| Excerpt from The WHO Reproductive Health Library | Published by Update Software Ltd. |
This review evaluates the effect of transcervical amnioinfusion performed for potential or suspected umbilical cord compression. Suspicion of cord compression was usually based on oligohydramnios detected by ultrasound and/or fetal heart rate monitoring showing repetitive variable decelerations. The review of all available controlled trials shows that amnioinfusion reduces the frequency of variable fetal heart rate decelerations and reduces the risk of caesarean section, especially caesarean section for suspected fetal distress. The author stresses that the reports included in the review do not mention the use of scalp pH to confirm fetal distress suspected by the presence of fetal heart rate abnormalities. It is unclear whether amnioinfusion will be associated with a similar reduction in the caesarean section rate when used in a context where the diagnosis of fetal distress is confirmed by scalp blood pH.
The review of the trials evaluating transabdominal amnioinfusion concludes that the benefits, if any, of this intervention must be weighed against potential harm from needle insertion. Amnioinfusion after rupture of membranes for more than six hours was evaluated in one small trial that suggested a reduction of the risk of puerperal infection. Both interventions are not as yet adequately evaluated, and thus this commentary will not include a discussion on these aspects.
The methodology used for this systematic review is appropriate. Criteria for inclusion and exclusion of controlled trials are well described. Main outcomes were pre-specified, and effects on intermediate outcomes (e.g. fetal heart rate decelerations, Apgar score) are given appropriate weight in the conclusions.
The full RHL commentary also includes sections on:
Relevance