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Amnioinfusion

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141. Prophylactic amnioinfusion as a treatment for oligohydramnios in laboring patients: a prospective, randomized trial. (Abstract)

Prophylactic amnioinfusion as a treatment for oligohydramnios in laboring patients: a prospective, randomized trial. Prophylactic amnioinfusion was studied in a randomized sample of 305 patients with oligohydramnios in labor. One hundred seventy-five patients underwent amnioinfusion with the remainder serving as controls. Amniotic fluid was titrated to an amniotic fluid index greater than 10.0 cm in the treatment group. Patients receiving amnioinfusion had significantly less operative (...) intervention for fetal distress (p = 0.0001) and fewer cesarean sections (p = 0.0001). Umbilical artery pH at the time of delivery also was increased (p = 0.0001). Rates of amnionitis and endometritis were not significantly different between infused patients and controls, although the length of hospital stay was significantly decreased (p = 0.002) in the treatment group. Our data support earlier reports in the literature that amnioinfusion is a useful technique for decreasing intrapartum morbidity for both

1991 American journal of obstetrics and gynecology Controlled trial quality: uncertain

142. Neonatal pulmonary mechanics and oxygenation after prophylactic amnioinfusion in labor: a randomized clinical trial. (Abstract)

Neonatal pulmonary mechanics and oxygenation after prophylactic amnioinfusion in labor: a randomized clinical trial. Amnioinfusion has been reported to improve the perinatal outcome of pregnancies complicated by decreased amniotic fluid volume, but detailed information on its possible adverse effects on neonatal pulmonary mechanics and oxygenation is not available.We evaluated 42 infants with birth weights of 2600 to 4320 g and gestational ages of 36 to 44 weeks, who were born to mothers (...) enrolled in a prospective, randomized trial of amnioinfusion for oligohydramnios in labor. Maternal entry criteria were gestational age 36 weeks or older, estimated fetal weight more than 2500 g, oligohydramnios defined as an amniotic fluid index of 5 cm or less, and a normal fetal heart rate pattern. Evaluation of pulmonary mechanics and oxygen saturation (SaO2) was done with the infants breathing room air between birth and day 3 of life. Transpulmonary pressure, flow, and tidal volume were recorded

1995 Pediatrics Controlled trial quality: uncertain

143. Amnioinfusion for preventing puerperal infection. A prospective study. (Abstract)

Amnioinfusion for preventing puerperal infection. A prospective study. To evaluate the hypothesis that irrigation of the uterine cavity by amnioinfusion in women with membranes ruptured for greater than six hours would decrease maternal puerperal infection.We designed a prospective study at three teaching institutions. Sixty-eight women were randomized to receive either amnioinfusion or routine care. Amnioinfusion was through preexisting internal uterine pressure catheters with a 300-500-mL (...) bolus and a 125-150 mL/h constant drip. Chorioamnionitis and endometritis were evaluated as the outcome variables.Women from the amnioinfusion group, n = 36, and the control group, n = 32, had similar times in labor (mean 4 hours), times of ruptured membranes (mean 18 hours), vaginal examinations (mean 7), gestational age (mean 40 weeks), types of anesthesia and methods of delivery. Women who received amnioinfusion had significantly less puerperal infection, 9/36, as compared to women in the control

1995 Journal of Reproductive Medicine Controlled trial quality: uncertain

144. Amnioinfusion: a review. (Abstract)

Amnioinfusion: a review. Amnioinfusion is a commonly practiced technique used for intrapartum improvement of the fetal condition. Room temperature normal saline (0.9 per cent) infused through an intrauterine pressure catheter has been used to alleviate variable decelerations, dilute thick meconium, and improve the intrauterine environment. Randomized studies comparing amnioinfusion to no therapy have shown that amnioinfusion is associated with lower cesarean delivery rates, decreased numbers (...) of operative deliveries, and improved umbilical artery and venous blood gas values. Amnioinfusion also has been suggested as means to instill antibiotics into an infected uterine cavity, or the uterine cavity of a woman with preterm premature rupture of the membranes. Transabdominal amnioinfusion may be used to improved prenatal ultrasound evaluation in pregnancies associated with oligohydramnios. Complications of amnioinfusion include umbilical cord prolapse, uterine overdistention, fetal bradycardia

