ROLE OF TRANSCERVICAL AMNIOINFUSION IN LABOUR COMPLICATED WITH THICK MECONIUM STAINED LIQUOR

: OBJECTIVE: This is to evaluate the effectiveness of amnio infusion in cases of thick and particulate meconium stained liquor to reduce the incidence of fetal distress and meconium aspiration syndrome in neonates and compare neonatal outcome with control group. METHODS: A prospective comparative case control study was conducted in the Department of Obstetrics and gynecology, Government General Hospital, Kakinada. A total of 100 cases of labour complicated with thick meconium stained liquor were studied of which in 50 cases Transcervical Amnioinfusion was given and remaining 50 cases without amnioinfusion were taken as controls. The statistical analysis of neonatal outcome was done by Chi square test analysis of variance and paired t test. Liquor to reduce the incidence of fetal distress and meconium aspiration syndrome in neonates and compare neonatal. RESULTS: Operative interventions for fetal distress were significantly less in infusion group (p<0.01). APGAR scores at 1min, 5min and 10min of >7 were observed in more cases of infusion group with significant difference in control group. Use of resuscitative measures for neonates were relatively more in control group with higher incidence of meconium at and below vocal cords (p<0.01). In amnioinfusion group, admissions in NICU were less (p<0.01) CONCLUSION : Transcervical amnioinfusion during labour is a safe, simple, inexpensive and effective procedure in improving the obstetric and perinatal outcome in patients labouring with thick meconium stained liquor OBJECTIVE OF STUDY: To evaluate the effectiveness of amnioinfusion in cases of thick and particulate meconium stained liquor to reduce the incidence of fetal distress & meconium aspiration syndrome in neonates and compare neonatal outcome in amnioinfusion group with control group. meconium aspiration is reported to range from 2-40%. 2 This highlights the need for various modalities to treat and prevent meconium aspiration. Current methods include combined obstetric and paediatric approach as described by Carson. 3 The trachea is directly suctioned if meconium is present at the cords. Clinical application of transcervical amnioinfusion was first described by Miyazaki and co-workers 4 as an intrapartum procedure for the relief of variable decelerations. Intrapartum amnioinfusion was later proposed by Wenstrom and Parsons 5 as a way of diluting the meconium to decrease the incidence of meconium aspiration syndrome. Since then, other prospective randomised trials 6,7,8,9 have also demonstrated a significant reduction in meconium below the cords, meconium aspiration syndrome, perinatal death and operative interference in patients receiving amnioinfusion (AI) in meconium stained amniotic fluid (MSAF) as compared to the non-infusion group. This study was undertaken to interfere in first stage of labour complicated with thick meconium stained liqour by infusing warm normal saline in to amniotic cavity and evaluate perinatal outcome. total of 100 cases of labour complicated with thick meconium stained liquor in 50 cases transcervical amnioinfusion & compared with 50 controls with thick meconium, in labour, after taking consent. Laryngoscopic examination of vocal cords done if there is any meconium in the trachea. If meconium is present, aspiration of trachea is done. Stomach wash was given to neonate. Neonate observed for any evidence of respiratory distress. If necessary NICU admission meconium in the trachea. If meconium is present, aspiration of trachea is done. Stomach wash was given to neonate. Neonate is observed for any evidence of respiratory distress. If necessary NICU admission was done and followed up. RESULTS: A total of 50 cases in study group and another 50 cases in control group enrolled in the study were subjected to z test (test of proportions) for statistical significance. Meconium was detected at 3-4cms of cervical dilatation on an average in both groups Amnioinfusion to delivery interval was on an avg. 3.3hrs Meconium infusion to delivery interval was 3.91hrs on avg. in control groups. On an average 794 ml of normal saline was infused Intervention for fetal distress was done in 26 cases (52%) in control group as compared to 3 cases 6% in infusion group. (p <.01, significant) 1min APGAR >7 was in 88% 0f infusion group & 46% in control group (p<.01, significant) 5 min APGAR >7 was in 99% of infusion group & 66% in control group (p<.01, significant) Incidence of meconium below vocal cords was 6% in infusion group & 40% in controls. (p <.01, significant) Respiratory distress & nicu admission was present in 56% cases of control group as compared to 4% in infusion group (p<.01,significant) In infusion group one baby developed meconium aspiration. Syndrome (2%), which recovered on 3 rd day. In control group 16% cases developed MAS of which 12% recovered. Incidence of MAS was 16% with mortality of 25% (p<.01, significant). Pernatal mortality was 6% in control group compared to 0% in study group (p<.05, significant)