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Intrapartum amnioinfusion reduces meconium aspiration syndrome and improves neonatal outcomes in patients with meconium-stained fluid: a systematic review and meta-analysis
This study aimed to reassess the effect of prophylactic transcervical amnioinfusion for intrapartum meconium-stained amniotic fluid on meconium aspiration syndrome and other adverse neonatal and maternal outcomes.
Data Sources
From inception to November 2021, a systematic search of the literature was performed in PubMed, Embase, Web of Science, and Scopus databases and gray literature sources.
Study Eligibility Criteria
We identified randomized controlled trials of patients with intrapartum moderate to thick meconium-stained amniotic fluid that evaluated the effect of amnioinfusion on adverse neonatal and maternal outcomes.
Methods
Of note, 2 reviewers independently abstracted data and gauged study quality by assigning a modified Jadad score. Meconium aspiration syndrome constituted the primary outcome. The secondary outcomes were meconium below the cords, Apgar scores of <7 at 5 minutes, neonatal acidosis, cesarean delivery, cesarean delivery for fetal heart rate abnormalities, neonatal intensive care unit admission, and postpartum endometritis. This study calculated the odds ratios with 95% confidence intervals for categorical outcomes and weighted mean differences with 95% confidence intervals for continuous outcomes.
Results
A total of 24 randomized studies with 5994 participants met the inclusion criteria. The overall odds of meconium aspiration syndrome was reduced by 67% in the amnioinfusion group (pooled odds ratio, 0.33; 95% confidence interval, 0.21–0.51). Except for postpartum endometritis, amnioinfusion was associated with a significant reduction in all secondary outcomes.
Conclusion
Our study found that the use of intrapartum amnioinfusion in the setting of meconium-stained amniotic fluid significantly reduces the odds of meconium aspiration syndrome and other adverse neonatal outcomes.
The routine use of amnioinfusion for meconium-stained amniotic fluid (MSAF) fell out of favor after the publication of a disputed meta-analysis 15 years ago. Since then, several more randomized trials have been conducted. This study sought to reappraise the value of intrapartum amnioinfusion for this indication, given that MSAF is associated with serious neonatal outcomes.
Key findings
This meta-analysis found that prophylactic intrapartum transcervical amnioinfusion in the setting of MSAF reduces the rate of meconium aspiration syndrome (MAS) and the incidence of meconium below the cords, low Apgar scores, neonatal acidosis, cesarean delivery rate, and neonatal intensive care unit admissions. The reduction of MAS in the amnioinfusion group was not substantially impacted by the type of intrapartum monitoring, study quality, country, or meconium consistency.
What does this add to what is known?
Amnioinfusion is a relatively simple procedure that is frequently used by obstetricians for suspected umbilical cord compression to reduce variable fetal heart rate decelerations and the likelihood of cesarean delivery. With this updated and comprehensive review, providers of obstetrical care should reconsider amnioinfusion in patients with intrapartum MSAF.
Introduction
Meconium-stained amniotic fluid (MSAF) occurs in 1 of 7 pregnancies, annually accounting for 400,000 to 600,000 deliveries in the United States.
MSAF is associated with neonatal and maternal adverse outcomes. Approximately 20% to 30% of neonates born with MSAF will demonstrate respiratory and neurologic depression at birth.
Given the gravity of MSAF complications, different types of preventative clinical strategies have been employed. One such intervention is amnioinfusion, a low-risk procedure using a transcervical intrauterine catheter to infuse fluid into the amniotic cavity. Several individual studies and several systematic reviews with meta-analysis
have shown that this strategy is highly effective in reducing neonatal morbidity. However, a 2005 multicenter randomized controlled trial (RCT) concluded that amnioinfusion did not reduce the risk of moderate or severe MAS, perinatal death, or other major neonatal or maternal complications. In that multinational trial, approximately 22.1% of patients randomized to the amnioinfusion group did not undergo amnioinfusion, or amnioinfusion was performed incorrectly. In addition, the level of perinatal care was highly variable among the 56 disparate centers.
Moreover, the authors did not report the number of eligible participants who were unwilling to participate. Recent individual studies and systematic reviews with meta-analyses have concluded that participants participating in RCTs on average experienced better outcomes than nonparticipants.
