there were no statistically significant differences ( p CONCLUSIONS: Amnioinfusion appears to be an acceptable procedure in women with previous cesarean births. The incidence of uterine rupture (0.8%) noted was similar to the 10-year institutional rate at Los Angeles County - University of Southern California Women's Hospital (0.7%). (AM J OBSTET GYNECOL 1996;174:783-6.)
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neonatal pulmonary mechanics and oxygenation after prophylactic Amnioinfusion in labor a randomized clinical trial
Pediatrics, 1995Co-Authors: Cindy T Mcevoy, Charles Macri, Richard H Paul, Smeeta Sardesai, Manuel DurandAbstract:Objective. Amnioinfusion has been reported to improve the perinatal outcome of pregnancies complicated by decreased amniotic fluid volume, but detailed information on its possible adverse effects on neonatal pulmonary mechanics and oxygenation is not available. Study design. We evaluated 42 infants with birth weights of 2600 to 4320 g and gestational ages of 36 to 44 weeks, who were born to mothers enrolled in a prospective, randomized trial of Amnioinfusion for oligohydramnios in labor. Maternal entry criteria were gestational age 36 weeks or older, estimated fetal weight more than 2500 g, oligohydramnios defined as an amniotic fluid index of 5 cm or less, and a normal fetal heart rate pattern. Evaluation of pulmonary mechanics and oxygen saturation (SaO 2 ) was done with the infants breathing room air between birth and day 3 of life. Transpulmonary pressure, flow, and tidal volume were recorded simultaneously, and pulmonary resistance and lung compliance were calculated. SaO 2 was measured for 30 minutes with the Nellcor N-200 oximeter and IBM computer oximetry software. Results. Evaluation of the data revealed no significant difference between the two groups for tidal volume, lung compliance, pulmonary resistance, or work of breathing. There were no differences between the two groups in the number of desaturation episodes or in percent of desaturations to less than 90%, 85%, or 80% SaO 2 . Conclusion. Prior studies have shown Amnioinfusion to improve perinatal outcome. Our findings demonstrate that Amnioinfusion for oligohydramnios in labor does not adversely affect neonatal pulmonary mechanics or oxygenation
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prophylactic Amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios
American Journal of Obstetrics and Gynecology, 1992Co-Authors: Charles Macri, David B Schrimmer, Anna Leung, Jeffrey S Greenspoon, Richard H PaulAbstract:Objective: The null hypothesis is that the use of intrapartum Amnioinfusion in labors complicated by the presence of thick meconium and oligohydramios will not decrease the incidence of fetal distress, cesarean delivery, meconium aspiration, or meconium aspiration syndrome. Study Design: One hundred seventy term and postterm patients with thick meconium and oligohydramnios were randomly chosen to receive Amnioinfusion or standard obstetric care without Amnioinfusion. The frequency of fetal distress, cesarean section, meconium aspiration, and meconium aspiration syndrome were subject to χ 2 analysis, Student's t test, or Fisher's exact test. Results: The rate of fetal distress was significantly reduced in the Amnioinfusion group compared with controls (three of 85 vs 19 of 85, relative risk 0.15, 95% confidence interval 0.06 to 0.42). The rate of cesarean section for fetal distress was significantly reduced in the Amnioinfusion group (two of 85 vs 17 of 85, relative risk 0.118, confidence interval 0.03 to 0.49). The rates of meconium aspiration (four of 85 vs 33 of 85, relative risk 0.12, confidence interval 0.0449 to 0.327) and meconium aspiration syndrome (0 of 85 vs five of 85, relative risk 0.09, confidence interval 0.009 to 0.872) were significantly reduced by Amnioinfusion. Conclusions: Amnioinfusion improves the outcome in pregnancies complicated by thick meconium and oligohydramnios.
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prophylactic Amnioinfusion as a treatment for oligohydramnios in laboring patients a prospective randomized trial
American Journal of Obstetrics and Gynecology, 1991Co-Authors: David B Schrimmer, Charles Macri, Richard H PaulAbstract:Abstract Prophylactic Amnioinfusion was studied in a randomized sample of 305 patients with oligohydramnios in labor. One hundred seventy-five patients underwent Amnioinfusion with the remainder serving as controls. Amniotic fluid was titrated to an amniotic fluid index τ10.0 em in the treatment group. Patients receiving Amnioinfusion had significantly less operative intervention for fetal distress ( p = 0.0001) and fewer cesarean sections ( p = 0.0001). Umbilical artery pH at the time of delivery also was increased ( p = 0.0001). Rates of amnionitis and endometritis were not significantly different between infused patients and controls, although the length of hospital stay was significantly decreased ( p = 0.002) in the treatment group. Our data support earlier reports in the literature that Amnioinfusion is a useful technique for decreasing intrapartum morbidity for both mother and fetus.