1993 Obstetrical & Gynecological Survey Controlled trial quality: uncertain

145. Prophylactic amnioinfusion for oligohydramnios: a reevaluation. (Abstract)

Prophylactic amnioinfusion for oligohydramnios: a reevaluation. To compare the effects of prophylactic amnioinfusion to standard care plus indicated therapeutic amnioinfusion (for variable decelerations) in term patients with oligohydramnios.One hundred sixteen term gestations with oligohydramnios (amniotic fluid index less than 5.0 cm) were randomly assigned to receive prophylactic saline amnioinfusion (600-mL bolus followed by 3 mL/minute) or standard obstetric care (control). Control (...) patients who subsequently developed moderate or severe variable decelerations received therapeutic amnioinfusion.There was no significant difference in overall cesarean delivery (21 versus 17%; P = .68), cesarean delivery for fetal distress (7 versus 10%; P = .83), or umbilical gas values between the prophylactic amnioinfusion group (N = 56) and control group (N = 60), respectively. The rate of intrapartum fever was significantly increased among the prophylactic amnioinfusion patients (23 versus 7%; P

1994 Obstetrics and Gynecology Controlled trial quality: uncertain

146. Prophylactic amnioinfusion in pregnancies complicated by thick meconium. (Abstract)

Prophylactic amnioinfusion in pregnancies complicated by thick meconium. We hypothesized that prophylactic intrapartum amnioinfusion in pregnancies complicated by thick meconium will not decrease the incidence of fetal distress, cesarean section for fetal distress, or meconium below the cords.Patients with thick meconium were randomized to amnioinfusion (n = 65) or control (n = 59). The amnioinfusion group received an 800 ml bolus of normal saline solution followed by a continuous infusion (...) at 180 ml/hr. Continuous variables were compared by Student t test, and discrete variables were compared by chi 2 analysis and Fisher's exact test as appropriate.The incidence of fetal distress (16 of 65 vs 8 of 59) and cesarean section for fetal distress (seven of 65 vs seven of 59) was not significantly different between the amnioinfusion and control groups, respectively. The rate of meconium below the cords (one of 65 vs eight of 59) was significantly lower in patients receiving amnioinfusion

1994 American journal of obstetrics and gynecology Controlled trial quality: uncertain

147. Prophylactic amnioinfusion for meconium-stained amniotic fluid. (Abstract)

Prophylactic amnioinfusion for meconium-stained amniotic fluid. Previous studies have demonstrated reduced perinatal morbidity in patients receiving amnioinfusion for meconium-stained amniotic fluid compared with control patients receiving no amnioinfusion. Because amnioinfusion for variable fetal heart rate decelerations has become accepted care, we sought to determine the benefit of prophylactic amnioinfusion for meconium compared with standard care, incorporating therapeutic amnioinfusion (...) for variable decelerations.Ninety-three term patients with moderate to heavy meconium and no variable fetal heart rate decelerations were randomized to immediate prophylactic amnioinfusion (600 ml saline solution bolus followed by 3 ml/min) or to standard care (including therapeutic amnioinfusion for variable decelerations developing later). All babies had DeLee suctioning on delivery of the head. Laryngeal cords were visualized and tracheal suctioning performed when meconium was seen below the cords

1994 American journal of obstetrics and gynecology Controlled trial quality: uncertain

148. Amnioinfusion during labor complicated by particulate meconium-stained amniotic fluid decreases neonatal morbidity. (Abstract)

Amnioinfusion during labor complicated by particulate meconium-stained amniotic fluid decreases neonatal morbidity. Our purpose was to evaluate the efficacy of prophylactic amnioinfusion in decreasing neonatal morbidity associated with labor complicated by particulate meconium-stained amniotic fluid and to assess potential complications of this procedure.One hundred five laboring pregnant women with particulate (moderate or thick) meconium by subjective clinical analysis were randomly assigned (...) to receive amnioinfusion or to receive standard obstetric care without amnioinfusion. Patients with any antepartum complications, other than the presence of meconium, were excluded from the study. Statistical analyses consisted of the two-tailed and paired Student t tests, Pearson chi 2 test, and Wilcoxon nonparametric test. Significance was set at p < 0.05.The study included 47 patients in the study group and 58 patients in the control group. A significantly greater proportion of study patients

