Amnioinfusion for potential or suspected umbilical cord compression in labour

Cochrane Review by Hofmeyr GJ

This record should be cited as: Hofmeyr GJ. Amnioinfusion for potential or suspected umbilical cord compression in labour. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000013. DOI: 10.1002/14651858.CD000013.

ABSTRACT

Title

Amnioinfusion for potential or suspected umbilical cord compression in labour

Background

Amnioinfusion aims to prevent or relieve umbilical cord compression or amniotic fluid infection during labour by infusing a solution into the uterine cavity.

Objectives

To assess the effects of amnioinfusion on maternal and perinatal outcome for potential or suspected umbilical cord compression or potential amnionitis.

Search strategy

The Cochrane Pregnancy and Childbirth Group Trials Register (November 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2004) and PubMed (1966 to November 2004).

Selection criteria

Randomized trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression; and women at risk of intrauterine infection.

Data collection and analysis

Eligibility and trial quality were assessed by the review author. Data were extracted and analyzed using RevMan software.

Main results

Fourteen studies were included, most with fewer than 200 participants. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: fetal heart rate decelerations (four studies, 227 women: relative risk (RR) 0.54; 95% confidence interval (CI) 0.43 to 0.68); caesarean section overall (nine studies, 953 women: RR 0.52; CI 0.40 to 0.69); Apgar score less than seven at five minutes (seven studies, 828 women: RR 0.54; CI 0.30 to 0.97); low cord arterial pH (six studies, 660 women: RR 0.45; CI 0.31 to 0.64); neonatal hospital stay greater than three days (one study, 305 women: RR 0.40; CI 0.26 to 0.62); postpartum endometritis (five studies, 619 women: RR 0.45; CI 0.25 to 0.81); maternal hospital stay greater than three days (two studies, 465 women: RR 0.41; CI 0.27 to 0.63). Transabdominal amnioinfusion showed similar trends, though numbers studied were small. Transcervical amnioinfusion to prevent infection in women with membranes ruptured for more than six hours was associated with a reduction in puerperal infection (one study, 68 women: RR 0.50; CI 0.26 to 0.97).

Authors' conclusions

Amnioinfusion appears useful to reduce the occurrence of variable fetal heart rate decelerations, improve short-term measures of neonatal outcome, and lower the use of caesarean section, mainly for 'fetal distress' diagnosed by fetal heart rate monitoring alone. However, most of the included studies were small, and there were methodological shortcomings. In one trial puerperal infection was reduced. The trials reviewed 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 the impact on caesarean section when the diagnosis of fetal distress is more stringent.

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