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prophylactic intrapartum Amnioinfusion a randomized clinical trial
International Journal of Gynecology & Obstetrics, 1991Co-Authors: T H Strong, Gretchen Hetzler, Albert P Sarno, Richard H PaulAbstract:Amnioinfusion was performed in a prospective, randomized trial of 60 women in the latent phase of labor with oligohydramnios, as defined by an amniotic fluid index ≤5.0 cm. All fetuses were at least 37 weeks' gestational age, had normal baseline fetal heart rate variability, and no clinically significant fetal heart rate decelerations at the outset. Subjects in the Amnioinfusion group ( n = 30) were titrated to and maintained at an amniotic fluid index level ≥8.0 cm throughout labor. In the group receiving Amnioinfusion, significantly lower rates of meconium passage ( p = 0.04), severe variable decelerations ( p = 0.04), end-stage bradycardia ( p = 0.05), and operative delivery for fetal distress ( p = 0.002) occurred. Significantly higher umbilical arterial blood pH values were also noted in the infusion group ( p = 0.02). We conclude that prophylactic intrapartum Amnioinfusion is an important technique for the reduction of intrapartum morbidity.
Justus G Hofmeyr - One of the best experts on this subject based on the ideXlab platform.
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Amnioinfusion for chorioamnionitis
Cochrane Database of Systematic Reviews, 2016Co-Authors: Justus G Hofmeyr, Joseph A K KiizaAbstract:Background Chorioamnionitis is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims at reducing the adverse effects of chorioamnionitis by dilution of the infective organisms or by an anti-microbial effect of the fluid infused. Objectives The objective of this review was to determine the effect of Amnioinfusion on clinical and sub-clinical chorioamnionitis, fetal well-being, fetal heart rate characteristics and perinatal and maternal morbidity and mortality. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2016), PubMed, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 July 2016) and reference lists of retrieved studies. Selection criteria Randomised clinical trials (RCTs) of Amnioinfusion (treatment group) versus no Amnioinfusion in women with chorioamnionitis. We would have also considered trials comparing Amnioinfusion with sham Amnioinfusion; different types or volumes of Amnioinfusion fluid but none were identified. Cluster-RCTs and quasi-RCTs were eligible for inclusion but none were identified. We identified one study published in abstract form but it did not contain any numerical data and has therefore been excluded. Studies using a cross-over design are not an appropriate study design and thus were not eligible for inclusion in this review. Data collection and analysis Two review authors independently assessed potential studies for inclusion and assessed trial quality. Both review authors independently extracted data and data were checked for accuracy. Main results We included one small trial (with data from 34 participants) comparing transcervical Amnioinfusion with no Amnioinfusion. The trial was considered to be at a high risk of bias overall, due to small numbers, inconsistency in the reporting and lack of information on blinding. Meta-analysis was not possible. Transcervical Amnioinfusion was with room temperature saline at 10 mL per minute for 60 minutes, then 3 mL per minute until delivery versus no Amnioinfusion. All women received intrauterine pressure catheter, acetaminophen and antibiotics (ampicillin or, if receiving Group B beta streptococcal prophylaxis, penicillin and gentamycin). We did not identify any trials that used transabdominal Amnioinfusion. Compared to no Amnioinfusion, transcervical Amnioinfusion had no clear effect on the incidence of postpartum endometritis (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.29 to 7.87; absolute risk 176/1000 (95% CI 34 to 96) versus 118/1000;low-quality evidence). Nor was there a clear effect in the incidence of neonatal infection (RR 3.00, 95% CI 0.13 to 68.84; absolute risk 0/1000 (95% CI 0 to 0) versus 0/1000; low-quality evidence). The outcome of perinatal death or severe morbidity (such as neonatal encephalopathy, intraventricular haemorrhage, admission to intensive/high care) was not reported in the included trial. In terms of this review's secondary outcomes, the rate of caesarean section was the same in both groups (RR 1.00, 95% CI 0.35 to 2.83; absolute risk 294/1000 (95% CI 103 to 832) versus 294/1000; low-quality evidence). There was no clear difference in the duration of maternal antibiotic treatment between the Amnioinfusion and no Amnioinfusion control group (mean difference (MD) 16 hours, 95% CI -1.75 to 33.75); nor in the duration of hospitalisation (MD 3.00 hours, 95% CI -15.49 to 21.49). The study did not report any information about how many babies had a low Apgar score at five minutes after birth. Women in the Amnioinfusion group had a lower temperature at delivery compared to women in the control group (MD -0.38°C, 95% CI -0.74 to -0.02) but this outcome was not pre-specified in the protocol for this review. The majority of this review's secondary outcomes were not reported in the included