Effects of Amnioinfusion in Meconium Stained Amniotic Fluid

In this prospective case controlled study, 200 patients with moderate or thick meconium strained amniotic fluid were selected from labour ward. Among them 100 were given Amnioinfusion and grouped as amnioinfusion group. The other 100 were kept as control group with out giving amnioinfusion. In analyzing the intrapartom course and perinatal outcome, the following points were summed up: 1. Majority of patients in amnioinfusion group and control group were in the age group of 19-30. Only 5% in amnioinfusion group and 9% in the control group were above 30 2. The parity is also same in both the groups. Majority of the patients were nullipara - 67% in amnioinfusion group and 58% in control group. 3. The gestation age for majority of the patients in the amnioinfusion group and control group were between 37 to 40 weeks. Only 21% of the amnioinfusion group and 28% in the control group had gestational age above 40 weeks. 4. On inclusion majority of the patients were in the active phase of labour. 85% in amnioinfusion and 83% in the control group 5. Augmentation with oxytocin was needed in 64% patients in the amnioinfusion and 67% in control group. 6. The mean duration of labour from rupture of membrane to delivery was 2.44 hrs in the Amnioinfusion group and 2.24 hrs in control group. The difference is not significant and this shows that in this study there was no effect on the duration of labour by Amnioinfusion. 7. The incidence of FHR abnormalities was significantly lower in the Amnioinfusion group, 24% versus 38% in the control group. 8. Considering the mode of delivery, majority of the patients in both the groups delivered by L N 61% in Amnioinfusion group and 51% in control group. The incidence of instrumental vaginal delivery was 5% in amnioinfusion group and 11% in control group. 9. The number of patients who delivered by LSCS was 34% in Amnioinfusion and 38% in control group which is not significant. 10. There was significant decrease in the number of LSCS done for fetal distress in Amnioinfusion group, 21% versus 34% in control group. 11. Most of the patients who were included in the study in the latent phase of labour underwent LSCS. 12. Discussing about the perinatal outcome, there was significant decrease in the number of babies with low Apgar score. 13. The presence of meconium below the vocal cords was significantly reduced in the amnioinfusion group, 10% versus 27% in the control group. 14. The incidence of meconium aspiration syndrome was also significantly reduced in amnioinfusion group, 3 versus 14 in control group. This shows that amnioinfusion is effective in reducing meconium below vocal cord and meconium aspiration syndrome. 15. New born babies admitted in NICU was lower in amnioinfusion group than the control group (13% versus 31%). Hence there is significant decrease in the neonatal admission in the amnioinfusion group. 16. Perinatal mortality in amnioinfusion group 0% where as in control 2%. 17. There are no adverse maternal or fetal complications reported with amnioinfusion in this study. CONCLUSION: In this study it is found that the use of amnioinfusion has significantly reduced the number of intrapartum fetal heart rate abnormalities. Amnioinfusion has no effect on the mode of delivery in patients with meconium strained amniotic fluid in labour. The incidence of caesarean deliveries is not reduced but the number of caesarean section done for fetal distress has been decreased by the use of amnioinfusion. The study shows a drastic improvement in the perinatal outcome in the patients who received amnioinfusion. There was significant improvement in the one minute and five minute Apgar score, decrease in the incidence of meconium below the level of vocal cord and decrease in meconium aspiration syndrome. The number of babies admitted in NICU is also significantly reduced in the amnioinfusion group. To conclude, amnioinfusion is a safe, easy and effective procedure, which needs little expertise and can be done in labour ward even with limited facilities to improve neonatal outcome in meconium stained liquour. The use of such simple technique is very useful and effective in developing countries even with limited newborn care facilities. It is also very cost effective.