AMNIOINFUSION DURING LABOR COMPLICATED BY PARTICULATE MECONIUM-STAINED AMNIOTIC-FLUID DECREASES NEONATAL MORBIDITY

OBJECTIVE: Our purpose was to evaluate the efficacy of prophylactic am nioinfusion in decreasing neonatal morbidity associated with labor com plicated by particulate meconium-stained amniotic fluid and to assess potential complications of this procedure. STUDY DESIGN: One hundred f ive laboring pregnant women with particulate (moderate or thick) mecon ium by subjective clinical analysis were ramdomly assigned to receive amnioinfusion or to receive standard obstetric care without amnioinfus ion. Patients with any antepartum complications, other than the presen ce of meconium, were excluded from the study. Statistical analyses con sisted of the two-tailed and paired Student t tests, Pearson chi2 test , and Wilcoxon nonparametric test. Significance was set at p < 0.05. R ESULTS: The study included 47 patients in the study group and 58 patie nts in the control group. A significantly greater proportion of study patients demonstrated decreased meconium concentration between rupture of membranes and delivery (46 of 46 vs 15 of 58, p < 0.001). The rela tive dilution of meconium consistency by objective analysis was signif icantly different between the study group and the control group (77.1 % decrease vs 9.3% increase, p < 0.001). The proportion of neonates wi th meconium below the vocal cords was reduced in the study group (two of 47 vs 36 of 58, p < 0.001). Umbilical artery pH was increased in th e study group neonates (7.29 +/- 0.01 vs 7.25 +/- 0.009, p < 0.05). Th e rate of neonatal acidemia was reduced in the study group (4 of 45 vs 12 of 50, p < 0.05). The rate of meconium aspiration syndrome was red uced in the study group (1 of 47 vs 8 of 58, p < 0.05). Maternal and n eonatal morbidity rates were similar. CONCLUSION: Prophylactic amnioin fusion should be considered a possible addition to the intrapartum man agement of patients with particulate meconium-stained amniotic fluid.