study. Authors' conclusions There is insufficient evidence to fully evaluate the effectiveness of using transcervical Amnioinfusion for chorioamnionitis and to assess the safety of this intervention or women’s satisfaction. We did not identify any trials that used transabdominal Amnioinfusion. The evidence in this review can neither support nor refute the use of transcervical Amnioinfusion outside of clinical trials. We included one small study that reported on a limited number of outcomes of interest in this review. The numbers included in this review are too small for meaningful assessment of substantive outcomes, where reported. For those outcomes we assessed using GRADE (postpartum endometritis, neonatal infection, and caesarean section), we downgraded the quality of the evidence to low - with downgrading decisions based on small numbers and a lack of information on blinding. The included study did not report on this review's other primary outcome (perinatal death or severe morbidity). The reduction in pyrexia, though not a pre-specified outcome of this review, may be of relevance in terms of benefits to the fetus of reduced exposure to heat. We postulate that the temperature reduction found may be a direct cooling effect of Amnioinfusion with room temperature fluid, rather than reduction of infection. Larger trials are needed to confirm and extend the findings of the trial reviewed here. These should be randomised controlled trials; participants, women with chorioamnionitis; interventions, Amnioinfusion; comparisons, no Amnioinfusion; outcomes, maternal and perinatal outcomes including neurodevelopmental measures. Further research is justified to determine possible benefits or risks of Amnioinfusion for chorioamnionitis, and to investigate possible benefits of reducing temperature in fetuses considered at risk of neurological damage. Research should include randomised trials to examine transcervical or transabdominal Amnioinfusion compared with no infusion for chorioamnionitis and examine outcomes listed in the methods of this review.
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Amnioinfusion for third trimester preterm premature rupture of membranes
Cochrane Database of Systematic Reviews, 2014Co-Authors: Justus G Hofmeyr, Ahizechukwu C Eke, Theresa A LawrieAbstract:Background Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. Objectives The objective of this review was to assess the effects of Amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2013). Selection criteria Randomised trials of Amnioinfusion compared with no Amnioinfusion in women with PPROM. Data collection and analysis Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. Main results We included five trials, of moderate quality, but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review. Transcervical Amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants). Transabdominal Amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26; 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the Amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. Authors' conclusions These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before Amnioinfusion for PPROM can be recommended for routine clinical practice.
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Amnioinfusion for meconium stained liquor in labour
Cochrane Database of Systematic Reviews, 2014Co-Authors: Justus G Hofmeyr, Ahizechukwu C EkeAbstract: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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prophylactic versus therapeutic Amnioinfusion for oligohydramnios in labour
Cochrane Database of Systematic Reviews, 2012Co-Authors: Natalia Novikova, Justus G Hofmeyr, George EssilfieappiahAbstract:Background Amnioinfusion aims to relieve umbilical cord compression during labour by infusing a liquid into the uterine cavity. Objectives The objective of this review was to assess the effects of prophylactic Amnioinfusion for oligohydramnios compared with therapeutic Amnioinfusion only if fetal heart rate decelerations or thick meconium-staining of the liquor occur. Search strategy The Cochrane Pregnancy and Childbirth Group trials register and Cochrane Controlled Trials Register were searched. Date of last search: October 1997. Selection criteria Randomised trials comparing prophylactic with therapeutic Amnioinfusion in women with oligohydramnios but not fetal heart rate deceleration in labour. Data collection and analysis The reviewer assessed trial quality and extracted data. Main results Two studies of 285 women were included. No differences were found in the rate of caesarean section (relative risk 0.98, 95% confidence interval 0.58 to 1.66), or forceps delivery. There were no difference in Apgar scores, cord arterial pH, oxytocin augmentation, meconium aspiration, neonatal pneumonia or postpartum endometritis. Prophylactic Amnioinfusion was associated with increased intrapartum fever (relative risk 3.48, 95% confidence interval 1.21 to 10.05). Reviewer's conclusions There appears to be no advantage of prophylactic Amnioinfusion over therapeutic Amnioinfusion carried out only when fetal heart rate decelerations or thick meconium-staining of the liquor occur.