In 2007, the authors of the multinational trial subsequently published an updated systematic review and meta-analysis that reached conclusions similar to those of the multinational RCT.
Unfortunately, because an inappropriate version of the manuscript not consistent with peer-reviewed recommendations was eventually published, the results have been disputed.
Given that several RCTs have been published since 2007, and the controversy regarding data incorporated into the previous meta-analysis, we aimed to perform an updated comprehensive systematic review and meta-analysis, which reappraises the value of amnioinfusion in laboring patients with meconium-stained fluid.
Objective
Our study aimed to assess the effect of prophylactic amnioinfusion when intrapartum MSAF is present on adverse neonatal and maternal outcomes.
Methods
Eligibility criteria, information sources, and search strategy
We followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines
We registered our protocol with the International Prospective Register of Systematic Reviews (registration number: CRD42022292913) on December 6, 2021, before introductory searches were performed. We searched the literature using strategies created by an experienced medical librarian for transcervical amnioinfusion in women with intrapartum MSAF. The search strategies were implemented in PubMed, Embase, Web of Science, and Scopus from their inception to November 30, 2021. Gray literature sources searched included Google Scholar, Mednar, Europe PubMed Central, OpenGrey, Global Index Medicus, the World Health Organization, and ClinicalTrials.gov. Furthermore, we manually searched the reference lists from selected studies to ensure a comprehensive review of the literature. We included studies irrespective of language, year of publication, or country. Prospective studies were identified using a combination of standardized terms and key words, including, but not limited to, intrapartum or MSAF and amnioinfusion and MAS or neonatal outcomes. The search syntax appears in the Supplemental Appendix. We used a sensitive search filter to focus on RCTs.
Study selection
We selected RCTs that evaluated the effect of prophylactic amnioinfusion during labor for patients with moderate to thick MSAF, allocated groups (amnioinfusion vs controls) based exclusively on the presence of MSAF during labor (not on other indications for amnioinfusion) and documented outcome data. We included abstracts in the analysis, but we did not include reviews, nonrandomized studies, and case reports or series.
Data extraction
The primary outcome of this quantitative review was MAS as defined in each study. The secondary outcomes included meconium below the cords, Apgar score of >7 at 5 minutes, neonatal acidosis, cesarean delivery, cesarean delivery for fetal distress, neonatal intensive care unit (NICU) admission, and postpartum endometritis. Titles and abstracts from the initial search results were independently reviewed by 2 authors (J.D.D. and J.M.). Full-text articles were obtained when there was uncertainty about inclusion based on the abstract. The 2 authors (J.D.D. and J.M.) independently abstracted data into standard extraction forms. Details regarding amnioinfusion protocols and strategies for peripartum fetal monitoring were collected. We downloaded all retrieved references into Endnote software (version X9; Thompson Reuters, Toronto, Canada) and Covidence, a screening and data extraction tool.
Assessment of quality of evidence
The 2 reviewers (J.D.D. and J.M.) independently gauged study quality by assigning a modified Jadad score.
Discrepancies in the assigned scores were resolved by discussion or by the senior author (L.S.R.). The overall quality of the studies was graded as follows: low risk of bias (modified Jadad score of ≥5) and high risk of bias (modified Jadad score <5).
The strength of the evidence of all meta-analyses was assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method according to the GRADE handbook.
Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013.
Inconsistent definition of neonatal acidosis or arterial cord gas pH cutoff used for diagnosis; bInterpretation of fetal distress on fetal heart tracing can be subjective; cOf note, 8 studies cited “maternal pyrexia” instead of diagnosis of endometritis.
Davis. Amnioinfusion for meconium amniotic fluid. Am J Obstet Gynecol 2022.
a Inconsistent definition of neonatal acidosis or arterial cord gas pH cutoff used for diagnosis; bInterpretation of fetal distress on fetal heart tracing can be subjective; cOf note, 8 studies cited “maternal pyrexia” instead of diagnosis of endometritis.
Specific outcome analyses were based on a variable number of studies because not all trials evaluated each outcome. We performed stratified analyses by study quality, country, meconium consistency, and type of peripartum fetal monitoring. For the primary outcome, MAS, we performed subgroup analyses by stratifying the data based on sample sizes of the included studies and also by performing a cumulative meta-analysis (Supplemental Figure 1, Supplemental Figure 2, Supplemental Figure 3). We used the I2 test to quantify and assess heterogeneity.
