INTRAPARTUM AMNIOINFUSION FOR MECONIUM-STAINED LIQUOR IN DEVELOPING-COUNTRIES

Background Intrapartum amnioinfusion (AI) has been reported to decreas e perinatal mortality and morbidity in women with meconium-stained liq uor. Such work has not previously been performed at King Edward VIII H ospital (KEH), in a developing country, where the incidence of meconiu m-stained liquor is said to be extremely high. Objective To establish whether AI during the intrapartum period for meconium-stained liquor d ecreases Caesarean section rates for fetal distress and decreases peri natal morbidity. Method 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 pr esentation 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 continu ous cardiotocographic monitoring, until a volume of 11 was completed. This was repeated if delivery did not occur within 4 h. Results The me an pH of umbilical arterial blood was significantly higher in the AI g roup (7.30 versus 7.23; P=0.0029). In addition fewer patients in this group developed hypoxic ischaemic encephalopathy (0 versus 2 controls) or meconium aspiration syndrome (1 versus 4 controls). This was not s tatistically significant. Caesarean section for fetal distress was per formed on fewer patients in the AI soup (3 versus 7 controls), althoug h this was not statistically significant. Conclusion These results dem onstrate that amnioinfusion is an effective technique for improving th e perinatal outcome of pregnancies complicated by meconium-stained liq uor in labour. The decrease in Caesarean sections for fetal distress, though not statistically significant in this study, has clinical relev ance. Furthermore, this study suggests that amnioinfusion is cost effe ctive in a busy, high-risk labour ward unit and consequently should be come standard practice in the management of meconium-stained liquor in labour.