BACKGROUND: Amnioinfusion, or transcervical infusion of saline into the amniotic cavity, has been proposed as a method for reducing the risk of meconium aspiration syndrome.
OBJECTIVE: This study aims to assess the effect of intrapartal amnioinfusion with meconium stained amniotic fluid on cesarean section rate, incidence of meconium aspiration syndrome, neonatal ICU admission, perinatal death and adverse maternal outcomes.
METHODS: This study is a randomized controlled trial from June to September 2013, conducted in the service wards of a university hospital. The study population consists of parturients 19-45 years old with singleton term low-risk pregnancies, in cephalic presentation, with cervical dilatation at 2-6 cm, with ruptured membranes showing meconium stained amniotic fluid.
RESULTS: Meconium aspiration syndrome occurred in one infant in the amnioinfusion group and in three infants in the control group (9% vs. 25%). There was a lower rate of neonatal pneumonia and neonatal sepsis in the treatment arm (0% vs. 8% and 9% vs. 17%, respectively). There were no perinatal deaths in both groups. Neonatal lCU admission was seen less in;the treatment arm (9% vs. 25%). The cesarean section rate did not differ significantly in both groups (9% vs. 8%). Maternal morbidity was seen less in the treatment group. None of the patients in the amnioinfusion arm had fever while two patients in the control group had pyrexia (0% vs. 17%). Hospital stay was also shorter for patients in the treatment group with an average duration of 3 days, as opposed to 4 days in the control arm.
CONCLUSION: Amnioinfusion is a relatively simple technique of reducing perinatal and maternal morbidity in patients with meconium stained amniotic fluid. Although this study did not show any significant difference between the two groups, there is a trend towards better neonatal outcomes and decreased maternal morbidity with amnioinfusion.

Human ; Female ; Adult ; Meconium Aspiration Syndrome ; Meconium ; Amniotic Fluid ; Perinatal Death ; Intensive Care Units, Neonatal ; Neonatal Sepsis ; Embolism, Amniotic Fluid ; Fever ; Pneumonia

Background: The rate of prolapse recurrence after vaginal hysterectomy ranges from 6% to 12%. Vaginal vault fixation procedures like the iliococcygeus fixation and the cul-de-sac obliteration (McCall culdoplasty) have been used to address the loss of apical support in patients with advanced-stage prolapse to prevent this recurrence. Objectives: This study aims to assess the rate of prolapse recurrence and risk factors for recurrence as well as urinary, bowel, and sexual symptoms in women who have undergone vaginal hysterectomy with and without vaginal vault fixation for pelvic organ prolapse stage 2 or higher. Methods: This study is a retrospective study that included patients with pelvic organ prolapse stage 2 or greater who underwent vaginal hysterectomy with and without vaginal vault fixation from 2009 to 2014 seen at the urogynecology clinic of a Philippine tertiary referral center. The cohorts were divided into those with iliococcygeal fixation (n=171) and those without (n=83). The Z test of mean difference was used in comparing average values between the two groups. Chi-square test of independence was used in comparing the proportion of patients as stratified by various variables and their corresponding groups, while some variables were adjusted for 2x2 Fischer Exact test. Any associated p-value less than 0.05 alpha were considered statistically significant. Results: Of the 876 patients operated on for prolapse between 2009 to 2014, 254 were included in the study. They were divided into those with iliococcygeal fixation (n=171) and those without (n=83). Recurrence was significantly lower in the group who underwent iliococcygeal fixation (23.39% vs 36.14%, p=0.037) after a median follow-up of 28.98 months for those with fixation and 31.08 for those without. The posterior compartment prolapse recurrence rate is higher in those without fixation (16.87% vs 6.43%, p=0.013). Longer duration of menopause (16.96 ± 7.16 vs 13.37 ± 7.1, p=0.001), unemployment (52.85% vs 36.41%, p=0.22) and longer time from surgery (37.84 ± 15.69 vs 26.55 ± 12.59, p=0.000) were significantly associated with recurrence. Moreover, higher pre- (6.24 ± 1.41 vs 5.78 ± 0.95, p=0.003) and post-operative genital hiatus (4.53 ± 0.97 vs 4.23 ± 0.54, p=0.002) and shorter pre-operative perineal body (1.86 ± 0.35 vs 1.97 ± 0.35, p=0.025) measurements were also significantly associated with recurrence. Both groups have no significant difference in urinary, sexual or bowel symptoms. Conclusion Iliococcygeus fixation is an effective method of preventing prolapse recurrence. Increased duration of menopause, longer time from surgery, longer genital hiatus, and shorter perineal body all contribute to recurrence. Moreover, urinary, sexual and bowel symptoms do not differ significantly between those with and without iliococcygeus fixation. Thus performing prophylactic vaginal vault fixation should be contemplated in patients undergoing prolapse surgery, with careful consideration of patient factors and potential morbidities.
Pelvic Organ Prolapse ; Recurrence ; Hysterectomy, Vaginal