THE COLLABORATIVE RANDOMISED AMNIOINFUSION FOR MECONIUM PROJECT (CRAMP) : 2. ZIMBABWE

The presence of meconium in the amniotic fluid is associated with increased perinatal morbidity and mortality. Saline amnioinfusion during labor has been shown in several clinical trials to reduce the incidence of cesarean section and meconium aspiration syndrome. A randomized controlled trial conducted at Harare Maternity Hospital in Zimbabwe sought to confirm the benefits of amnioinfusion for meconium-stained amniotic fluid during labor for perinatal outcome. In the intervention group (n = 325) 500 ml of saline was transcervically amnioinfused over a 30-minute period followed by 500 ml at 30 drops per minute for the duration of labor. The control group (n = 336) received routine obstetric care. The cesarean section rate was 9.5% in the intervention group and 12.3% in the control group (relative risk (RR) 0.84; 95% confidence interval (CI) 0.53-1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1%) than the control group (12.8%) (RR 0.24; 95% CI 0.12-0.48). The perinatal death rate was 1.2% in the amnioinfusion group and 3.6% among controls (RR 0.34; 95% CI 0.11-1.06). Also recorded in the amnioinfusion group were significant reductions in the following perinatal morbidity measures: 5-minute Apgar score below 7 neonatal intensive care admissions neonatal ventilation and hypoxic ischemic encephalopathy. The striking improvements in perinatal outcome recorded among women in the amnioinfusion group suggest the feasibility of more widespread use of this simple procedure in developing country settings without routine electronic fetal monitoring facilities.