Hofmeyr G Justus, Xu Hairong
Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD000014. doi: 10.1002/14651858.CD000014.pub3.
Amnioinfusion is thought to dilute meconium present in the amniotic fluid and so reduce the risk of meconium aspiration.
To assess the effects of amnioinfusion for meconium-stained liquor on perinatal outcome.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (May 2009).
Randomised trials comparing amnioinfusion with no amnioinfusion for women in labour with moderate or thick meconium-staining of the amniotic fluid.
Two review authors assessed eligibility and trial quality, and extracted data, independently.
Thirteen studies of variable quality (4143 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: two studies (855 women) were included. In the amnioinfusion group there was a reduction in CS for fetal distress and overall; meconium aspiration syndrome (RR 0.25, 95% CI 0.13 to 0.47), and neonatal ventilation or neonatal intensive care unit admission; and a trend towards reduced perinatal mortality (RR 0.37, 95% CI 0.13 to 1.01). 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.
羊膜腔灌注被认为可稀释羊水中的胎粪，从而降低胎粪吸入的风险。
评估羊膜腔灌注对羊水胎粪污染围产期结局的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2009年5月）。
将羊水呈中度或重度胎粪污染的分娩妇女随机分为羊膜腔灌注组和非羊膜腔灌注组的试验。
两位综述作者独立评估纳入标准和试验质量，并提取数据。
纳入了13项质量各异的研究（4143名妇女）。对分娩期间监测婴儿状况及有效干预设施有限的研究和标准围产期监测的研究进行了亚组分析。标准围产期监测的研究：几个结局存在相当大的异质性。胎粪吸入综合征、围产期死亡或严重发病率以及孕产妇死亡或严重发病率等主要结局没有显著降低。因胎儿窘迫行剖宫产的比例有所降低，但总体上没有。喉镜检查诊断的声带以下胎粪减少，新生儿通气或入住新生儿重症监护病房的比例也降低，但围产期死亡或其他发病率没有显著降低。排除偏倚风险较高的试验进行的计划敏感性分析显示，所研究的任何结局均无益处。围产期监测有限的研究：纳入了两项研究（855名妇女）。羊膜腔灌注组因胎儿窘迫行剖宫产的比例及总体剖宫产比例降低；胎粪吸入综合征（相对危险度0.25，95%可信区间0.13至0.47），以及新生儿通气或入住新生儿重症监护病房的比例降低；围产期死亡率有降低趋势（相对危险度0.37，95%可信区间0.13至1.01）。在其中一项研究中，声带以下胎粪减少，在另一项研究中，新生儿脑病减少。
仅在围产期监测设施有限的情况下，羊膜腔灌注与围产期结局的实质性改善相关。尚不清楚这些益处是由于胎粪稀释还是羊水过少缓解所致。在标准围产期监测的情况下，初始分析中一些非实质性结局有所改善，但排除偏倚风险较高的试验进行的敏感性分析消除了这些差异。在这种情况下，羊膜腔灌注要么无效，要么其效果被其他优化新生儿结局的策略所掩盖。所综述的试验规模太小，无法探讨羊膜腔灌注罕见但严重的孕产妇不良反应的可能性。
