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Ingvarsson S, Schildmeijer K, Oscarsson M. Swedish midwives' experiences and views of amniotomy: An interview study. Midwifery 2020; 91:102840. [PMID: 32980755 PMCID: PMC7500359 DOI: 10.1016/j.midw.2020.102840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore midwives' experiences and views of amniotomy. DESIGN A qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12. SETTING AND PARTICIPANTS Sixteen midwives working at delivery wards at three hospitals in the south of Sweden. FINDINGS Three categories emerged: "Promote, protect and support the physiological process of labour", "To make the decision -to do or not to do" and "Unpredictable response". The overall theme linking the three categories was "We become our decisions", portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy. CONCLUSIONS Amniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.
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Affiliation(s)
- Sofia Ingvarsson
- Department of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
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Vadivelu M, Rathore S, Benjamin SJ, Abraham A, Belavendra A, Mathews JE. Randomized controlled trial of the effect of amniotomy on the duration of spontaneous labor. Int J Gynaecol Obstet 2017; 138:152-157. [DOI: 10.1002/ijgo.12203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 03/20/2017] [Accepted: 05/05/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Malarvizhi Vadivelu
- Department of Obstetrics and Gynaecology; Christian Medical College; Vellore Tamilnadu India
| | - Swati Rathore
- Department of Obstetrics and Gynaecology; Christian Medical College; Vellore Tamilnadu India
| | - Santosh J. Benjamin
- Department of Obstetrics and Gynaecology; Christian Medical College; Vellore Tamilnadu India
| | - Anuja Abraham
- Department of Obstetrics and Gynaecology; Christian Medical College; Vellore Tamilnadu India
| | | | - Jiji E. Mathews
- Department of Obstetrics and Gynaecology; Christian Medical College; Vellore Tamilnadu India
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Onah LN, Dim CC, Nwagha UI, Ozumba BC. Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria. Afr Health Sci 2015; 15:1097-103. [PMID: 26958009 PMCID: PMC4765421 DOI: 10.4314/ahs.v15i4.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early amniotomy is common in obstetric practice but, its effectiveness has not been proven. OBJECTIVES To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal outcomes of uncomplicated pregnancies in Enugu, South-east Nigeria. METHODS A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved. RESULTS Mean duration of labour for the amniotomy group (279.4 ± 53.7 minutes) was significantly lower than that of control group (354.4 ± 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin augmentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 - 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. CONCLUSION Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications.
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Affiliation(s)
- Livinus N Onah
- Departments of Obstetrics and Gynaecology, College of Medicine Enugu State University of Science and Technology, Enugu Nigeria
| | - Cyril C Dim
- Departments of Obstetrics and Gynaecology, College of Medicine University of Nigeria Enugu Campus, Nigeria
| | - Uchenna I Nwagha
- Departments of Obstetrics and Gynaecology, College of Medicine University of Nigeria Enugu Campus, Nigeria
| | - Benjamin C Ozumba
- Departments of Obstetrics and Gynaecology, College of Medicine University of Nigeria Enugu Campus, Nigeria
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Sinclair JL, Brown HC. Active management of spontaneous labour versus routine care in women who have had one or more previous caesarean sections. Hippokratia 2015. [DOI: 10.1002/14651858.cd010046.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Joanna L Sinclair
- Tunbridge Wells Hospital; Department of Obstetrics and Gynaecology; Tonbridge Road Tunbridge Wells Kent UK TN2 4QJ
| | - Heather C Brown
- Royal Sussex County Hospital; Department of Obstetrics and Gynaecology; Eastern Road Brighton UK BN2 5BE
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Ting WH, Peng FH, Lin HH, Lu HF, Hsiao SM. Factors influencing the abortion interval of second trimester pregnancy termination using misoprostol. Taiwan J Obstet Gynecol 2015; 54:408-11. [DOI: 10.1016/j.tjog.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 10/23/2022] Open
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Abstract
BACKGROUND Amniotomy (the deliberate rupture of membranes) was described almost two centuries ago and since then has been used both for induction and augmentation of labour - which are common obstetric practices. Trends have shown a rise in the induction rates over the last decade and data suggest that the rate of labour inductions is increasing faster than the rate of pregnancy complications. Recent years have seen the emergence of a variety of other methods of induction of labour but amniotomy combined with oxytocin infusion remains the most commonly used method of augmentation of labour. The newer agents for induction are expensive and in resource-poor settings amniotomy is still the chosen method for both induction and augmentation.As with any invasive procedure amniotomy can lead to infection, ascending from the vagina into the uterine cavity and can contribute significantly to both maternal and neonatal infectious morbidity. OBJECTIVES The objective of this review was to evaluate the prophylactic use of antibiotics versus placebo or no treatment prior to amniotomy on maternal and neonatal infectious morbidity and mortality. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014), the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (12 September 2014). SELECTION CRITERIA Randomised controlled trials or cluster-randomised trials comparing antibiotics prior to amniotomy versus placebo (or no treatment) were eligible for inclusion in this review but none were identified. Quasi-randomised trials or cross-over trials were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed one trial report for inclusion. In future updates of this review, two review authors will independently assess risk of bias and carry out data extraction. Data will be checked for accuracy. MAIN RESULTS We identified one trial report but this was excluded. No studies met the inclusion criteria for this review. AUTHORS' CONCLUSIONS High-quality trials are needed to justify or refute the routine use of antibiotics at amniotomy for prevention of infection in the mother and infant.Future studies should be conducted, especially in resource-constrained settings where amniotomy is still used as a means of induction of labour, in order to evaluate the routine use of antibiotics at amniotomy in these settings. Future research in this area should include important maternal and infant outcomes listed in this review and also consider cost effectiveness and side effects of antibiotic use, including the emergence of antibiotic-resistant strains.
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Affiliation(s)
- Amita Ray
- Srinivas Medical CollegeDepartment of Obstetrics and GynaecologyMukka, SurathkalMangaloreIndia574146
| | - Sujoy Ray
- Kasturba Medical College, Manipal UniversityManipalKarnatakaIndia576104
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Hiersch L, Rosen H, Salzer L, Aviram A, Ben-Haroush A, Yogev Y. Does artificial rupturing of membranes in the active phase of labor enhance myometrial electrical activity? J Matern Fetal Neonatal Med 2014; 28:515-8. [PMID: 24863634 DOI: 10.3109/14767058.2014.927431] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether artificial rupture of membranes (AROM) during active phase of labor augments uterine contractility using Electrical Uterine Myography (EUM). STUDY DESIGN A prospective study of 31 women with term singleton pregnancy during active phase of labor. Using a non-invasive EUM technique, electrical uterine activity was recorded in the 30 min preceding AROM and in the immediate 30 min thereafter. Augmentation was defined as >5% increase in EUM index between the basal and post-AROM states, representing the mean EUM increase of the entire cohort. Low basal uterine contraction was defined as EUM index of less than the entire cohort median result prior AROM (3.5 micro-Watt-Second (mWS)). RESULTS Mean dilatation in which AROM was preformed was 5.5 ± 1.8 cm. There was a significant increase in mean EUM measurement in the post-AROM compared to the basal state (3.59 ± 0.39 versus 3.42 ± 0.47 mWS, p < 0.001). In multivariate analysis, low BMI and low basal uterine contractions were the only significant predictors for augmentation following AROM (OR 0.69, 95% C.I 0.45-0.97, p = 0.009 and OR 16.03, 95% CI 1.90-134.69, p = 0.003, respectively). CONCLUSION Myometrial electrical activity was significantly enhanced following AROM. Augmentation was mostly pronounced in patients with lower BMI and initial lower basal uterine contraction.
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Affiliation(s)
- Liran Hiersch
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
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Ray A, Ray S, George AT. Antibiotics prior to amniotomy for reducing infectious morbidity in mother and infant. Cochrane Database Syst Rev 2013. [DOI: 10.1002/14651858.cd010626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
BACKGROUND Intentional artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or 'breaking of the waters', is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour. However, there are concerns regarding unintended adverse effects on the woman and baby. OBJECTIVES To determine the effectiveness and safety of amniotomy alone for routinely shortening all labours that start spontaneously. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2013). SELECTION CRITERIA Randomised controlled trials comparing amniotomy alone versus intention to preserve the membranes. We excluded quasi-randomised trials. DATA COLLECTION AND ANALYSIS Two review authors assessed identified studies for inclusion, assessed risk of bias and extracted data. Primary analysis was by intention-to-treat. MAIN RESULTS We have included 15 studies in this updated review, involving 5583 women. Amniotomy alone versus intention to preserve the membranes (no amniotomy) for spontaneous labour There was no clear statistically significant difference between women in the amniotomy and control groups in length of the first stage of labour (mean difference (MD) -20.43 minutes, 95% confidence interval (CI) -95.93 to 55.06), caesarean section (risk ratio (RR) 1.27, 95% CI 0.99 to 1.63), maternal satisfaction with childbirth experience (MD -1.10, 95% CI -7.15 to 4.95) or Apgar score less than seven at five minutes (RR 0.53, 95% CI 0.28 to 1.00). There was no consistency between trials regarding the timing of amniotomy during labour in terms of cervical dilatation. Amniotomy alone versus intention to preserve the membranes (no amniotomy) for spontaneous labours that have become prolonged There was no clear statistically significant difference between women in the amniotomy and control group in caesarean section (RR 0.95, 95% CI 0.15 to 6.08), maternal satisfaction with childbirth experience (MD 22.00, 95% CI 2.74 to 41.26) or Apgar score less than seven at five minutes (RR 2.86, 95% CI 0.12 to 66.11). AUTHORS' CONCLUSIONS On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.
