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Hofmeyr GJ, Eke AC, Lawrie TA. Amnioinfusion for third trimester preterm premature rupture of membranes. Cochrane Database Syst Rev 2014; 2014:CD000942. [PMID: 24683009 PMCID: PMC7061243 DOI: 10.1002/14651858.cd000942.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. OBJECTIVES The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 December 2013). SELECTION CRITERIA Randomised trials of amnioinfusion compared with no amnioinfusion in women with PPROM. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. MAIN RESULTS We included five trials, of moderate quality, but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26; 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. AUTHORS' CONCLUSIONS These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.
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Affiliation(s)
- G Justus Hofmeyr
- University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of HealthDepartment of Obstetrics and Gynaecology, East London Hospital ComplexFrere and Cecilia Makiwane HospitalsPrivate Bag X 9047East LondonEastern CapeSouth Africa5200
| | - Ahizechukwu C Eke
- Michigan State University School of Medicine/Sparrow HospitalDepartment of Obstetrics and Gynecology1322 East Michigan AvenueSuite 220LansingMichiganUSA48912
| | - Theresa A Lawrie
- Royal United HospitalCochrane Gynaecological Cancer GroupEducation CentreBathUKBA13NG
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Resucitación fetal intrauterina. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2013. [DOI: 10.1016/j.gine.2012.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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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.
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Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of FortHare, Eastern Cape Department of Health, East London, South Africa.
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Abstract
BACKGROUND Preterm premature rupture of membranes (PPROM) is a leading cause of perinatal morbidity and mortality. Amnioinfusion aims to restore amniotic fluid volume by infusing a solution into the uterine cavity. OBJECTIVES The objective of this review was to assess the effects of amnioinfusion for PPROM on perinatal and maternal morbidity and mortality. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2011). SELECTION CRITERIA Randomised trials of amnioinfusion compared to no amnioinfusion in women with PPROM. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trials for inclusion. Two review authors independently assessed trial quality and extracted data. Data were checked for accuracy. MAIN RESULTS We included five trials but we only analysed data from four studies (with a total of 241 participants). One trial did not contribute any data to the review.Transcervical amnioinfusion improved fetal umbilical artery pH at delivery (mean difference 0.11; 95% confidence interval (CI) 0.08 to 0.14; one trial, 61 participants) and reduced persistent variable decelerations during labour (risk ratio (RR) 0.52; 95% CI 0.30 to 0.91; one trial, 86 participants).Transabdominal amnioinfusion was associated with a reduction in neonatal death (RR 0.30; 95% CI 0.14 to 0.66; two trials, 94 participants), neonatal sepsis (RR 0.26, 95% CI 0.11 to 0.61; one trial, 60 participants), pulmonary hypoplasia (RR 0.22; 95% CI 0.06 to 0.88; one trial, 34 participants) and puerperal sepsis (RR 0.20; 95% CI 0.05 to 0.84; one trial, 60 participants). Women in the amnioinfusion group were also less likely to deliver within seven days of membrane rupture (RR 0.18; 95% CI 0.05 to 0.70; one trial, 34 participants). These results should be treated with circumspection as the positive findings were mainly due to one trial with unclear allocation concealment. AUTHORS' CONCLUSIONS These results are encouraging but are limited by the sparse data and unclear methodological robustness, therefore further evidence is required before amnioinfusion for PPROM can be recommended for routine clinical practice.
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Affiliation(s)
- G Justus Hofmeyr
- Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200
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Simpson KR. Intrauterine Resuscitation During Labor: Review of Current Methods and Supportive Evidence. J Midwifery Womens Health 2010; 52:229-37. [PMID: 17467589 DOI: 10.1016/j.jmwh.2006.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When the fetal heart rate pattern is suggestive of fetal compromise during labor, various methods to promote fetal well-being are traditionally initiated. They include maternal repositioning, reduction of uterine activity, an intravenous fluid bolus, oxygen administration, correction of maternal hypotension, amnioinfusion, and alteration of second-stage labor pushing efforts. Although these intrauterine resuscitation techniques are commonly used, and in some cases considered standard care, supportive data could be more robust. Nevertheless, there is enough evidence to suggest they are beneficial to the fetus and there is minimal risk of harm when used with clinical common sense. Until more data are available, it seems reasonable to err on the side of fetal safety by using these techniques when appropriate, based on the specific fetal heart rate pattern.
