The Collaborative Randomised Amnioinfusion for Meconium Project (CRAMP): 1. South Africa

Numerous clinical trials have indicated that amnioinfusion for potential or suspected umbilical cord compression reduces the frequency of fetal heart rate decelerations and cesarean section. The present study conducted at four urban teaching hospitals in South Africa further evaluated the benefits of transcervical amnioinfusion for meconium-stained amniotic fluid during labor on perinatal outcome. In the intervention group (n = 176) 800 ml of saline was amnioinfused at 15 ml/minute followed by a maintenance dose of 3 ml/minute for the duration of labor. The control group (n = 176) received routine obstetric care. There were 70 cesarean sections in the amnioinfusion group and 68 in the control group (relative risk (RR) 0.98; 95% confidence interval (CI) 0.76-1.26). The prevalence of meconium aspiration syndrome was unexpectedly low: 4 cases in the intervention group and 6 cases in the control group (RR 0.67; 95% CI 0.19-2.33). There were no perinatal deaths in either group. Subsidiary outcomes (e.g. Apgar score assisted delivery cord pH neonatal ventilation) did not differ between groups. These findings provide preliminary support for use of amnioinfusion in women whose fetuses are considered at risk of meconium aspiration syndrome. A similar study conducted in Zimbabwe demonstrated larger effects of amnioinfusion on reductions in cesarean section meconium aspiration syndrome and perinatal mortality.