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The Cochrane Database of Systematic... Sep 2012Amnioinfusion aims to relieve umbilical cord compression during labour by infusing a liquid into the uterine cavity. (Review)
Review
BACKGROUND
Amnioinfusion aims to relieve umbilical cord compression during labour by infusing a liquid into the uterine cavity.
OBJECTIVES
The objective of this review was to assess the effects of prophylactic amnioinfusion for women in labour with oligohydramnios, but not fetal heart deceleration, compared with therapeutic amnioinfusion only if fetal heart rate decelerations or thick meconium-staining of the liquor occur.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 February 2012).
SELECTION CRITERIA
Randomised trials comparing prophylactic amnioinfusion in women in labour with oligohydramnios but not fetal heart rate deceleration in labour with therapeutic amnioinfusion.
DATA COLLECTION AND ANALYSIS
The authors assessed trial quality and extracted data.
MAIN RESULTS
One randomized trial of 116 women was included. No differences were found in the rate of caesarean section (risk ratio 1.29, 95% confidence interval 0.60 to 2.74). There were no differences in cord arterial pH, oxytocin augmentation, neonatal pneumonia or postpartum endometritis. Prophylactic amnioinfusion was associated with increased intrapartum fever (risk ratio 3.48, 95% confidence interval 1.21 to 10.05).
AUTHORS' CONCLUSIONS
There appears to be no advantage of prophylactic amnioinfusion over therapeutic amnioinfusion carried out only when fetal heart rate decelerations or thick meconium-staining of the liquor occur.
Topics: Amnion; Female; Fetal Distress; Fetal Heart; Heart Rate, Fetal; Humans; Injections; Obstetric Labor Complications; Oligohydramnios; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 22972040
DOI: 10.1002/14651858.CD000176.pub2 -
The Cochrane Database of Systematic... Jan 2012Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Amnioinfusion aims to prevent or relieve umbilical cord compression during labour by infusing a solution into the uterine cavity.
OBJECTIVES
To assess the effects of amnioinfusion for potential or suspected umbilical cord compression on maternal and perinatal outcome .
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011).
SELECTION CRITERIA
Randomised trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression in labour.
DATA COLLECTION AND ANALYSIS
The original review had one author only (Justus Hofmeyr (GJH)). For this update, two authors (GJH and T Lawrie) assessed 13 additional trial reports for eligibility and quality. We extracted data and checked for accuracy.
MAIN RESULTS
We have included 19 studies, with all but two studies having fewer than 200 participants. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: caesarean section overall (13 trials, 1493 participants; average risk ratio (RR) 0.62, 95% confidence interval (CI) 0.46 to 0.83); fetal heart rate (FHR) decelerations (seven trials, 1006 participants; average RR 0.53, 95% CI 0.38 to 0.74); Apgar score less than seven at five minutes (12 trials, 1804 participants; average RR 0.47, 95% CI 0.30 to 0.72); meconium below the vocal cords (three trials, 674 participants, RR 0.53, 95% CI 0.31 to 0.92); postpartum endometritis (six trials, 767 participants; RR 0.45, 95% CI 0.25 to 0.81) and maternal hospital stay greater than three days (four trials, 1051 participants; average RR 0.45, 95% CI 0.25 to 0.78). Transabdominal amnioinfusion showed similar trends, though numbers studied were small.Mean cord umbilical artery pH was higher in the amnioinfusion group (seven trials, 855 participants; average mean difference 0.03, 95% CI 0.00 to 0.06) and there was a trend toward fewer neonates with a low cord arterial pH (less than 7.2 or as defined by trial authors) in the amnioinfusion group (eight trials, 972 participants, average RR 0.58, 95% CI 0.29 to 1.14).
AUTHORS' CONCLUSIONS
The use of amnioinfusion for potential or suspected umbilical cord compression may be of considerable benefit to mother and baby by reducing the occurrence of variable FHR decelerations, improving short-term measures of neonatal outcome, reducing maternal postpartum endometritis and lowering the use of caesarean section, although there were methodological limitations to the trials reviewed here. In addition, the trials are too small to address the possibility of rare but serious maternal adverse effects of amnioinfusion. More research is needed to confirm the findings, assess longer-term measures of fetal outcome, and to assess the impact on caesarean section rates when the diagnosis of fetal distress is more stringent. Trials should assess amnioinfusion in specific clinical situations, such as FHR decelerations, oligohydramnios or prelabour rupture of membranes.
