[Multicenter randomized trial of amnioinfusion]. / Essai randomisé multicentrique sur l'amnio-infusion.

Meconium staining of the amniotic fluid in labor is a frequent problem that is associated with an increase in the risk of neonatal and maternal morbidity. Amnioinfusion is a simple technique that is designed to prevent neonatal and maternal morbidity associated with meconium. Preliminary studies indicate that amnioinfusion is a promising approach to the prevention of such complications of labor. However, further research is required. The primary objective of this multi-centre randomized controlled study is to determine if amnioinfusion for thick meconium stained amniotic fluid results in a reduction in perinatal death or moderate to severe meconium aspiration syndrome. We will also assess the effects of amnioinfusion on other indicators of neonatal morbidity and on cesarean section. The study includes an evaluation of womens views on their childbirth experience and an economic evaluation of a policy of amnioinfusion The study will be achieved with the collaboration of approximately 50 obstetrical centres from across Canada, US, Europe, South America and South Africa. This multicentre trial will provide urgently needed information on the efficacy and effectiveness of amniofusion for the indication of meconium stained amniotic fluid.

Blue Cross/Blue Shield alternate delivery system.

Major changes have taken place in medical care in the past few years, including the way in which we pay for health care. Blue Cross and Blue Shield have kept pace with these changes through the development of HMOs, PPOs and more recently through Managed Care Benefits. They have been innovators in providing quality care at the lowest possible price, and have diligently attempted to unite the interests of physicians, institutions and employers for the benefit of the patient/employee. The following article describes how Blue Cross and Blue Shield have participated in this process.