The impact of a policy of amnioinfusion for meconium-stained amniotic fluid

Usta, Ihab M.; Mercer, Brian M.; Aswad, Naji; Ai, Baha M. Sib

doi:10.1016/0029-7844(94)00385-q

Cited by 36 publications

(16 citation statements)

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“…Some have shown improved acid-base balance in the fetus 55,61 and decreased likelihood of meconium below the cords 60,62 and MAS, 55,56,60 whereas others have not. 53,58 These differing results may, in part, be explained by the relatively small sample sizes of these studies and their differing study designs. In a retrospective study involving the largest sample studied to date, Usta et al 53 were unable to demonstrate any difference in neonatal outcomes in infants born to women who had received amnioinfusion for MSAF compared with women who had not received amnioinfusion.…”

Section: Prenatal Management Amnioinfusionmentioning

confidence: 94%

“…53,58 These differing results may, in part, be explained by the relatively small sample sizes of these studies and their differing study designs. In a retrospective study involving the largest sample studied to date, Usta et al 53 were unable to demonstrate any difference in neonatal outcomes in infants born to women who had received amnioinfusion for MSAF compared with women who had not received amnioinfusion. Moreover, they noted a higher incidence of fetal heart rate abnormalities and an increased likelihood of instrumental delivery and endometritis in women who received amnioinfusion.…”

Section: Prenatal Management Amnioinfusionmentioning

confidence: 94%

“…4,26,27 Furthermore, in the presence of oligohydramnios, which like MSAF is more often found in post-term pregancies, cord compression may be relieved by increasing amniotic fluid volume, which potentially prevents fetal hypoxia and acidosis, further meconium passage, fetal gasping, and in utero aspiration of meconium. Several retrospective analyses 53,54 and randomized clinical trials [55][56][57][58][59][60][61] have assessed the effectiveness of amnioinfusion for improving neonatal outcomes. Some have shown improved acid-base balance in the fetus 55,61 and decreased likelihood of meconium below the cords 60,62 and MAS, 55,56,60 whereas others have not.…”

Section: Prenatal Management Amnioinfusionmentioning

confidence: 99%

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Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Fuloria

Wiswell

1999

J Perinatol

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The term meconium was originally coined by Aristotle who used the Greek word meconium-arion 1 meaning "opium-like," because he believed meconium induced fetal sleep. It is probable that he recognized the association between the presence of meconium in the amniotic fluid and the occurrence of fetal deaths and neonatal depression.Depending on the population studied, the frequency of meconium-stained amniotic fluid (MSAF) at the time of delivery is variable, ranging between approximately 8% and 19% of all term deliveries. [2][3][4][5][6][7][8] Alexander and colleagues 9 noted a 1.5-fold increased risk for MSAF in black women compared with white women. The authors recommended that maternal ethnicity be viewed as a risk indicator of, and not a causal factor for, MSAF. They also observed an increased likelihood of MSAF with increasing gestational age in both ethnic groups.Regardless of the reason for meconium passage, its presence may be associated with adverse fetal and neonatal outcomes, including death, acute respiratory complications, and long-term pulmonary and neurologic abnormalities. Depending on various factors, including the population studied and the criteria used for making a diagnosis, meconium aspiration syndrome (MAS) will develop in 2% to 33% of infants born through MSAF. 3,4,10,11 As many as 30% or more of infants with MAS require mechanical ventilation. 3,12 Accompanying persistent pulmonary hypertension of the newborn (PPHN) is present in approximately one-third of these infants. 13 The mortality associated with MAS is disturbingly high, ranging from 4% to 19% 3,12,14 ; a large proportion of this mortality is attributable to PPHN.Early-onset neonatal seizures, secondary to hypoxic events, have been reported in infants born through thick MSAF. 15 Berkus et al. 16 observed a sevenfold increased risk of neonatal seizures and a fivefold increased likelihood of hypotonia in infants born through moderate to thick compared with thin meconium-stained or clear amniotic fluid. Some investigators have noted an increased likelihood of cerebral palsy in surviving infants with a low Apgar score who were born through MSAF. 17 In addition, there may be long-term pulmonary sequelae associated with MAS. Yuksel et al. 18 have shown increased functional residual capacity and airway reactivity at 6 months of age in infants with MAS; infants who required more respiratory support in the neonatal period had significantly more symptoms and required bronchodilator therapy more often. MAS has also been implicated in increased airway reactivity and abnormal pulmonary function tests in later childhood. 19,20 PATHOPHYSIOLOGY OF MECONIUM PASSAGEMeconium is a viscous green substance composed primarily of water (72% to 80%). Other components of meconium include gastrointestinal secretions, bile, bile acids, mucus, pancreatic juice, cellular debris, and swallowed amniotic fluid, lanugo, vernix caseosa, and blood. 1,21 The substance may first be noted in the fetal gastrointestinal tract as early as 10 to 16 weeks' gestation. At birt...