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Amnioinfusion for potential or suspected umbilical cord compression in labour
Cochrane Database of Systematic Reviews, 2012Co-Authors: Justus G Hofmeyr, Theresa A LawrieAbstract:Background Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. Objectives To assess the effects of Amnioinfusion for potential or suspected umbilical cord compression on maternal and perinatal outcome . Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011). Selection criteria Randomised trials of Amnioinfusion compared with no Amnioinfusion in women with babies at risk of umbilical cord compression in labour. Data collection and analysis The original review had one author only (Justus Hofmeyr (GJH)). For this update, two authors (GJH and T Lawrie) assessed 13 additional trial reports for eligibility and quality. We extracted data and checked for accuracy. Main results We have included 19 studies, with all but two studies having fewer than 200 participants. Transcervical Amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: caesarean section overall (13 trials, 1493 participants; average risk ratio (RR) 0.62, 95% confidence interval (CI) 0.46 to 0.83); fetal heart rate (FHR) decelerations (seven trials, 1006 participants; average RR 0.53, 95% CI 0.38 to 0.74); Apgar score less than seven at five minutes (12 trials, 1804 participants; average RR 0.47, 95% CI 0.30 to 0.72); meconium below the vocal cords (three trials, 674 participants, RR 0.53, 95% CI 0.31 to 0.92); postpartum endometritis (six trials, 767 participants; RR 0.45, 95% CI 0.25 to 0.81) and maternal hospital stay greater than three days (four trials, 1051 participants; average RR 0.45, 95% CI 0.25 to 0.78). Transabdominal Amnioinfusion showed similar trends, though numbers studied were small. Mean cord umbilical artery pH was higher in the Amnioinfusion group (seven trials, 855 participants; average mean difference 0.03, 95% CI 0.00 to 0.06) and there was a trend toward fewer neonates with a low cord arterial pH (less than 7.2 or as defined by trial authors) in the Amnioinfusion group (eight trials, 972 participants, average RR 0.58, 95% CI 0.29 to 1.14). Authors' conclusions The use of Amnioinfusion for potential or suspected umbilical cord compression may be of considerable benefit to mother and baby by reducing the occurrence of variable FHR decelerations, improving short-term measures of neonatal outcome, reducing maternal postpartum endometritis and lowering the use of caesarean section, although there were methodological limitations to the trials reviewed here. In addition, the trials are too small to address the possibility of rare but serious maternal adverse effects of Amnioinfusion. More research is needed to confirm the findings, assess longer-term measures of fetal outcome, and to assess the impact on caesarean section rates when the diagnosis of fetal distress is more stringent. Trials should assess Amnioinfusion in specific clinical situations, such as FHR decelerations, oligohydramnios or prelabour rupture of membranes.
Michael G Ross - One of the best experts on this subject based on the ideXlab platform.
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amniotic fluid index predicts the relief of variable decelerations after Amnioinfusion bolus
American Journal of Obstetrics and Gynecology, 1996Co-Authors: Catherine Y Spong, Frances Mckindsey, Michael G RossAbstract:Abstract OBJECTIVE: Our purpose was to determine whether intrapartum amniotic fluid index before Amnioinfusion can be used to predict response to therapeutic Amnioinfusion. STUDY DESIGN: Intrapartum patients (n = 85) with repetitive variable decelerations in fetal heart rate that necessitated Amnioinfusion (10 ml/min for 60 minutes) underwent determination of amniotic fluid index before and after bolus Amnioinfusion. The fetal heart tracing was scored (scorer blinded to amniotic fluid index values) for number and characteristics of variable decelerations before and 1 hour after initiation of Amnioinfusion. The Amnioinfusion was considered successful if it resulted in a decrease of ≥50% in total number of variable decelerations or a decrease of ≥50% in the rate of atypical or severe variable decelerations after administration of the bolus. Spontaneous vaginal births before completion of administration of the bolus (n = 18) were excluded from analysis. The probability of success of Amnioinfusion in relation to amniotic fluid index was analyzed with the χ2 test for progressive sequence. RESULTS: The mean amniotic fluid index before Amnioinfusion was 6.2 ± 3.3 cm. An amniotic fluid index of ≤5 cm was present in 40% of patients (27/67), and an amniotic fluid index of ≤8 cm was present in 72% of patients (48/67). The probability of success of Amnioinfusion decreased with increasing amniotic fluid index before Amnioinfusion (76% [16/21] when initial amniotic fluid index was 0 to 4 cm, 63% [17/27] when initial amniotic fluid index was 4 to 8 cm, 44% [7/16] when initial amniotic fluid index was 8 to 12 cm, and 33% [1/3] when initial amniotic fluid index was >12 cm, p = 0.03). The incidence of nuchal cords or true umbilical cord knots increased in relation to amniotic fluid index before Amnioinfusion. CONCLUSIONS: Amniotic fluid index before Amnioinfusion can be used to predict the success of Amnioinfusion for relief of variable decelerations in fetal heart rate. Failure of Amnioinfusion at a high amniotic fluid index before Amnioinfusion may be explained by the increased prevalence of nuchal cords or true knots in the umbilical cord. (Am J Obstet Gynecol 1996;175:1066-70.)