1994 American journal of obstetrics and gynecology Controlled trial quality: uncertain

149. Transabdominal amnioinfusion in oligohydramnios at term before induction of labor with intact membranes: a randomized clinical trial. (Abstract)

Transabdominal amnioinfusion in oligohydramnios at term before induction of labor with intact membranes: a randomized clinical trial. Our purpose was to determine the effectiveness of transabdominal amnioinfusion before induction of labor in reducing the incidence of fetal distress in pregnancies with oligohydramnios at term.Between June 1991 and September 1994 primiparous women with ultrasonographic evidence of oligohydramnios at term, intact membranes, and unripe cervix (Bishop score < or = 6 (...) ), candidates for induction of labor with cervical or vaginal prostaglandin E2 gel, were randomly selected to receive transabdominal amnioinfusion (amnioinfused group, n = 39) or to proceed with direct labor induction (control group, n = 40). Inclusion criteria were (1) singleton gestation, (2) vertex presentation, (3) ultrasonographic estimation of fetal weight > or = 2500 gm, and (4) reactive nonstress test. Fetoneonatal outcome variables were compared between the two groups. Statistical analysis used

1996 American journal of obstetrics and gynecology Controlled trial quality: uncertain

150. A prospective randomized trial of two solutions for intrapartum amnioinfusion: effects on fetal electrolytes, osmolality, and acid-base status. (Abstract)

A prospective randomized trial of two solutions for intrapartum amnioinfusion: effects on fetal electrolytes, osmolality, and acid-base status. Our purpose was to compare the effects of intrapartum amnioinfusion with normal saline solution versus lactated Ringer's solution plus physiologic glucose on neonatal electrolytes and acid-base balance.Patients undergoing amnioinfusion for obstetric indications were randomized to receive normal saline solution or lactated Ringer's solution plus (...) physiologic glucose at standardized amnioinfusion rates. Data were collected prospectively on maternal demographics, course of labor, and maternal and neonatal outcome. Arterial cord blood was obtained for analysis of electrolytes, glucose, osmolality, lactic acid, and blood gases. Control subjects with normal fetal heart rate patterns, and clear amniotic fluid not receiving amnioinfusion were studied concurrently.Data were collected on 59 patients (21 normal saline solution, 18 lactated Ringer's solution

1996 American journal of obstetrics and gynecology Controlled trial quality: uncertain

151. Neonatal electrolyte response to amnioinfusion with lactated Ringer's solution vs. normal saline. A prospective study. (Abstract)

Neonatal electrolyte response to amnioinfusion with lactated Ringer's solution vs. normal saline. A prospective study. To determine if amnioinfusion with normal saline vs. lactated Ringer's solution crystalloids causes electrolyte imbalance in the human neonate.Over two months, all parturients undergoing amnioinfusion in the active phase of labor were prospectively randomized to receive either normal saline (n = 37) or lactated Ringer's solution (n = 30). Maternal electrolytes were obtained (...) prior to amnioinfusion, and neonatal electrolytes were obtained from cord blood samples at the time of delivery.Our results showed the two groups were similar in maternal age, ethnicity, gravidity, parity, gestational age, maternal electrolyte levels prior to amnioinfusion, amount of solution amnioinfused, duration of labor after amnioinfusion, mode of delivery and mean birth weight. The chloride concentrations were nearly identical among neonates who had received normal saline and those who had

1996 Journal of Reproductive Medicine Controlled trial quality: uncertain

152. Intrapartum amnioinfusion for meconium-stained liquor in developing countries. (Abstract)

Intrapartum amnioinfusion for meconium-stained liquor in developing countries. Intrapartum amnioinfusion (AI) has been reported to decrease perinatal mortality and morbidity in women with meconium-stained liquor. Such work has not previously been performed at King Edward VIII Hospital (KEH), in a developing country, where the incidence of meconium-stained liquor is said to be extremely high.To establish whether AI during the intrapartum period for meconium-stained liquor decreases Caesarean (...) section rates for fetal distress and decreases perinatal morbidity.Informed consent was obtained from patients in labour who were 3-8 cm dilated, with meconium-staining of the liquor, grades I to III inclusive, and who had a normal cardiotocograph on presentation at term. Sixty patients were included in the trial; 30 had AI. The control group was managed by standard methods. The study group had an amnioinfusion of 0.9% normal saline at 15 ml/min under continuous cardiotocographic monitoring, until

