Rathor Asmita Muthal, Singh Ruchira, Ramji S, Tripathi Reva
Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.
BJOG. 2002 Jan;109(1):17-20. doi: 10.1111/j.1471-0528.2002.01140.x.
To assess the effect of amnioinfusion during labour with meconium stained amniotic fluid on caesarean section rate and perinatal outcome.
Prospective randomised controlled study.
A tertiary care teaching hospital in India.
Women in labour at term with meconium stained amniotic fluid.
Two hundred women in labour with > or = 37 weeks gestation, single cephalic presentation with moderate or thick meconium were randomised to control and amnioinfusion groups at a 1:1 ratio. Amnioinfusion was performed using 500 mL of normal saline over a period of 30 minutes in a study group. The control group received routine care. Both groups had intermittent auscultation of fetal heart rate during labour.
The primary outcome measure was caesarean section rate. Secondary outcome measures were meconium aspiration syndrome, 1 minute and 5 minute apgar < 7, hypoxic ischaemic encephalopathy, neonatal intensive care unit admission, meconium at the level of vocal cords.
The caesarean section rate in the amnioinfusion group was less than the control group (RR 0.47; 95% CI 0.24-0.93). Amnioinfusion was associated with a significant decrease in the incidence of meconium at the vocal cords (P = 0.001); improvement in 1 minute apgar scores (P < 0.05), respiratory distress (P = 0.002) and fewer admissions to nursery compared with the controls. This sample size was inadequate to study the impact on meconium aspiration syndrome.
Amnioinfusion in an under resourced labour ward decreases caesarean section rates and fetal morbidity.
评估产时羊水粪染时羊膜腔灌注对剖宫产率及围产期结局的影响。
前瞻性随机对照研究。
印度一家三级护理教学医院。
足月产时羊水粪染的妇女。
200例妊娠≥37周、单头位、羊水粪染为中度或重度的临产妇女按1:1比例随机分为对照组和羊膜腔灌注组。研究组在30分钟内使用500毫升生理盐水进行羊膜腔灌注。对照组接受常规护理。两组在产时均间断听诊胎心。
主要结局指标为剖宫产率。次要结局指标为胎粪吸入综合征、1分钟和5分钟阿氏评分<7、缺氧缺血性脑病、新生儿重症监护病房收治率、声带水平有胎粪。
羊膜腔灌注组的剖宫产率低于对照组（相对危险度0.47；95%可信区间0.24 - 0.93）。羊膜腔灌注与声带处有胎粪的发生率显著降低相关（P = 0.001）；与对照组相比，1分钟阿氏评分改善（P < 0.05）、呼吸窘迫（P = 0.002）以及新生儿重症监护病房收治率降低。该样本量不足以研究对胎粪吸入综合征的影响。
在资源匮乏的产房进行羊膜腔灌注可降低剖宫产率及胎儿发病率。