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Section: Prenatal Management Amnioinfusionmentioning

confidence: 94%

Section: Prenatal Management Amnioinfusionmentioning

confidence: 94%

Section: Prenatal Management Amnioinfusionmentioning

confidence: 99%

See 1 more Smart Citation

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Fuloria

Wiswell

1999

J Perinatol

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“…Sample size calculations assumed a rate of aggregate maternal infection of 40% (based on incidences in the literature 10,12,13,15,17,18 ) and a 50% reduction in infection rate with antibiotic prophylaxis. For a significance level of a type-I error of 0.05 and a type-II error of 0.2, 93 subjects in each study arm were necessary.…”

Section: Methodsmentioning

confidence: 99%

Prophylactic cefazolin in amnioinfusions administered for meconium-stained amniotic fluid

Edwards

Duff

1999

Infect. Dis. Obstet. Gynecol.

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Objective To determine if amnioinfusion with an antibiotic solution decreased the rate of clinical chorioamnionitis and puerperal endometritis in patients with meconium‐stained amniotic fluid. Methods Patients in labor at 36 weeks of gestation or greater with singleton pregnancies and meconium‐stained amniotic fluid were randomized to receive either cefazolin, 1 g/1,000 mL, of normal saline (n = 90) or normal saline (n = 93) amnioinfusion. Rates of clinically diagnosed chorioamnionitis and endometritis and of suspected and culture‐proven neonatal infection were determined. Results Between the study and control groups, the incidences of clinical chorioamnionitis (7.8% vs. 8.6%), endometritis (2.4% vs. 3.5%), aggregate intrauterine infection (10.0% vs. 11.8%), suspected neonatal infection (17.8% vs. 21.5%), and proven neonatal infection (0.0% vs. 2.2%) were not significantly different. Conclusions Prophylactic use of cefazolin in amnioinfusions did not significantly reduce rates of maternal or neonatal infection in patients with meconium‐stained amniotic fluid. Infect. Dis. Obstet. Gynecol. 7:153–157, 1999. © 1999 Wiley‐Liss, Inc.

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“…139 EDITORIAL COMMENT: A multicenter, multinational trial to assess whether intubation and suctioning of apparently vigorous, meconiumstained neonates would reduce the incidence of meconium-aspiration syndrome (MAS) enrolled 2094 neonates. Positive pressure resuscitation should be delayed in these infants if possible until adequate laryngotracheal toilet has been performed.…”

Section: Meconium Aspiration Syndromementioning

confidence: 99%

Respiratory Problems

Martin¹,

Sosenko²,

Bancalari³

2001

Care of the High-Risk Neonate

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The impact of a policy of amnioinfusion for meconium-stained amniotic fluid

Abstract: With the policy of routine AI for moderate or thick meconium-stained AF, AI was not clinically feasible in 53% of the cases. We were unable to demonstrate any improvement in neonatal outcome in those who received AI for moderate or thick meconium.

Cited by 36 publications

References 17 publications

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Resuscitation of the Meconium-Stained Infant and Prevention of Meconium Aspiration Syndrome

Prophylactic cefazolin in amnioinfusions administered for meconium-stained amniotic fluid

Respiratory Problems

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