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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.
Source Information
From Hôpital Sainte-Justine, Université de Montréal, Montreal (W.D.F., C.G., C.R., H.-R.X., B.W.); University of the Witwatersrand, East London, South Africa (J.H.); Institut Argentino de Medicina Basada en las Evidencias, Buenos Aires (R.L.); Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Brugmann (G.F.), and Département de Médecine Sociale et Préventive, Université Libre de Bruxelles (S.A.) — both in Brussels; Department of Obstetrics, Maternité de Port-Royal, Hôpital Cochin, Paris (F.G.); Department of Pediatrics, University of Toronto, Toronto (A.O.); Université Laval–Hôpital Saint-François d'Assise (L.T.-L., L.L.), and Département de Médecine Sociale et Préventive, Université Laval (S.M.) — both in Quebec, Que., Canada; Department of Obstetrics and Gynaecology, Coombe Lying-In Hospital, Dublin (W.P.); and National Perinatal Epidemiology Unit, Oxford University, Oxford, United Kingdom (S.P.).
Address reprint requests to Dr. Fraser at the Department of Obstetrics and Gynecology, Université de Montréal, 3175 Chemin de la Côte Sainte-Catherine, Montreal, QC H3T 1C5, Canada, or at william.fraser{at}umontreal.ca.
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