We considered heterogeneity to be significant if I2 is >50%. Using random-effects models (DerSimonian and Laird), raw data from the studies were pooled to obtain odds ratios (ORs) with 95% confidence intervals (CIs) for categorical outcomes and weighted mean differences (WMDs) with 95% CIs for continuous outcomes. A 2-sided P<.05 was considered statistically significant for pooled analyses. We used random-effects models because of expected clinical heterogeneity among the studies. The 95% prediction intervals (PIs) were performed to estimate what true treatment effects can be expected in future settings and to better interpret heterogeneity.
We performed a sequential leave-one-out analysis to investigate the influence of individual studies on the overall meta-analysis summary estimate. To assess for publication bias or small study effects, we visually inspected funnel plots and performed an Egger test.
We used the trim-and-fill method to estimate potentially missing studies because of publication bias in the funnel plots and adjust the overall effect estimates.
Trial sequential analysis was performed for the primary outcome of our meta-analysis, to consider the risk of random error and better estimate the certainty of our findings.
We performed statistical analyses with Stata (version 16.1; StataCorp LLC, College Station, TX).
Results
Study selection
Our initial database search yielded 1249 articles. After the elimination of duplicate studies or studies with abstracts or titles not pertinent to the topic of interest, 34 studies remained. We excluded an additional 10 studies after full-text review. Ultimately, a total of 24 RCTs with 5994 participants (2916 treated and 3078 controls) met the inclusion criteria. Figure 1 depicts a summary diagram of the study selection methodology.
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
met our inclusion criteria. These studies varied by size, year, country, type of peripartum fetal surveillance, meconium consistency, amnioinfusion protocol, and criteria for diagnosis of MAS. Table 2 summarizes the study characteristics. Continuous fetal monitoring was used in 17 of the studies.
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
Table 2 summarizes the assignment of these scores. After subgroup analysis, study quality was not shown to substantially affect the primary outcome (MAS) results as a significant reduction with amnioinfusion was seen for both high-quality studies (OR, 0.34; 95% CI, 0.19–0.62) and low-quality studies (OR, 0.29; 95% CI, 0.17–0.47) (Supplemental Table 1). Meta-regression analysis for the impact of study quality on results was not shown to be considerable for any investigated outcome (reported in the Appendix, Supplemental Table 2).
Synthesis of results
Prophylactic amnioinfusion used for the indication of MSAF reduced MAS on average by approximately 67% (OR, 0.33; 95% CI, 0.22–0.51) (Figure 2; Supplemental Figure 4). Our cumulative forest plot for MAS demonstrated that accumulative evidence since 1994 has shown a substantial reduction in MAS with intrapartum amnioinfusion (Figure 3). A high fragility index score of 39 was found for the outcome of MAS, signifying that the statistical significance of the synthesized OR was robust. In addition, amnioinfusion was associated with a marked reduction in all secondary outcomes except for postpartum endometritis (Table 3; Supplemental Figure 5, Supplemental Figure 6, Supplemental Figure 7, Supplemental Figure 8, Supplemental Figure 9, Supplemental Figure 10, Supplemental Figure 11). This includes an approximately 63% decrease in NICU admissions (OR, 0.37; 95% CI, 0.24–0.57) and an approximately 40% reduction in cesarean delivery rate (OR, 0.60; 95% CI, 0.46–0.78). Neonatal cord pH was higher in patients that received amnioinfusion (WMD, 0.03; 95% CI, 0.02–0.05).
