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Amnioinfusion

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161. Prophylactic amnioinfusion during labor complicated by meconium: a preliminary report. (PubMed)

Prophylactic amnioinfusion during labor complicated by meconium: a preliminary report. The purpose of this prospective and randomized study is to evaluate the safety and efficacy of prophylactic transcervical amnioinfusion in the management of labor complicated by meconium. A preexisting intrauterine pressure catheter was used for amnioinfusion. The incidence of thick meconium was significantly lower after amnioinfusion, compared with standard management (5% versus 62% p less than 0.0005 (...) ). This was also demonstrated with spectrophotometry. Significant differences between the amnioinfusion group and the control group were found for the following: arterial cord pH less than 7.20 (16% versus 38%, p less than 0.05); meconium more than trace below the vocal cords at delivery (0% versus 29%, p less than 0.05) and need for positive pressure ventilation at birth (16% versus 48%, p less than 0.05). No complications related to amnioinfusion were observed. We conclude that (1) transcervical

1989 American journal of obstetrics and gynecology Controlled trial quality: uncertain

162. A prospective randomized study of saline solution amnioinfusion. (PubMed)

A prospective randomized study of saline solution amnioinfusion. We performed a prospective randomized study of saline solution amnioinfusion in four types of pregnancy complications: postterm pregnancy, variable decelerations in labor, preterm labor, and oligohydramnios-suspected growth retardation. A total of 100 patients were randomized, 43 to undergo amnioinfusion and 57 to be in a control group. Patients undergoing amnioinfusion had a significantly decreased incidence of postpartum (...) endometritis (2.4% vs 19%, p = 0.01) and a lower incidence of cesarean delivery that was due to fetal distress in labor (4.7% vs 16%, p = 0.07). The use of amnioinfusion also made a significant contribution to the four-quadrant ultrasonographic estimate of amniotic fluid volume (14.7 vs 9.8 cm, p less than 0.001). All other maternal and neonatal outcome parameters were similar between the two groups. We conclude that saline solution amnioinfusion in labor may be a beneficial procedure but that further

1990 American journal of obstetrics and gynecology Controlled trial quality: uncertain

163. A prospective, randomized evaluation of intrapartum amnioinfusion. Fetal acid-base status and cesarean delivery. (PubMed)

A prospective, randomized evaluation of intrapartum amnioinfusion. Fetal acid-base status and cesarean delivery. Pregnancies with decreased amniotic fluid volume are prediposed to umbilical cord compression and variable fetal heart rate declerations. Intrapartum amnioinfusion has been utilized in an effort to reduce cord compression. Previous studies suggested that amnioinfusion may improve the fetal metabolic state and reduce the incidence of cesarean delivery in selected patients (...) . In this study the hypothesis was tested that intrapartum amnioinfusion will relieve cord compression in pregnancies complicated by oligohydramnios and will result in a reduced incidence of fetal intolerance to labor as well as improved fetal acid-base status at delivery. Thirty-five patients fulfilling the inclusion criteria were randomized to either the control (n = 16) or amnioinfusion treatment group (n = 19). Analysis of the data suggested that the two groups were similar for the perinatal parameters

1991 Journal of Reproductive Medicine Controlled trial quality: uncertain

164. Prophylactic intrapartum amnioinfusion: a randomized clinical trial. (PubMed)

Prophylactic intrapartum amnioinfusion: a randomized clinical trial. Amnioinfusion was performed in a prospective, randomized trial of 60 women in the latent phase of labor with oligohydramnios, as defined by an amniotic fluid index less than or equal to 5.0 cm. All fetuses were at least 37 weeks' gestational age, had normal baseline fetal heart rate variability, and no clinically significant fetal heart rate decelerations at the outset. Subjects in the amnioinfusion group (n = 30) were (...) titrated to and maintained at an amniotic fluid index level greater than or equal to 8.0 cm throughout labor. In the group receiving amnioinfusion, significantly lower rates of meconium passage (p = 0.04), severe variable decelerations (p = 0.04), end-stage bradycardia (p = 0.05), and operative delivery for fetal distress (p = 0.002) occurred. Significantly higher umbilical arterial blood pH values were also noted in the infusion group (p = 0.02). We conclude that prophylactic intrapartum amnioinfusion

1990 American journal of obstetrics and gynecology Controlled trial quality: uncertain

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

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

166. Prophylactic amnioinfusion in pregnancies complicated by oligohydramnios: a prospective study. (PubMed)

Prophylactic amnioinfusion in pregnancies complicated by oligohydramnios: a prospective study. Prophylactic amnioinfusion was assessed in term and post-dates pregnancies with decreased amniotic fluid volume. Subjects were randomly assigned to one of three groups: amnioinfusion with warmed saline solution, room-temperature saline, or control. Patients receiving prophylactic amnioinfusion had a significant decrease in both the frequency and severity of variable decelerations in the first stage (...) of labor (P = .006) and in the average total number of variable decelerations in the first and second stages of labor (P = .01) compared with controls. There was no observed effect on newborn serum electrolyte levels with amnioinfusion, nor was there any apparent benefit of infusion of warmed saline compared with room-temperature saline. In contrast to premature gestations with oligohydramnios, prophylactic amnioinfusion was not associated with a significant improvement in mean umbilical arterial

1991 Obstetrics and Gynecology Controlled trial quality: uncertain

167. Prophylactic amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios. (PubMed)

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

168. Amnioinfusion: a review. (PubMed)

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

169. Amnioinfusion does not affect the length of labor. (PubMed)

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

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

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

171. Prophylactic intrapartum amnioinfusion for patients with oligohydramnios. A prospective randomized study. (PubMed)

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

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

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

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

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

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

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

175. Prophylactic amnioinfusion in pregnancies complicated by thick meconium. (PubMed)

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

176. Prophylactic amnioinfusion for meconium-stained amniotic fluid. (PubMed)

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

177. Prophylactic amnioinfusion for oligohydramnios: a reevaluation. (PubMed)

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

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

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

179. The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa. (PubMed)

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

180. The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 2. Zimbabwe. (PubMed)

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

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