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prophylactic Amnioinfusion for oligohydramnios a reevaluation
Obstetrics & Gynecology, 1994Co-Authors: O A Ogundipe, Catherine Y Spong, Michael G RossAbstract:Objective To compare the effects of prophylactic Amnioinfusion to standard care plus indicated therapeutic Amnioinfusion (for variable decelerations) in term patients with oligohydramnios. Methods One hundred sixteen term gestations with oligohydramnios (amniotic fluid index less than 5.0 cm) were randomly assigned to receive prophylactic saline Amnioinfusion (600-mL bolus followed by 3 mL/minute) or standard obstetric care (control). Control patients who subsequently developed moderate or severe variable decelerations received therapeutic Amnioinfusion. Results There was no significant difference in overall cesarean delivery (21 versus 17%; P = .68), cesarean delivery for fetal distress (7 versus 10%; P = .83), or umbilical gas values between the prophylactic Amnioinfusion group (N = 56) and control group (N = 60), respectively. The rate of intrapartum fever was significantly increased among the prophylactic Amnioinfusion patients (23 versus 7%; P = .02), although the duration of intrauterine monitoring (8.8 versus 6.5 hours; P = .06) and time from ruptured membranes to delivery (12.3 versus 14.3 hours; P = .51) were not different. Only 22% of the controls developed moderate or severe variable decelerations in the first stage of labor and received therapeutic Amnioinfusion. Thus, in approximately four of five term patients with oligohydramnios, neither prophylactic nor therapeutic Amnioinfusion would be indicated. Conclusions Compared to indicated Amnioinfusion, prophylactic Amnioinfusion did not improve perinatal outcome. Amnioinfusion should be reserved for term laboring patients with variable fetal heart rate decelerations, rather than all patients with oligohydramnios.
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prophylactic Amnioinfusion for meconium stained amniotic fluid
American Journal of Obstetrics and Gynecology, 1994Co-Authors: Catherine Y Spong, O A Ogundipe, Michael G RossAbstract:Abstract Objective: Previous studies have demonstrated reduced perinatal morbidity in patients receiving Amnioinfusion for meconium-stained amniotic fluid compared with control patients receiving no Amnioinfusion. Because Amnioinfusion for variable fetal heart rate decelerations has become accepted care, we sought to determine the benefit of prophylactic Amnioinfusion for meconium compared with standard care, incorporating therapeutic Amnioinfusion for variable decelerations. Study Design: Ninety-three term patients with moderate to heavy meconium and no variable fetal heart rate decelerations were randomized to immediate prophylactic Amnioinfusion (600 ml saline solution bolus followed by 3 ml/min) or to standard care (including therapeutic Amnioinfusion for variable decelerations developing later). All babies had DeLee suctioning on delivery of the head. Laryngeal cords were visualized and tracheal suctioning performed when meconium was seen below the cords. Statistical comparisons were performed using Student t test, Fisher's exact test, or x 2 analysis. Results: There were no significant differences in the incidence of operative delivery, fetal distress, or meconium below the cords or in newborn Apgar scores and umbilical artery gas values between the Amnioinfusion ( n = 43) and control ( n = 50) patients. There were four cases of meconium aspiration, three in the Amnioinfusion group, one in the standard care group. The rate of endometritis-chorioamnionitis was higher ( p = 0.3) in the Amnioinfusion (16%) than in the control group (810), although time from ruptured membranes to delivery (8.5 hours vs 7.3 hours) and duration of intrauterine monitoring (6.1 hours vs 5.3 hours) were not different. Conclusions: Although Amnioinfusion does dilute amniotic meconium, prophylactic Amnioinfusion for meconium in the absence of variable decelerations remains controversial. Prophylactic Amnioinfusion in term pregnancies did not improve perinatal outcome and increased the risk for chorioamnionitis-endometritis. Together with recent reports, the current data suggest that the benefit of Amnioinfusion for meconium-stained amniotic fluid is a result of the alleviation of variable fetal heart rate decelerations rather than meconium dilution.