Figure 2Forest plot for meconium aspiration syndrome
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
After meta-regression and subgroup analyses (Table 4; Supplemental Figure 12, Supplemental Figure 13, Supplemental Figure 14), our findings for the primary outcome of MAS were not substantially affected by the potential confounders of country, Jadad score, thick meconium, continuous fetal monitoring only, or sample size (Supplemental Figure 1, Supplemental Figure 2, Supplemental Figure 3). When we performed a leave-one-out analysis for all outcomes, we did not find undue influence from any single study (Supplemental Table 3). We noted considerable heterogeneity for all outcomes except for Apgar score of <7 at 5 minutes and postpartum endometritis. Using the Egger and Rucker tests and inspection of funnel plots, we noted substantial publication bias for MAS, meconium below the cords, neonatal acidosis, and cesarean delivery (Figure 4; Supplemental Table 4). Based on the trim-and-fill method that accounted for publication bias for the outcome MAS, the adjusted OR remained noteworthy (Figure 5). In trial sequential analysis, the cumulative z score curve is beyond the upper trial sequential monitoring boundary (for benefit) confirming that amnioinfusion is superior to controls for the prevention of MAS (Supplemental Figure 15). Based on the P curve analysis, we can rule out selective reporting as the sole explanation for the substantial reduction in MAS with intrapartum transcervical amnioinfusion (Supplemental Figure 16).
Table 4Subgroup analysis for different covariates
Outcome
OR (95% CI) for continuous fetal monitoring
OR (95% CI) for limited peripartum surveillance
OR (95% CI) for thick meconium only
OR (95% CI) for trials performed in the United States
Meconium aspiration syndrome
0.39 (0.24–0.64)
0.20 (0.09–0.47)
0.32 (0.14–0.76)
0.37 (0.14–0.97)
Meconium below the cords
0.25 (0.16–0.41)
0.28 (0.19–0.41)
0.24 (0.11–0.50)
0.12 (0.06–0.22)
Apgar score of <7 at 5 min
0.62 (0.39–0.99)
0.26 (0.15–0.48)
0.48 (0.23–1.01)
0.57 (0.18–1.80)
Neonatal acidosis (cord pH<7.2)
0.52 (0.31–0.88)
No studies applicable
0.53 (0.16–1.75)
0.22 (0.11–0.41)
Cesarean delivery
0.68 (0.51–0.90)
0.47 (0.27–0.84)
0.56 (0.33–0.96)
0.62 (0.33–1.15)
Cesarean delivery for NRFHT
0.44 (0.21–0.70)
0.31 (0.14–0.69)
0.56 (0.16–1.98)
0.29 (0.08–1.02)
NICU admission
0.44 (0.25–0.78)
0.45 (0.31–0.66)
0.13 (0.07–0.24)
0.93 (0.19–4.62)
Postpartum endometritis
0.89 (0.59–1.35)
0.55 (0.26–1.16)
0.94 (0.52–1.70)
0.82 (0.45–1.50)
CI, confidence interval; NICU, neonatal intensive care unit; NRFHT, nonreassuring fetal heart tracing; OR, pooled odds ratio.
Davis. Amnioinfusion for meconium amniotic fluid. Am J Obstet Gynecol 2022.
Our systematic review and meta-analysis found that intrapartum amnioinfusion in the setting of MSAF prevents adverse neonatal outcomes, including MAS. Meta-regression and subgroup analyses for covariates did not significantly alter these findings.
Pathophysiology of meconium aspiration syndrome
The pathophysiology of MAS is complex and has long been debated. Evidence suggests that MAS occurs not only from mechanical obstruction but also from lung inflammation.
However, critics hypothesize that MAS results from chronic in utero pathologies, such as prolonged asphyxia, infection, and persistent pulmonary hypertension.
The consistency of meconium may play a role in determining the validity of these 2 hypotheses and contribute to MAS’s multifactorial pathogenesis; although thin meconium is associated with chronic hypoxic stress, acute hypoxic stress and inflammation result in thick meconium.
A 2021 retrospective cohort study and systematic review found that neonates born in the setting of thick MSAF had considerably higher rates of MAS than those born in thin MSAF. The authors of this report also identified a trend toward worse neonatal outcomes in the thick MSAF group.
found that longer exposure to thick meconium led to more lung inflammation and pulmonary cell death. This same report identified that thick meconium was associated with more intensive birth resuscitation, NICU admission, and short-term ventilation than thin meconium.
Proposed mechanism of action
We propose that amnioinfusion causes the beneficial effects that we found in our study by diluting the meconium in the amniotic fluid. Amnioinfusion may improve neonatal outcomes by attenuating the acute event of thick meconium, thereby reducing meconium’s mechanical and inflammatory effects.
