Re: [ozmidwifery] Castor oil

[Tania Smallwood]

Sorry for butting in, but just found this quickly in my saved file, thought it might clarify current findings...   Tania   Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled rial  . ARTICLE The Lancet, Volume 364, Issue 9434, 14 August 2004, Pages 597-602 Nestor E Vain, Edgardo G Szyld, Luis M Prudent, Thomas E Wiswell, Adriana M Aguilar and Norma I Vivas Abstract Background Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS. Methods We designed a randomised controlled trial in 11 hospitals in Argentina and one in the USA. 2514 patients with MSAF of any consistency, gestational age at least 37 weeks, and cephalic presentation were randomly assigned to suctioning of the oropharynx and nasopharynx (including the hypopharynx) before delivery of the shoulders (n=1263), or no suctioning before delivery (n=1251). Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines. The primary outcome was incidence of MAS. Clinicians diagnosing the syndrome and designating other study outcomes were masked to group assignment. An informed consent waiver was used. Analysis was by intention to treat. Findings 18 infants in the suction group and 15 in the no suction group did not meet entry criteria after random assignment. 87 in the suction group were not suctioned, and 26 in the no suction group were suctioned. No significant difference between treatment groups was seen in the incidence of MAS (52 [4%] suction vs 47 [4%] no suction; relative risk 0·9, 95% CI 0·6-1·3), need for mechanical ventilation for MAS (24 [2%] vs 18 [1%]; 0·8, 0·4-1·4), mortality (9 [1%] vs 4 [0·3%]; 0·4, 0·1-1·5), or in the duration of ventilation, oxygen treatment, and hospital care. Interpretation Routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation infants born through MSAF does not prevent MAS. Consideration should be given to revision of present recommendations ----- Original Message ----- From: Marcia To: ozmidwifery@acegraphics.com.au Sent: Saturday, February 19, 2005 1:08 PM Subject: Re: [ozmidwifery] Castor oil I have been watching this discussion re mec liquor and perineal suction. Anne, could you please give reference to your research that does not support this practice? thank you. marcia ----- Original Message ----- From: Anne Clarke To: ozmidwifery@acegraphics.com.au Sent: Friday, February 18, 2005 9:50 AM Subject: Re: [ozmidwifery] Castor oil Dear Katrina,   It seems that almost everyone does suction at the peri with mec. liq. but the resarch does not support this routine procedure.   Regards, Anne Clarke Brisbane ----- Original Message ----- From: Ceri & Katrina To: ozmidwifery@acegraphics.com.au Sent: Thursday, February 17, 2005 3:23 PM Subject: Re: [ozmidwifery] Castor oil Hi Anne Are these articles on Cochrane? I had a lady the other day I was supporting and helping birth, and there was mec liquor, thin, but wen to thick right at the end, and the midwife I was working with suctioned at the peri, I had no idea it was not the thing to do.... Thanks Katrina On 16/02/2005, at 3:13 PM, Anne Clarke wrote: Mec. liq. is not the end of the world, especially if the mother is overdue and there is no signs of fetal distress.  Depending on your workplace the mother needs to negotiate for intermittent electronic fetal monitoring (if you have to do it at all) and no suction of the baby at birth as the evidence does not support this procedure if done purely to reduce mec. aspriation.  If a baby is going to have mec. aspiration suctioning of the oro-nasal pharynx is not going to help and doesn't reduce the risk.