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Affiliation(s)
- Rebecca M D Smyth
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Abstract
BACKGROUND Intentional artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or 'breaking of the waters', is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour. However, there are concerns regarding unintended adverse effects on the woman and baby. OBJECTIVES To determine the effectiveness and safety of amniotomy alone for routinely shortening all labours that start spontaneously. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2010). SELECTION CRITERIA Randomised controlled trials comparing amniotomy alone versus intention to preserve the membranes. We excluded quasi-randomised trials. DATA COLLECTION AND ANALYSIS Two authors assessed identified studies for inclusion, assessed risk of bias and extracted data. Primary analysis was by intention to treat. MAIN RESULTS We have included 15 studies in this updated review, involving 5583 women. In the current review, data for women with spontaneous normal labour were pooled with data from one trial (involving 61 women) where women had spontaneous, but prolonged labour.There was no clear statistically significant difference between the amniotomy and control groups in length of the first stage of labour (mean difference (MD) -20.43 minutes, 95% confidence interval (CI) -95.93 to 55.06), caesarean section (risk ratio (RR) 1.27, 95% CI 0.99 to 1.62), maternal satisfaction with childbirth experience (standardised mean difference (SMD) 0.27, 95% CI -0.49 to 1.04) or low Apgar score less than seven at five minutes (RR 0.57, 95% CI 0.31 to 1.06). There was no consistency between papers regarding the timing of amniotomy during labour in terms of cervical dilatation. AUTHORS' CONCLUSIONS On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.
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Affiliation(s)
- Rebecca M D Smyth
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester,
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Chua WK, Oyen ML. Do we know the strength of the chorioamnion? Eur J Obstet Gynecol Reprod Biol 2009; 144 Suppl 1:S128-33. [DOI: 10.1016/j.ejogrb.2009.02.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND Intentional artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or 'breaking of the waters', is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour. However, there are concerns regarding unintended adverse effects on the woman and baby. OBJECTIVES To determine the effectiveness and safety of amniotomy alone for (1) routinely shortening all labours that start spontaneously, and (2) shortening labours that have started spontaneously, but have become prolonged. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2007). SELECTION CRITERIA Randomised controlled trials comparing amniotomy alone versus intention to preserve the membranes. We excluded quasi-randomised trials. DATA COLLECTION AND ANALYSIS Two authors assessed identified studies for inclusion. Both authors extracted data. Primary analysis was by intention to treat. MAIN RESULTS We have included 14 studies in this review, involving 4893 women. There was no evidence of any statistical difference in length of first stage of labour (weighted mean difference -20.43 minutes, 95% confidence interval (CI) -95.93 to 55.06), maternal satisfaction with childbirth experience (standardised mean difference 0.27, 95% CI -0.49 to 1.04) or low Apgar score less than seven at five minutes (RR 0.55, 95% CI 0.29 to 1.05). Amniotomy was associated with an increased risk of delivery by caesarean section compared to women in the control group, although the difference was not statistically significant (RR 1.26, 95% CI 0.98 to 1.62). There was no consistency between papers regarding the timing of amniotomy during labour in terms of cervical dilatation. AUTHORS' CONCLUSIONS On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We do recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.
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Affiliation(s)
- R M D Smyth
- University of Liverpool, Department of Public Health, School of Population, Community and Behavioural Sciences, Whelan Building, Quadrangle, Liverpool, UK, L69 3GB.