1998 Tropical Doctor Controlled trial quality: uncertain

153. Lipid peroxidation in cord blood: a randomised sequential pairs study of prophylactic saline amnioinfusion for intrapartum oligohydramnios. (Abstract)

Lipid peroxidation in cord blood: a randomised sequential pairs study of prophylactic saline amnioinfusion for intrapartum oligohydramnios. To determine the efficacy of prophylactic intrapartum amnioinfusion in reducing cord arterial lipid peroxide levels in cases of intrapartum oligohydramnios.Sequential randomised pairs trial.Delivery suite of a teaching hospital, the Chinese University of Hong Kong.Women with singleton, term pregnancy, cephalic presentation, clear amniotic fluid (...) and an amniotic fluid index < or = 5 cm, with a normal intrapartum fetal heart rate tracing within 30 minutes of amniotomy.Selected patients were randomised either for prophylactic saline amnioinfusion or as control cases. Cord arterial lipid peroxide concentrations and acid base balance were determined at delivery.Operative intervention for fetal distress, cord arterial malondialdehyde and organic hydroperoxide levels, pH and base excess.Amnioinfusion was associated with significant reductions

1997 British journal of obstetrics and gynaecology Controlled trial quality: uncertain

154. The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa. (Abstract)

The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa. To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labout.Multicentre randomised controlled trial.Four urban academic hospitals in South Africa. Obstetric surveillance included the use of electronic fetal heart rate monitoring in most cases.Women in labour at term with moderate or thick meconium staining of the amniotic fluid.Transcervical amnioinfusion of 800 mL saline (...) at 15 mL per minute, followed by a maintenance infusion at 3 mL per minute. The control group received routine care. Blinding of the intervention was not possible.Caesarean section, meconium aspiration syndrome and perinatal mortality.Caesarean section rates were similar (amnioinfusion group 70/167 vs control group 68/159; RR 0.98, 95% CI 0.76-1.26). The incidence of meconium aspiration syndrome was lower than expected on the basis of previous studies (4/162 vs 6/163; RR 0.67, 95% CI 0.19-2.33

1998 British journal of obstetrics and gynaecology Controlled trial quality: predicted high

155. The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 2. Zimbabwe. (Abstract)

The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 2. Zimbabwe. To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.Multicentre randomised controlled trial.A large urban academic hospital. Electronic fetal heart rate monitoring was not used.Women in labour at term with moderate or thick meconium staining of the amniotic fluid.Transcervical amnioinfusion of 500 mL saline over 30 minutes, then 500 mL at 30 drops per minute. The control (...) group received routine care. Blinding of the intervention was not possible.Caesarean section, meconium aspiration syndrome and perinatal mortality.There was no difference in risk for caesarean section in the two groups (amnioinfusion 9.5% vs control 12.3%; RR 0.84, 95% CI 0.53-1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1% vs 12.8%; RR 0.24, 95% CI 0.12-0.48), and there was a trend towards fewer perinatal deaths (1.2% vs 3.6%; RR 0.34, 95% CI

1998 British journal of obstetrics and gynaecology Controlled trial quality: uncertain

156. Amnioinfusion in labor induction of term pregnancies with premature rupture of the membranes and low amniotic fluid. (Abstract)

Amnioinfusion in labor induction of term pregnancies with premature rupture of the membranes and low amniotic fluid. To analyze the utility of prophylactic amnioinfusion in term pregnancies with PROM and a low amniotic fluid index during labor induction.Forty-two women with amnioinfusion and 42 in a control group with amniotic fluid index (AFI) below 10 cm when admitted to labor induction were studied. All patients had electronic fetal heart rate and intrauterine pressure continuous monitoring (...) . Amnioinfusion of normal saline (37 degrees C) was realized in the study group, using a continuous perfusion pump at 600 ml/h for 1 h, after which the AFI was again recorded; if this was < 15, the perfusion was continued at 180 ml/h until full cervical dilatation was achieved or until uterine baseline activity reached 20 mm Hg. The control group received identical obstetric care except in respect of amnioinfusion.Both groups were similar in age, primiparity, gestational age, initial AFI, interval from

