The Effects of Amnioinfused Solutions for Meconium-Stained Amniotic Fluid on Neonatal Plasma Electrolyte Concentrations and pH

González, Jose L.; Mooney, Susan; Gardner, Michael O.; Martin, Donald A.; Curet, Luis B.

doi:10.1038/sj.jp.7210732

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Trials included in the analysis used either a computer-generated randomisation list or sealed envelopes. Several studies excluded a significant number of women after randomisation 20 Treatment allocation is not at random Khosla et al 21 Treatment allocation is not at random Gonzalez et al 22 There are no meaningful data. Women who received AI were either allocated to receive normal saline or lactate Ringer's Solution Lembet et al 23 There are no data on clinically important outcomes Edwards and Duff 24 There are no meaningful data.…”

Section: Resultsmentioning

confidence: 99%

“…After exclusion of duplicate and irrelevant references, we identified 23 studies. Eight studies were excluded either because of nonrandomisation study, failure to provide meaningful clinical data or data included in a subsequent study 14,[19][20][21][22][23][24][25] (Table 1). Studies were retained if they were randomised controlled trials that evaluated the effect of prophylactic AI during labour with MSAF; treatment was randomly allocated (AI versus controls) exclusively in the presence of MSAF during labour.…”

Section: Methodsmentioning

confidence: 99%

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Intrapartum amnioinfusion for meconium‐stained amniotic fluid: a systematic review of randomised controlled trials

Hofmeyr

Roy

et al. 2007

BJOG

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Background Amnioinfusion (AI) is thought to dilute meconium when present in the amniotic fluid and so reduces the risk of meconium aspiration.Objectives To evaluate if AI reduces meconium aspiration syndrome (MAS) and other indicators of morbidity in babies born to women with meconium-stained amniotic fluid (MSAF). Selection criteria Randomised trials comparing AI with no AI for women in labour with MSAF. Trial quality was evaluated using pre-established criteria.Data collection and analysis The following morbidity indicators were assessed: MAS, 5-minute Apgar score < 7, arterial cord pH < 7.2, and caesarean section. Studies were stratified according to the level of peripartum surveillance (standard versus limited).Typical relative risks (RRs) with their 95% confidence intervals were calculated for each outcome using a random effects model. Main resultsIn clinical settings with standard peripartum surveillance, we found no evidence that AI reduced the risk of MAS (RR 0.59, 95% CI 0.28-1.25), 5-minute Apgar score < 7 (RR 0.90, 95% CI 0.58-1.41), or caesarean delivery (RR 0.89, 95% CI 0.73-1.10). In clinical settings with limited peripartum surveillance, AI appeared to reduce the risk of MAS (RR 0.25, 95% CI 0.13-0.47).Conclusion In clinical settings with standard peripartum surveillance, the evidence does not support the use of AI for MSAF. In settings with limited peripartum surveillance, where complications of MSAF are common, AI appears to reduce the risk of MAS. However, this finding requires confirmation by further studies.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Intrapartum amnioinfusion for meconium‐stained amniotic fluid: a systematic review of randomised controlled trials

Hofmeyr

Roy

et al. 2007

BJOG

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“…Interestingly however, whereas saline resulted in a significant decrease of pH, infusion of lactated Ringer's solution did not influence the pH of the amniotic fluid. In humans, intrapartum infusion of saline or Ringer's appeared to have no clinically significant effect on neonatal electrolyte composition and pH [11] . Secondly, it has been demonstrated that an acidic environment is an important contributor in the weakening of amnionchorion [6,12] .…”

Section: Discussionmentioning

confidence: 99%

Biochemical Composition of Fluids for Amnioinfusion during Fetoscopy

Scheltema

Anker²,

Vereecken³

et al. 2008

Gynecol Obstet Invest

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Objective: To evaluate which of the commercially available solutions is best suited for amnioinfusion during fetoscopy, based on resemblance with the biochemical properties of amniotic fluid. Materials and Methods: Amniotic fluid samples from 10 pregnancies were studied. Specimens were obtained from 5 pathologic pregnancies (of which 3 were complicated by polyhydramnios) and 5 uncomplicated pregnancies. The concentrations of sodium, potassium, chloride, bicarbonate, calcium, glucose, osmolality, pH, total protein content and albumin were determined in each sample. A literature search (PubMed, Embase) was performed to identify commercially available fluids used for amnioinfusion in clinical practice. The composition of these infusion solutions was compared to the amniotic fluid samples mentioned above. Results: We identified two different electrolyte solutions used in clinical practice for amnioinfusion. We identified four additional commercially available solutions that could potentially be used for amnioinfusion. Most of these infusion solutions differ considerably from midtrimester amniotic fluid samples both in electrolyte composition and pH, with the most striking difference in the latter. Conclusion: Lactated Ringer’s solution approximates amniotic fluid the closest for both electrolyte composition and pH. This infusion solution seems to be the most suitable choice for amnioinfusion during fetoscopy.

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Amnioinfusion for meconium-stained liquor in labour

Hofmeyr¹,

Xu²

2010

Cochrane Database of Systematic Reviews

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The Effects of Amnioinfused Solutions for Meconium-Stained Amniotic Fluid on Neonatal Plasma Electrolyte Concentrations and pH

Cited by 5 publications

References 9 publications

Intrapartum amnioinfusion for meconium‐stained amniotic fluid: a systematic review of randomised controlled trials

Intrapartum amnioinfusion for meconium‐stained amniotic fluid: a systematic review of randomised controlled trials

Biochemical Composition of Fluids for Amnioinfusion during Fetoscopy

Amnioinfusion for meconium-stained liquor in labour

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