Amnioinfusion for potential or suspected umbilical cord compression in labour

 

Abstract

Background

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

Objectives

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

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2011).

Selection criteria

Randomised trials of amnioinfusion compared with no amnioinfusion in women with babies at risk of umbilical cord compression in labour.

Data collection and analysis

The original review had one author only (Justus Hofmeyr (GJH)). For this update, two authors (GJH and T Lawrie) assessed 13 additional trial reports for eligibility and quality. We extracted data and checked for accuracy.

Main results

We have included 19 studies, with all but two studies having fewer than 200 participants. Transcervical amnioinfusion for potential or suspected umbilical cord compression was associated with the following reductions: caesarean section overall (13 trials, 1493 participants; average risk ratio (RR) 0.62, 95% confidence interval (CI) 0.46 to 0.83); fetal heart rate (FHR) decelerations (seven trials, 1006 participants; average RR 0.53, 95% CI 0.38 to 0.74); Apgar score less than seven at five minutes (12 trials, 1804 participants; average RR 0.47, 95% CI 0.30 to 0.72); meconium below the vocal cords (three trials, 674 participants, RR 0.53, 95% CI 0.31 to 0.92); postpartum endometritis (six trials, 767 participants; RR 0.45, 95% CI 0.25 to 0.81) and maternal hospital stay greater than three days (four trials, 1051 participants; average RR 0.45, 95% CI 0.25 to 0.78). Transabdominal amnioinfusion showed similar trends, though numbers studied were small.

Mean cord umbilical artery pH was higher in the amnioinfusion group (seven trials, 855 participants; average mean difference 0.03, 95% CI 0.00 to 0.06) and there was a trend toward fewer neonates with a low cord arterial pH (less than 7.2 or as defined by trial authors) in the amnioinfusion group (eight trials, 972 participants, average RR 0.58, 95% CI 0.29 to 1.14).

Authors' conclusions

The use of amnioinfusion for potential or suspected umbilical cord compression may be of considerable benefit to mother and baby by reducing the occurrence of variable FHR decelerations, improving short-term measures of neonatal outcome, reducing maternal postpartum endometritis and lowering the use of caesarean section, although there were methodological limitations to the trials reviewed here. In addition, the trials 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 to assess the impact on caesarean section rates when the diagnosis of fetal distress is more stringent. Trials should assess amnioinfusion in specific clinical situations, such as FHR decelerations, oligohydramnios or prelabour rupture of membranes.

 

Plain language summary

Amnioinfusion for potential or suspected umbilical cord compression in labour

Infusing fluid into the uterus during labour may reduce fetal heart rate abnormalities and reduce caesarean sections.

Most women have adequate amniotic fluid to protect their baby during pregnancy and labour. Occasionally the volume of amniotic fluid is reduced, and this may cause compression of the umbilical cord. This in turn might lead to intermittent slowing of the baby's heart rate during labour. Infusing fluid into the uterus through a catheter placed through the cervix, or a needle through the abdomen may reduce this problem and the incidence of caesarean section. In addition, it may improve the newborn baby's condition at birth and prevent infection of the womb. The 19 studies reviewed were of average quality, and too small to measure the risk of rare complications for the mother; all but two studies had fewer than 200 participants.

 

摘要

背景

羊水灌注用於生產時可能或疑似臍帶壓迫情況

羊水灌注(Amnioinfusion)藉由輸注液體進入子宮腔內，目的是預防或緩解生產時的臍帶壓迫或羊水感染

目標

評估羊水灌注用於可能或疑似臍帶壓迫或羊膜感染(amnionitis)時，對母嬰預後的影響

搜尋策略

我們搜尋Cochrane Pregnancy和Childbirth Group Trials Register (2004年11月)、Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2004)和PubMed (1966年2004年11月)

選擇標準

比較羊水灌注和未使用羊水灌注，對於有臍帶壓迫風險及子宮內感染風險之孕婦的隨機試驗

資料收集與分析

由回顧作者評估適用性與試驗品質。摘錄資料並使用RevMan軟體分析資料

主要結論

納入14篇研究，多數的研究樣本在200人以下。經子宮頸之羊水灌注用於可能或疑似臍帶壓迫情況與以下之減低有關：胎兒心律減速(4篇研究、227名婦女：RR為0.54 5% CI為0.43 – 0.68)；整體之剖腹產(9篇研究、953名婦女：RR為0.52; CI為 0.40 – 0.69); 5分鐘時的Apgar分數小於7(7篇研究、828名婦女: RR為0.54; CI為0.30 – 0.97); 臍動脈pH值低(6篇研究、660名婦女: RR為 0.45;CI為0.31 – 0.64);新生兒住院天數超過3天(1篇研究、305名婦女: RR為0.40; CI為0.26 – 0.62);產後子宮內膜炎(5篇研究、619名婦女: RR為0.45; CI為0.25 – 0.81);母親住院天數超過3天(2篇研究、465名婦女: RR為0.41;CI為0.27 .63)。經腹部之羊水灌注顯示類似的趨勢，不過研究篇數少。經子宮頸之羊水灌注以預防婦女因羊膜破裂超過6小時而引起之感染，與減少產褥感染(puerperal infection)有關(1篇研究、68名婦女: RR為0.50; CI為0.26 – 0.97)

作者結論

羊水灌注可有效降低異動之胎兒心律減速的發生、改善短期測量之新生兒預後、及減少因胎兒窘迫診斷(主要由胎心律監測之)而使用剖腹產。不過，納入的研究多數為小型，研究方法上有缺點。有1篇試驗的產褥感染減少。回顧的試驗數太少而無法顯示出因羊水灌注而造成罕見但嚴重的的母親不良反應。需要更多研究來(1)確認這些發現，(2)評估長期測量之胎兒預後，(3)當胎兒窘迫診斷更迫切時，對於剖腹產的影響

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

生產時輸注液體進入子宮可能可以降低胎兒心律異常，減少剖腹產。多數婦女有足量的羊水，以在懷孕和生產時來保護她們的嬰兒。羊水量偶有減少的情況，這可能會引起臍帶壓迫的情況，因此而可能會造成胎兒心律在生產時降低。透過放置於子宮頸的導管、或者經腹部的針頭將液體輸注進入子宮，可以減少這些問題與降低剖腹產之機會。回顧的這些研究，品質屬於平均水準，回顧研究數量太少而無法測量出母親之罕見併發症的風險