1998 International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics Controlled trial quality: uncertain

157. Amnioinfusion does not affect the length of labor. (Abstract)

Amnioinfusion does not affect the length of labor. Our objective was to determine whether amnioinfusion prolongs or shortens the length of labor in patients who have an accepted indication for amnioinfusion.We performed a retrospective post hoc analysis of the length of labor of 437 patients who were enrolled in three prospective, randomized, controlled studies of amnioinfusion.The length of labor was not significantly different for patients who received amnioinfusion compared with those who (...) did not receive amnioinfusion (control group). Among the subgroup with vaginal delivery, the duration of labor after amnioinfusion did not differ from the duration of labor among the controls. The length of labor (mean +/- SD, in hours) for the amnioinfusion group was 9.3 +/- 6.3 versus 10.6 +/- 6.9 for the control groups (p not significant). Among the subgroup that required cesarean delivery, the duration of labor after amnioinfusion did not differ from the duration of labor among the controls

1992 American journal of obstetrics and gynecology Controlled trial quality: uncertain

158. Prophylactic amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios. (Abstract)

Prophylactic amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios. The null hypothesis is that the use of intrapartum amnioinfusion in labors complicated by the presence of thick meconium and oligohydramnios will not decrease the incidence of fetal distress, cesarean delivery, meconium aspiration, or meconium aspiration syndrome.One hundred seventy term and postterm patients with thick meconium and oligohydramnios were randomly chosen to receive (...) amnioinfusion or standard obstetric care without amnioinfusion. The frequency of fetal distress, cesarean section, meconium aspiration, and meconium aspiration syndrome were subject to chi 2 analysis, Student's t test, or Fisher's exact test.The rate of fetal distress was significantly reduced in the amnioinfusion group compared with controls (three of 85 vs 19 of 85, relative risk 0.15, 95% confidence interval 0.06 to 0.42). The rate of cesarean section for fetal distress was significantly reduced

1992 American journal of obstetrics and gynecology Controlled trial quality: uncertain

159. A controlled trial of amnioinfusion: the prevention of meconium aspiration in labour. (Abstract)

A controlled trial of amnioinfusion: the prevention of meconium aspiration in labour. The purpose of this study was to examine the effect of amnioinfusion on the incidence of meconium aspiration syndrome, perinatal asphyxia and obstetrical intervention rate amongst patients with moderate and thick meconium-stained liquor. A total of 112 patients were studied in a prospective fashion; 60 received amnioinfusion and 52 served as controls. We have shown that amnioinfusion is a simple, relatively

1993 The Australian & New Zealand journal of obstetrics & gynaecology

160. Prophylactic intrapartum amnioinfusion for patients with oligohydramnios. A prospective randomized study. (Abstract)

Prophylactic intrapartum amnioinfusion for patients with oligohydramnios. A prospective randomized study. This prospective study evaluated whether prophylactic saline amnioinfusion among patients with amniotic fluid index (AFI) < or = 5.0 cm decreases the incidence of adverse fetal outcomes. Randomization of 53 patients with decreased AFI at term, resulted in 21 patients' receiving prophylactic saline amnioinfusion early in labor, prior to development of an abnormal fetal heart rate tracing (...) . For the treatment group the mean AFI on admission was 3.0 cm, and the postamnioinfusion AFI was 8.9 cm. For 32 comparison (noninfusion) patients, the mean AFI was 2.9 cm; the group consisted of 17 patients randomized to receive no amnioinfusion (control group) and 15 patients who refused to participate in the study. There was no statistically significant difference between the amnioinfused and nonamnioinfused patients with regard to age, parity, gestational age, AFI at admission or duration of first or second

1992 Journal of Reproductive Medicine Controlled trial quality: uncertain

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