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Velayudhareddy S, Kirankumar H. Management of foetal asphyxia by intrauterine foetal resuscitation. Indian J Anaesth 2010; 54:394-9. [PMID: 21189876 PMCID: PMC2991648 DOI: 10.4103/0019-5049.71032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Management of foetal distress is a subject of gynaecological interest, but an anaesthesiologist should know about resuscitation, because he should be able to treat the patient, whenever he is directly involved in managing the parturient patient during labour analgesia and before an emergency operative delivery. Progressive asphyxia is known as foetal distress; the foetus does not breathe directly from the atmosphere, but depends on maternal circulation for its oxygen requirement. The oxygen delivery to the foetus depends on the placental (maternal side), placental transfer and foetal circulation. Oxygen transport to the foetus is reduced physiologically during uterine contractions in labour. Significant impairment of oxygen transport to the foetus, either temporary or permanent may cause foetal distress, resulting in progressive hypoxia and acidosis. Intrauterine foetal resuscitation comprises of applying measures to a mother in active labour, with the intention of improving oxygen delivery to the distressed foetus to the base line, if the placenta is functioning normally. These measures include left lateral recumbent position, high flow oxygen administration, tocolysis to reduce uterine contractions, rapid intravenous fluid administration, vasopressors for correction of maternal hypotension and amnioinfusion for improving uterine blood flow. Intrauterine Foetal Resuscitation measures are easy to perform and do not require extensive resources, but the results are encouraging in improving the foetal well-being. The anaesthesiologist plays a major role in the application of intrauterine foetal resuscitation measures.
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Affiliation(s)
- S. Velayudhareddy
- Department of Anaesthesiology, Rajeev Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
| | - H Kirankumar
- Department of Anaesthesiology, Rajeev Gandhi Institute of Medical Sciences, Kadapa, Andhra Pradesh, India
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Puertas A, Tirado P, Pérez I, López MS, Montoya F, Cañizares JM, Miranda JA. Transcervical intrapartum amnioinfusion for preterm premature rupture of the membranes. Eur J Obstet Gynecol Reprod Biol 2007; 131:40-44. [PMID: 16730113 DOI: 10.1016/j.ejogrb.2006.04.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Revised: 03/24/2006] [Accepted: 04/20/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the effect of transcervical amnioinfusion on the management of labour and neonatal outcomes in preterm premature rupture of the membranes. STUDY DESIGN This clinical trial included 86 patients with premature rupture of the membranes between weeks 27 and 35 of gestation. Patients were randomly assigned to receive amnioinfusion via a two-way catheter or to the control group. Clinical management was otherwise the same in both groups. RESULTS Amnioinfusion decreased the frequency of variable decelerations in fetal heart rate (27.9% versus 53.5%, p<0.05) and the rate of obstetric interventions motivated by nonreassuring fetal status (13.6% versus 52.4%, p<0.05). At delivery, pH values were significantly higher in the treatment group than in the conventionally managed control group (median 7.29 versus 7.27). CONCLUSIONS Intrapartum transcervical amnioinfusion for preterm premature rupture of the membranes reduced the number of interventions needed because of nonreassuring fetal status, and improved neonatal gasometric values without increasing maternal or fetal morbidity.
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Affiliation(s)
- Alberto Puertas
- Obstetrics and Gynaecology Service, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas s/n, 18014 Granada, Spain.
| | - Pilar Tirado
- Obstetrics and Gynaecology Service, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas s/n, 18014 Granada, Spain
| | - Isabel Pérez
- Obstetrics and Gynaecology Service, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas s/n, 18014 Granada, Spain
| | - María S López
- Obstetrics and Gynaecology Service, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas s/n, 18014 Granada, Spain
| | - Francisco Montoya
- Obstetrics and Gynaecology Service, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas s/n, 18014 Granada, Spain
| | - José M Cañizares
- Obstetrics and Gynaecology Service, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas s/n, 18014 Granada, Spain
| | - José A Miranda
- Obstetrics and Gynaecology Service, Virgen de las Nieves University Hospital, Avenida Fuerzas Armadas s/n, 18014 Granada, Spain
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Hicks P. Systematic Review of the Risk of Uterine Rupture with the Use of Amnioinfusion After Previous Cesarean Delivery. South Med J 2005; 98:458-61. [PMID: 15898523 DOI: 10.1097/01.smj.0000129791.09557.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Amnioinfusion is commonly used for the intrapartum treatment of women with pregnancy complicated by thick meconium or oligohydramnios with deep variable fetal heart rate decelerations. Its benefit in women with previous cesarean deliveries is less known. Theoretically, rapid increases in intrauterine volume would lead to a higher risk of uterine rupture. METHODS Searches of the Cochrane Library from inception to the third quarter of 2001 and MEDLINE, 1966 to November 2001, were performed by using keywords "cesarean" and "amnioinfusion." Search terms were expanded to maximize results. All languages were included. Review articles, editorials, and data previously published in other sites were not analyzed. RESULTS Four studies were retrieved having unduplicated data describing amnioinfusion in women who were attempting a trial of labor after previous cesarean section. As the studies were of disparate types, meta-analysis was not possible. CONCLUSIONS The use of amnioinfusion in women with previous cesarean delivery who are undergoing a trial of labor may be a safe procedure, but confirmatory large, controlled prospective studies are needed before definitive recommendations can be made.
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Affiliation(s)
- Paul Hicks
- Salud Family Health Center, Fort Lupton, CO, USA.