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Calvin SE, Oyen ML. Microstructure and mechanics of the chorioamnion membrane with an emphasis on fracture properties. Ann N Y Acad Sci 2007; 1101:166-85. [PMID: 17332077 DOI: 10.1196/annals.1389.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The normal mechanical functioning of an intact chorioamnion (CA) membrane is essential to successful human reproduction. The amnion and the chorion, separately and together as the bilayer chorioamnion, serve barrier and container functions throughout gestation, and these two important roles are required from conception to birth. The event associated with the "breaking of waters" is a landmark event in labor and delivery. Mechanical rupture of the CA membrane is part of the natural sequence of term delivery, but has serious implications when rupture occurs prior to term; preterm premature rupture of the CA membrane (PPROM) is associated with one-third of premature births. The current manuscript reviews PPROM from a clinical, anatomical, and mechanical perspective with a special focus on the clinically relevant fracture properties of these membranes. Emphasis is given to the link between membrane structure and properties at macroscopic and microscopic length scales. Because it has been demonstrated that the mechanical properties of prematurely failed membranes are not different from membranes of the same gestational age that have remained intact, membrane failure is a local process that must be explored in terms of local changes in structure and properties of isolated portions of the membrane. Future diagnostic techniques aimed at detection of changes in membrane structure (including thickness) and altered mechanical stiffness or strength may allow for prefailure diagnosis of membrane weak spots, thus opening the door for potential intervention and treatment techniques for preterm membrane rupture.
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Affiliation(s)
- Steven E Calvin
- Minnesota Perinatal Physicians--Allina Health System, Minneapolis, Minnesota, USA
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Marques IR, Barbosa SDF, Basile ALDO, Marin HF. Guia de Apoio à Decisão em Enfermagem Obstétrica: aplicação da técnica da Lógica Fuzzy. Rev Bras Enferm 2005; 58:349-54. [PMID: 16335192 DOI: 10.1590/s0034-71672005000300019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A Lógica Fuzzy tem sido utilizada como uma forma de representação de conhecimento e uma técnica para a modelagem de Sistemas de Apoio à Decisões Clínicas. Ao considerar a pouca utilização desta técnica para modelar decisões clínicas de enfermagem, este ensaio objetiva apresentar noções gerais sobre esta técnica e por meio dela desenvolver uma formulação teórica, em forma de guia prático, para o apoio à decisão nos casos de amniotomia em gestantes pimíparas em trabalho de parto normal.
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Affiliation(s)
- Isaac R Marques
- Faculdade de Enfermagem da Universidade de Santo Amaro Endereço.
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Segal D, Sheiner E, Yohai D, Shoham-Vardi I, Katz M. Early amniotomy -- high risk factor for cesarean section. Eur J Obstet Gynecol Reprod Biol 1999; 86:145-9. [PMID: 10509782 DOI: 10.1016/s0301-2115(99)00058-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the effect of early amniotomy on mode of delivery and pregnancy outcome in comparison to a group of patients admitted with premature rupture of membranes at term. STUDY DESIGN The study population consists of all women (n=338) whose labor was induced by amniotomy, between the years 1988 to 1995. The comparison group were all women (n=1865) who were admitted with premature rupture of membranes during the same period. RESULTS Cesarean section was significantly higher in the amniotomy group than in the comparison group (162 (47.9%) vs. 348 (18.7%), P<0.001). This significant difference was noted only for those who did not had a previous cesarean section (106 (42.4%) vs. 224 (13.8%), P<0.001). Non progressive labor during the first stage was threefold higher in the amniotomy group than in the control group (30.8% vs. 10.9%, P<0.001). Abnormal fetal heart rate patterns were detected during labor in 52 patients (15.4%) of amniotomy group, as compared to 141 cases (7.6%) in the control group (P<0.001). To assess the independent contribution of early amniotomy to having cesarean section in the present delivery, a multiple logistic model was used. Early amniotomy (odds ratio [OR] 3.07, 95% confidence interval [CI] 2.36-4.01), as well as a previous cesarean section (OR 5.04, 95% CI 3.90-6.52) and high parity (OR 1.07, 95% CI 1.03-1.26) were all found as independent risk factors for cesarean section. CONCLUSIONS Early amniotomy appears to be associated with an increased risk for cesarean section.
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Affiliation(s)
- D Segal
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Affiliation(s)
- D W Laube
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison 53792-6188, USA
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