Comparison with existing literature
The use of amnioinfusion for MSAF began to fall out of favor after the publication of a systematic review by Xu et al
by the same authors found that amnioinfusion failed to significantly reduce the risk of moderate or severe MAS, perinatal death, or other major maternal or neonatal complications. However, after inspection of this 2005 trial, we identified several limitations, including that the level of perinatal care was highly variable between centers and that >20% of patients in the treatment group either did or did not undergo amnioinfusion or amnioinfusion was not properly performed.
included 12 RCTs with 4030 participants and found that the incidence of MAS did not differ considerably between the amnioinfusion and control groups in settings with standard peripartum surveillance (relative risk [RR], 0.59; 95% CI, 0.28–1.25). The fragility index score for this pooled effect estimate was 5, which is much lower than our score of 39, indicating that our findings were markedly more robust. Xu et al’s
report did find a significant reduction in MAS (RR, 0.25; 95% CI, 0.13–0.47) in settings with limited peripartum surveillance. The findings of our study differed from this earlier meta-analysis as we found that amnioinfusion reduced MAS regardless of the type of peripartum surveillance, country, or study quality.
In addition to submitting an inappropriate version of the manuscript for publication,
underwent peer review, and the expert referees recommended that these studies with low-quality scores should be included in their analysis. Some expressed concern that these studies were omitted so that the conclusions of the review would be similar to the results of Fraser et al’s
2005 randomized clinical trial. When these 3 studies with low-quality scores were included, the outcome of MAS was substantially reduced for clinical settings with standard (RR, 0.53; 95% CI, 0.29–0.98) and limited (RR, 0.25; 95% CI, 0.13–0.47) peripartum surveillance. With the inclusion of these 3 studies, the overall RR regardless of surveillance type was 0.46 (95% CI, 0.26–0.84).
our study found a substantial reduction in the overall cesarean delivery rate and Apgar score of<7 at 5 minutes. In addition, we investigated and found a substantial reduction in NICU admissions, which is important given its effect on healthcare costs.
Strengths and limitations
Our study has several strengths, including (1) a comprehensive literature search, (2) the inclusion of twice as many studies as the previous meta-analysis for a total of 5994 participants, (3) the use of the well-established modified Jadad score for study quality analysis, (4) the performance of a sequential leave-one-out analysis to investigate the influence of each study on the overall meta-analysis summary estimate, (5) meta-regression and subgroup analysis to search for sources of heterogeneity, (6) publication bias assessment with funnel plots and statistical tests, (7) trim-and-fill method to adjust the summary estimate, (8) 95% PIs to further assess heterogeneity, (9) trial sequential analysis to consider the risk of random error, (10) P curve analysis to rule out selective reporting, and (11) fragility index scoring to assess the robustness of our results for the primary outcome of MAS.
However, we noted several limitations of our study. There was considerable heterogeneity for most of the investigated outcomes. Heterogeneity measures the variability between studies. Some of this can be attributed to study size, intervention specifics, and baseline differences between study participants. To account for heterogeneity, random-effects models were used, 95% PIs were calculated, and subgroup analyses were performed. Unfortunately, our attempts to identify sources of heterogeneity were unsuccessful.
Even after a comprehensive literature search, we identified considerable publication bias for the outcomes of MAS, meconium below the cords, neonatal acidosis, and cesarean delivery. Publication bias often occurs in meta-analyses and may result from a variety of factors, including selective reporting of favorable outcomes and that small studies are more likely to show significant results.
After performing the trim-and-fill method, the adjusted OR for MAS continued to indicate a substantial reduction with amnioinfusion use.
In addition to these statistical limitations, there were also clinical limitations. The diagnostic criteria for MAS differed between some studies or were not always defined; accordingly, we could not stratify included studies by these criteria. Although amnioinfusion is a relatively safe procedure, rare complications have been reported, including uterine hypertonia or rupture, fetal heart rate abnormalities, cord prolapse, and chorioamnionitis.
These complications were not routinely reported in the included articles, preventing a safety analysis in our study and underscoring the importance of updated assessments of amnioinfusion’s safety. Finally, amnioinfusion protocols were highly variable between studies. If prophylactic amnioinfusion is used to regain popularity in intrapartum practice for the indication of MSAF, best practices for infusion protocols should be explored.