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Amin AF, Mohammed MS, Sayed GH, Abdel-Razik S. Prophylactic transcervical amnioinfusion in laboring women with oligohydramnios. Int J Gynaecol Obstet 2003; 81:183-9. [PMID: 12706276 DOI: 10.1016/s0020-7292(03)00041-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Evaluation of prophylactic intrapartum amnioinfusion in women with oligohydramnios. METHODS Assiut University Hospital during the period from February 2000 to September 2001, 160 laboring women with oligohydramnios [amniotic fluid index (AFI) </=5 cm] were randomized into: amnioinfusion and control groups. Inclusion criteria were: term singleton gestation, vertex presentation, cervical dilatation <4 cm, and assuring fetal heart rate (FHR). Trans-cervical amnioinfusion was done with warmed normal saline. RESULTS there was a significant increase in AFI after amnioinfusion (P<0.001). The amnioinfusion group showed lower cesarean section rate for fetal distress (P=0.003), lower incidence of abnormal FHR (P=0.006), fewer neonates with Apgar score <7 at 1 min (P<0.001), and 5 min (P=0.009), meconium below vocal cords (P<0.001), umbilical arterial pH<7.1 (P=0.003), and significantly shorter hospital stay (P=0.02). CONCLUSION Prophylactic trans-cervical amnioinfusion is a simple, safe and effective procedure.
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Affiliation(s)
- A F Amin
- Department of Obstetrics and Gynecology, Assiut University Hospital, Assiut, Egypt.
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Sánchez-Sánchez M, Puertas A, Navarro M, Velasco P, Malde F, Pérez-Herrezuelo I, Recio A, Carrillo M, Miranda J. Efecto de la amnioinfusión profiláctica intraparto sobre la frecuencia cardíaca fetal en gestaciones con oligoamnios causado por rotura prematura de membranas. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2002. [DOI: 10.1016/s0210-573x(02)77189-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Valor de la amnioinfusión transcervical intraparto en gestaciones con oligoamnios y membranas íntegras. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2002. [DOI: 10.1016/s0210-573x(02)77147-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Puertas A, Paz Carrillo M, Moltó L, Alvarez M, Sedeño S, Miranda JA. Meconium-stained amniotic fluid in labor: a randomized trial of prophylactic amniofusion. Eur J Obstet Gynecol Reprod Biol 2001; 99:33-7. [PMID: 11604183 DOI: 10.1016/s0301-2115(01)00354-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the effect of amnioinfusion in women with meconium-stained amniotic fluid on the rate of cesarian sections and on neonatal morbidity. STUDY DESIGN A randomized controlled trial. A total of 206 women with meconium-stained amniotic fluid were assigned to receive amnioinfusion via two-way catheter or no amnioinfusion (control group). The catheter was inserted and other treatment was the same in both groups. RESULTS Amnioinfusion decreased the rate of cesarian sections for fetal distress (RR 0.23, 95% CI 0.07-0.79) and increased mean pH at birth (7.24+/-0.1 versus 7.21+/-0.1, P<0.05). It also decreased the frequency of variable fetal heart rate decelerations (RR 0.74, 95% CI 0.59-0.92), and of meconium below the vocal cords in neonates (RR 0.37, 95% CI 0.19-0.69). CONCLUSIONS Amnioinfusion improves the neonatal outcome and reduces the frequency of cesarian sections.
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Affiliation(s)
- A Puertas
- Department of Obstetrics and Gynecology, Virgen de las Nieves University Hospital, Avda de las Fuerzas Armadas s/n, 18014 Granada, Spain.
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Abstract
BACKGROUND Preterm rupture of membranes places a fetus at risk of cord compression and amnionitis. Amnioinfusion aims to prevent or relieve umbilical cord compression by infusing a solution into the uterine cavity. OBJECTIVES The objective of this review was to assess the effects of amnioinfusion for preterm rupture of membranes on maternal and perinatal outcomes. SEARCH STRATEGY The Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register were searched. SELECTION CRITERIA Randomised trials of amnioinfusion compared to no amnioinfusion in women with preterm rupture of membranes. DATA COLLECTION AND ANALYSIS Eligibility and trial quality were assessed by the reviewer. MAIN RESULTS One trial of 66 women was included. It had some methodological flaws. No significant differences between amnioinfusion and no amnioinfusion were detected for caesarean section (relative risk 0.32, 95% confidence interval 0.07 to 1.40); low Apgar scores (relative risk 0.28, 95% confidence interval 0.03 to 2.33) or neonatal death (relative risk 0.55, 95% confidence interval 0.05 to 5.77). In the amnioinfusion group, the number of severe fetal heart rate decelerations per hour during the first stage of labour were reduced (weighted mean difference -1.20, 95% confidence interval -1.83 to -0.57). These outcomes are consistent with those found in the Cochrane review on amnioinfusion for cord compression. REVIEWER'S CONCLUSIONS There is not enough evidence concerning the use of amnioinfusion for preterm rupture of membranes.
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Affiliation(s)
- G J Hofmeyr
- Department of Obstetrics and Gynaecology, Coronation Hospital and University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa.
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