PROPHYLACTIC INTRAPARTUM AMNIOINFUSION - A CONTROLLED RETROSPECTIVE STUDY OF 135 CASES

Objective: To show that intrapartum prophylactic amnioinfusion (AI) in case of oligohydramnios or particulate meconium-stained amniotic flui d could be beneficial. Study design: From the first March 1993 until t he 30th June 1995, 4031 women were delivered at the University Hospita l of Poitiers. Patients presenting with oligohydramnios (G1) (71 patie nts with an amniotic fluid index below 5 cm) or a particulate meconium -stained amniotic fluid (G2) (64 patients) were included. Each group w as compared to an historical control group constituted retrospectively according to the following criteria: oligohydramnios (CG1), particula te meconium-stained amniotic fluid (CG2)), age, parity, gestational ag e and duration of labor. Statistical analysis was performed using the Student's t-test and the Fisher's exact test when appropriate with a l evel of significance of P less than 0.05. Results: The mean infused vo lume was 893 ml in G1 and 734 ml in G2. A significant difference was f ound in terms of cesarean section between G1 and CG1 (11.3 vs. 24.5%; P<0.05) and of assisted deliveries for fetal distress between G2 and C G2 (12.5 vs. 23.43%; P<0.05). No other significant difference was foun d between the study groups and their control for all other studied cri teria. When considering more specifically the presence of meconium bel ow the vocal cords we also could not find any significant difference b etween G2 and CG2 (1.6 vs. 9.4%; P=0.05). No neonatal or maternal adve rse effect happened in this short study. Comment: AI is easy to perfor m during labour in case of oligohydramnios or particulate meconium-sta ined amniotic fluid. In case of oligohydramnios, a decreased rate of c esarean sections has been observed in the infused group. Considering p atients with particulate meconium-stained amniotic fluid, less interve ntions for fetal distress and neonates with meconium below the vocal c ords has been found in the infused group. Further prospective evaluati on is needed to confirm these results in case of particulate meconium- stained amniotic fluid and to compare the advantage of prophylactic ve rsus therapeutic AI performed in case of oligohydramnios and abnormal fetal heart rate. (C) 1997 Elsevier Science Ireland Ltd.