Sheiner E, Segal D, Shoham-Vardi I, Ben-Tov J, Katz M, Mazor M
Department of Obstetrics and Gynecology, Soroka University Medical Center, Beer-Sheva, Israel.
Arch Gynecol Obstet. 2000 Sep;264(2):63-7. doi: 10.1007/s004040000071.
To evaluate the effect of early amniotomy in term gestation on the mode of delivery and pregnancy outcome in comparison with premature rupture of membranes (PROM) and oxytocin induction.
The study population consisted of 60 consecutive parturients induced by early amniotomy. The two comparison groups were 147 women admitted with term PROM and 65 patients induced by oxytocin. All study participants were evaluated prospectively and had unfavorable cervical scores.
The duration of the first stage of labor was significantly longer in the PROM group (987.8 +/- 572.3 min) as compared with the early amniotomy group (615.0 +/- 389.6 min) and the oxytocin induction group (650.9 +/- 349.5 min, P<0.001). Higher rates of CS were found in the study group (26.7%) as compared to the controls (11.6% in the PROM and 16.9% in the oxytocin groups, p=0.012). Neonatal outcome was similar in all groups. A stratified analysis comparing the risk of CS while controlling for a previous one did not show a significant difference between the early amniotomy and the oxytocin administration groups.
Early amniotomy is associated with a higher rate of CS. While controlling for a previous CS, both ways of induction were comparable. In order to decrease the CS rates, induction should probably start with cervical ripening techniques in order to improve the Bishop scores.
与胎膜早破（PROM）及缩宫素引产相比，评估足月妊娠早期人工破膜对分娩方式及妊娠结局的影响。
研究人群包括60例连续接受早期人工破膜引产的产妇。两个对照组分别为147例足月胎膜早破入院的妇女及65例接受缩宫素引产的患者。所有研究参与者均进行前瞻性评估，且宫颈评分均不理想。
与早期人工破膜组（615.0±389.6分钟）和缩宫素引产组（650.9±349.5分钟，P<0.001）相比，PROM组第一产程持续时间显著更长（987.8±572.3分钟）。研究组剖宫产率（26.7%）高于对照组（PROM组为11.6%，缩宫素组为16.9%，p = 0.012）。所有组新生儿结局相似。在控制既往剖宫产史的情况下进行分层分析，早期人工破膜组与缩宫素给药组之间未显示出显著差异。
早期人工破膜与较高的剖宫产率相关。在控制既往剖宫产史的情况下，两种引产方式具有可比性。为降低剖宫产率，引产可能应从宫颈成熟技术开始以改善Bishop评分。
