J G Ouzounian1, D A Miller, R H Paul. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Los Angeles County-University of Southern California Medical Center, Los Angeles 90033, USA.
Abstract
OBJECTIVE: Our purpose was to evaluate the use of intrapartum amnioinfusion in women undergoing a trial of labor after a previous cesarean delivery. STUDY DESIGN: Labor and delivery records of women undergoing intrapartum amnioinfusion over a 1-year period were reviewed retrospectively. Neonatal data were obtained by chart review. RESULTS: During the study period 936 women underwent intrapartum amnioinfusion for the following indications: oligohydramnios (76.6%), meconium-stained amniotic fluid (12.8%),and variable decelerations (7.5%). Among these, 122 (13%) had previous cesarean births. Seventy-one (58.2%) women were delivered vaginally; the remaining 51 (41.8%) were delivered by repeat cesarean. Among women undergoing intrapartum amnioinfusion there were no statistically significant differences (p<0.05) between those with previous cesarean births and those with unscarred uteri with respect to the following: cesarean section for fetal distress (1.6% vs 1.4%), meconium aspiration (0% vs 0.9%), or low 5-minute Apgar scores (2.5% vs 0.9%). There were no perinatal or maternal deaths in either group. One uterine rupture occurred in a woman with one previous cesarean birth. CONCLUSIONS: Amnioinfusion appears to be an acceptable procedure in women with previous cesarean births. The incidence of uterine rupture (0.8%) noted was similar to the 10-year institutional rate at Los Angeles County-University of Southern California Women's Hospital (0.7%).
OBJECTIVE: Our purpose was to evaluate the use of intrapartum amnioinfusion in women undergoing a trial of labor after a previous cesarean delivery. STUDY DESIGN:Labor and delivery records of women undergoing intrapartum amnioinfusion over a 1-year period were reviewed retrospectively. Neonatal data were obtained by chart review. RESULTS: During the study period 936 women underwent intrapartum amnioinfusion for the following indications: oligohydramnios (76.6%), meconium-stained amniotic fluid (12.8%),and variable decelerations (7.5%). Among these, 122 (13%) had previous cesarean births. Seventy-one (58.2%) women were delivered vaginally; the remaining 51 (41.8%) were delivered by repeat cesarean. Among women undergoing intrapartum amnioinfusion there were no statistically significant differences (p<0.05) between those with previous cesarean births and those with unscarred uteri with respect to the following: cesarean section for fetal distress (1.6% vs 1.4%), meconium aspiration (0% vs 0.9%), or low 5-minute Apgar scores (2.5% vs 0.9%). There were no perinatal or maternal deaths in either group. One uterine rupture occurred in a woman with one previous cesarean birth. CONCLUSIONS: Amnioinfusion appears to be an acceptable procedure in women with previous cesarean births. The incidence of uterine rupture (0.8%) noted was similar to the 10-year institutional rate at Los Angeles County-University of Southern California Women's Hospital (0.7%).