Dr. William D. Fraser’s Interview

My name is Bill Fraser; I am an obstetrician/gynaecologist and clinical epidemiologist at the University of Montreal.

Dr. Fraser studies Meconium Aspiration Syndrome, a condition in which a fetus inhales amniotic fluid stained with stool during delivery.
The baby takes its first breath moments after delivery and if the airways are filled with meconium-stained amniotic fluid and particularly particles of meconium then that fluid can go into the bronchial tree and cause a chemical pneumonia and also cause mechanical plugging of the airways.

The Treatment
This is a problem that has been present both in developed and developing nations since the beginning of obstetrics and more in the last 30 years there have been a variety of attempts to try to prevent Meconium Aspiration Syndrome.

Most of these attempts have focused on trying to remove the meconium from the baby's airway before the first breath.

There have also been approaches that have attempted to dilute the amniotic fluid.

Amnioinfusion dilutes the amniotic fluid through the addition of saline.
We considered that it was important to conduct a large, well designed multi-centre clinical trial to evaluate the effects of amnioinfusion of Meconium Aspiration Syndrome.

The Study
We conducted the trial in 56 centres in 13 countries, we had networks of research collaborators in Europe, in South America and South Africa and in North America and we randomized nearly 2,000 patients in the trial, to either standard care, which is without amnioinfusion or to amnioinfusion, all of the patients had moderate to thickly stained amniotic fluid at the time of entering into the study.

The Results
The study was -- results were, I think, quite definitive in the sense that we found no evidence of a benefit of amnioinfusion on Meconium Aspiration Syndrome. If anything there was a suggestion that there may be increased morbidity in patients undergoing the procedure.

The Impact
The findings of the trial have been integrated into the Guidelines for Neonatal Recessitation of the American Academy of Paediatrics and also have been integrated into the Practice Guidelines of the Society of Obstetricians and Gynaecologists of Canada.

I think it's very gratifying when results of a trial are clear and simple and rapidly integrated into practice. And I think that our trial was able to provide such a clear and definitive answer and did have a significant impact on practice.

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