Amnioinfusion for meconium-stained liquor in labour

Amnioinfusion decreases the risk of meconium aspiration syndrome, caesarean section and neonatal morbidity. Available evidence supports its use in women with meconium-stained amniotic fluid, even in under-resourced settings, as relatively inexpensive instruments for amnioinfusion are available. Evidence is scarce on the possibility of rare but serious maternal adverse effects of amnioinfusion.

RHL Commentary by Michel Boulvain

EVIDENCE SUMMARY

This systematic review suggests that the use of amnioinfusion for meconium-stained amniotic may be beneficial. Amnioinfusion decreases the risk of meconium aspiration syndrome, caesarean section and neonatal morbidity. The results of the only trial conducted in an under-resourced setting are reported separately. This trial showed a reduction in meconium aspiration syndrome and an important trend towards fewer perinatal deaths in the amnioinfusion group. Overall, the trials reviewed are too small to address the potential side-effects of amnioinfusion for the mother. The effect of amnioinfusion on vertical HIV transmission is unknown.

The methodology used for this systematic review is appropriate. Criteria for inclusion and exclusion of randomized 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 appropriately lesser weight in the conclusions.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research
References

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This document should be cited as: Michel Boulvain. Amnioinfusion for meconium-stained amniotic fluid: RHL commentary (last revised: 24 June 2002). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com