Topics: Amnion; Cesarean Section; Constriction, Pathologic; Endometritis; Female; Fetal Distress; Heart Rate, Fetal; Humans; Injections; Meconium; Oligohydramnios; Pregnancy; Randomized Controlled Trials as Topic; Umbilical Cord
PubMed: 22258939
DOI: 10.1002/14651858.CD000013.pub2 -
The Cochrane Database of Systematic... Jul 2008Amniotic fluid volume is an important parameter in the assessment of fetal well-being. Oligohydramnios occurs in many high-risk conditions and is associated with poor... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Amniotic fluid volume is an important parameter in the assessment of fetal well-being. Oligohydramnios occurs in many high-risk conditions and is associated with poor perinatal outcomes. Many caregivers practice planned delivery by induction of labor or caesarean section after diagnosis of decreased amniotic fluid volume at term. There is no clear consensus on the best method to assess amniotic fluid adequacy.
OBJECTIVES
To compare the use of the amniotic fluid index with the single deepest vertical pocket measurement as a screening tool for decreased amniotic fluid volume in preventing adverse pregnancy outcome.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 2), MEDLINE (1966 to May 2007) and the metaRegister of Controlled Trials (May 2007). We handsearched the citation lists of relevant publications, review articles, and included studies.
SELECTION CRITERIA
Randomised controlled trials involving women with a singleton pregnancy, whether at low or high risk, undergoing ultrasound measurement of amniotic fluid volume as part of antepartum assessment of fetal well-being that compared the amniotic fluid index and the single deepest vertical pocket measurement.
DATA COLLECTION AND ANALYSIS
Both authors independently assessed eligibility and quality, and extracted the data.
MAIN RESULTS
Four trials (3125 women) met the inclusion criteria. There is no evidence that one method is superior to the other in the prevention of poor peripartum outcomes, including: admission to a neonatal intensive care unit; an umbilical artery pH of less than 7.1; the presence of meconium; an Apgar score of less than 7 at five minutes; or caesarean delivery. When the amniotic fluid index was used, significantly more cases of oligohydramnios were diagnosed (risk ratio (RR, random) 2.33, 95% CI 1.67 to 3.24), and more women had inductions of labor (RR (fixed) 2.10, 95% CI 1.60 to 2.76) and caesarean delivery for fetal distress (RR (fixed) 1.45, 95% CI 1.07 to 1.97).
AUTHORS' CONCLUSIONS
The single deepest vertical pocket measurement in the assessment of amniotic fluid volume during fetal surveillance seems a better choice since the use of the amniotic fluid index increases the rate of diagnosis of oligohydramnios and the rate of induction of labor without improvement in peripartum outcomes. A systematic review of the diagnostic accuracy of both methods in detecting decreased amniotic fluid volume is required.
Topics: Amniotic Fluid; Female; Humans; Oligohydramnios; Pregnancy; Pregnancy Outcome; Ultrasonography
PubMed: 18646160
DOI: 10.1002/14651858.CD006593.pub2 -
The Cochrane Database of Systematic... 2000Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and... (Review)
Review
BACKGROUND
Oligohydramnios (reduced amniotic fluid) may be responsible for malpresentation problems, umbilical cord compression, concentration of meconium in the liquor, and difficult or failed external cephalic version. Simple maternal hydration has been suggested as a way of increasing amniotic fluid volume in order to reduce some of these problems.
OBJECTIVES
The objective of this review was to assess the effects of maternal hydration on amniotic fluid volume and measures of pregnancy outcome.
SEARCH STRATEGY
The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. Date of last search: 1 February 1999.
SELECTION CRITERIA
Randomised trials comparing maternal hydration with no hydration in pregnant women with reduced or normal amniotic fluid volume.
DATA COLLECTION AND ANALYSIS
Eligibility and trial quality were assessed by both reviewers.
MAIN RESULTS
Two studies of 77 women were included. The women were asked to drink two litres of water before having a repeat ultrasound examination. Maternal hydration in women with and without oligohydramnios was associated with an increase in amniotic volume (weighted mean difference for women with oligohydramnios 2.01, 95% confidence interval 1.43 to 2.56; and weighted mean difference for women with normal amniotic fluid volume 4.5, 95% confidence interval 2.92 to 6.08). Intravenous hypotonic hydration in women with oligohydramnios was associated with an increase in amniotic fluid volume (weighted mean difference 2.3, 95% confidence interval 1.36 to 3.24). Isotonic intravenous hydration had no measurable effect. No clinically important outcomes were assessed in any of the trials.
REVIEWER'S CONCLUSIONS
Simple maternal hydration appears to increase amniotic fluid volume and may be beneficial in the management of oligohydramnios and prevention of oligohydramnios during labour or prior to external cephalic version. Controlled trials are needed to assess the clinical benefits and possible risks of maternal hydration for specific clinical purposes.
Topics: Amniotic Fluid; Female; Fluid Therapy; Humans; Oligohydramnios; Pregnancy
PubMed: 10796151
DOI: 10.1002/14651858.CD000134