Conclusions and implications
Our meta-analysis suggested that implementation of amnioinfusion in the setting of MSAF can reduce not only the rate of MAS but also the incidence of meconium below the cords, low Apgar scores, neonatal acidosis, cesarean delivery rate, and NICU admissions. Accordingly, contemporary recommendations involving intrapartum amnioinfusion for the indication of MSAF should be reexamined by obstetrics professional societies. Since 2007, approximately 6 million neonates in the United States have been born in the setting of MSAF with approximately 5% of these infants developing MAS.
Our data suggested that if prophylactic amnioinfusion had been implemented during their intrapartum course, approximately 200,000 cases of MAS of the estimated 300,000 total national cases since 2007 could have been prevented. Given that the mortality rate of MAS is as high as 12%, widespread implementation of amnioinfusion since 2007 could have prevented deaths of approximately 24,000 newborns in the United States.
Supplemental Table 4 The Egger and Rucker tests for small study effects on investigated outcomes
Search syntax
Mesh terms used were “meconium,” “meconium aspiration syndrome,” “amniotic fluid,” and “infusions, parenteral.” Emtree terms used were “meconium stained amniotic fluid,” “meconium,” “meconium aspiration,” “amnioinfusion,” “amnion fluid,” and “infusion.” Key words used were “amnioinfusion,” “meconium,” “intra-amniotic infusion,” “intraamniotic administration,” and “intraamniotic injection.” Search filters included PubMed and Emtree-specific filters for “randomized controlled trials,” “randomized controlled trial as topic,” and keywords “randomized controlled trial” and “RCT.”
PubMed search
((Meconium[Mesh] OR “meconium aspiration syndrome”[mesh] OR meconium) AND (Amnioinfusion OR (amniotic fluid AND infus∗ OR inject∗) OR (amniotic fluid[mesh] AND (“infusions, parenteral”[mesh] OR injections[mesh]))OR intra-amniotic infusion))
37 citations
Embase search
1.
'meconium stained amniotic fluid'/exp OR 'meconium'/exp OR 'meconium' OR 'meconium aspiration'/exp OR 'meconium aspiration' OR 'meconium aspiration syndrome'
2.
‘amnioinfusion’/exp OR ‘amnioinfusion’
3.
('amnion fluid'/exp OR 'allantois fluid' OR 'amnion fluid' OR 'amnion liquid' OR 'amnionic fluid' OR 'amniotic fluid' OR 'liquor amnii') AND ('infusion'/exp OR 'drip infusion' OR 'infusion') OR 'intra-amniotic drug administration'/exp OR 'intra-amniotic administration' OR 'intra-amniotic drug administration' OR 'intra-amniotic injection' OR 'intraamniotic administration' OR 'intraamniotic injection'
4.
#2 OR #3
5.
#4 AND #1
6.
‘randomized controlled trial’/de OR ‘randomized controlled trial topic”/de
7.
‘randomized controlled trial’ OR ‘rct’
8.
#5 AND (#6 OR #7)
37 citations
Web of Science
All databases
TS=meconium AND
TS= amnioinfusion OR ((TS=amniotic fluid OR TS=amnion) AND (TS=infus∗) OR TS=intra-amniotic infusion
262 citations
Scopus
( TITLE-ABS-KEY (amnioinfusion OR (( amniotic OR amnion OR intra-amniotic) AND infus∗)) AND TITLE-ABS-KEY (meconium) AND TITLE-ABS-KEY (“randomized controlled trial” OR “RCT”))
59 citations
Supplemental Figure 1Studies with at least 200 participants
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
PowerPoint Video Summary of Intrapartum amnioinfusion reduces meconium aspiration syndrome and improves neonatal outcomes in patients with meconium-stained fluid.
Davis. Amnioinfusion for meconium amniotic fluid. Am J Obstet Gynecol 2022.
References
Lee J.
Romero R.
Lee K.A.
et al.
Meconium aspiration syndrome: a role for fetal systemic inflammation.
Schünemann H, Brożek J, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. The GRADE Working Group, 2013.
A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre.
Int J Reprod Contracept Obstet Gynecol.2017; 6: 4347-4350
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