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child outcomes after Amnioinfusion compared with no intervention in women with second trimester rupture of membranes a long term follow up study of the promexil iii trial
British Journal of Obstetrics and Gynaecology, 2021Co-Authors: A A De Ruigh, Dick Oepkes, Noor E Simons, J Van T Hooft, A S P Van Teeffelen, Ruben G Duijnhoven, A G Van Wassenaerleemhuis, C S H Aarnoudsemoens, C Van De Beek, Monique C HaakAbstract:Objective To assess the effect of transabdominal Amnioinfusion or no intervention on long-term outcomes in children born after second-trimester prelabour rupture of the membranes (PROM between 16+0/7 -24+0/7 weeks) and oligohydramnios. Population Follow up of infants of women who participated in the randomised controlled trial: PPROMEXIL-III (NTR3492). Methods Surviving infants were invited for neurodevelopmental assessment up to 5 years of corrected age using a Bayley Scales of Infant and Toddler Development or a Wechsler Preschool and Primary Scale of Intelligence. Parents were asked to complete several questionnaires. Main outcome measures Neurodevelopmental outcomes were measured. Mild delay was defined as -1 standard deviation (SD), severe delay as -2 SD. Healthy long-term survival was defined as survival without neurodevelopmental delay or respiratory problems. Results In the Amnioinfusion group, 18/28 children (64%) died versus 21/28 (75%) in the no intervention group (relative risk 0.86; 95% confidence interval [CI] 0.60-1.22). Follow-up data were obtained from 14/17 (82%) children (10 Amnioinfusion, 4 no intervention). In both groups, 2/28 (7.1%) had a mild neurodevelopmental delay. No severe delay was seen. Healthy long-term survival occurred in 5/28 children (17.9%) after Amnioinfusion versus 2/28 (7.1%) after no intervention (odds ratio 2.50; 95% CI 0.53-11.83). When analysing data for all assessed survivors, 10/14 (71.4%) survived without mild neurodevelopmental delay and 7/14 (50%) were classified healthy long-term survivor. Conclusions In this small sample of women suffering second-trimester PROM and oligohydramnios, Amnioinfusion did not improve long-term outcomes. Overall, 71% of survivors had no neurodevelopmental delay. Tweetable abstract Healthy long-term survival was comparable for children born after second-trimester PROM and treatment with Amnioinfusion or no intervention.
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Amnioinfusion to facilitate external cephalic version after initial failure.
Obstetrics & Gynecology, 2006Co-Authors: P. N. Adama Van Scheltema, A H. Feitsma, Johanna M. Middeldorp, Frank P.h.a. Vandenbussche, Dick OepkesAbstract:OBJECTIVE: To evaluate the effectiveness of antepartum transabdominal Amnioinfusion to facilitate external cephalic version after initial failure. METHODS: Women with a structurally normal fetus in breech lie at term, with a failed external cephalic version and an amniotic fluid index (AFI) less than 15 cm, were asked to participate in our study. After tocolysis with indomethacin, a transabdominal Amnioinfusion was performed with an 18G spinal needle. Lactated Ringers solution was infused until the AFI reached 15 cm, with a maximum of 1 L. External cephalic version was performed directly afterward. RESULTS: Seven women participated in the study. The gestational age of the women was between 36 +4 and 38 +3 weeks, and three women were primiparous. The AFI ranged from 4 cm to 13 cm. A median amount of 1,000 mL Ringers solution (range 700-1,000 mL) was infused per procedure. The repeat external cephalic versions after Amnioinfusion were not successful in any of the patients. CONCLUSION: In our experience, Amnioinfusion does not facilitate external cephalic version.