Li Nan, Wang Yan, Zhou Hong
Department of Child, Adolescent and Women's Health, Publichealth School, University, Beijing 100083, China.
Zhonghua Fu Chan Ke Za Zhi. 2006 Jan;41(1):16-9.
To analyze the effects of routine early amniotomy on labor and health status of foetus and neonate.
The results of Early amniotomy increases the frequency of fetal heart rate abnormalities, A randomized controlled trial of early amniotomy, Effect of early amniotomy on the risk of dystocia in nulliparous women, The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients: A randomized study, Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term and A randomized controlled trial and meta-analysis of active management of labour were analyzed using Mantel-Haenszel method (fixed effect model) in meta-analysis.
(1) The routine early amniotomy can shorten 94.90 min of the first stage of labor, 95% CI (-119.17, -70.52). (2) The OR for cesarean section was 1.25, 95% CI (0.99-1.57), for instrumental vaginal delivery was 1.05, 95% CI (0.90-1.24). (3) There was no difference in abnormal fetal heart rate at first stage (OR = 0.95, 95% CI: 0.75-1.21), but there was increased abnormal fetal heart rate at second stage (OR = 1.28, 95% CI: 1.02-1.61). (4) The frequency of stained amniotic fluid and abnormal Apgar scores at 1 minute was not different significantly [OR = 1.17, 95% CI (0.78-1.73); OR = 0.71, 95% CI: (0.49-1.03)].
Routine early amniotomy appears to be associated with both benefits and risks. Beneficial effects include reductions in labor duration and possible decrease in frequency of abnormal Apgar score at one minute. Risks include increase in abnormal fetal heart rate at second stage and possible rise in cesarean section rate.
分析常规早期破膜对产程及胎儿和新生儿健康状况的影响。
采用Mantel-Haenszel法（固定效应模型）对《早期破膜增加胎儿心率异常频率》《早期破膜的随机对照试验》《早期破膜对初产妇难产风险的影响》《择期破膜对足月患者胎儿心率模式及产程的影响：一项随机研究》《足月无并发症分娩中早期与选择性破膜策略比较的随机试验》以及《产程积极管理的随机对照试验和荟萃分析》的结果进行荟萃分析。
（1）常规早期破膜可使第一产程缩短94.90分钟，95%置信区间（-119.17，-70.52）。（2）剖宫产的比值比为1.25，95%置信区间（0.99 - 1.57）；器械助产阴道分娩的比值比为1.05，95%置信区间（0.90 - 1.24）。（3）第一产程胎儿心率异常无差异（比值比 = 0.95，95%置信区间：0.75 - 1.21），但第二产程胎儿心率异常增加（比值比 = 1.28，95%置信区间：1.02 - 1.61）。（4）羊水污染频率及1分钟时阿氏评分异常无显著差异[比值比 = 1.17，95%置信区间（0.78 - 1.73）；比值比 = 0.71，95%置信区间：（0.49 - 1.03）]。
常规早期破膜似乎既有益处也有风险。有益影响包括缩短产程以及可能降低1分钟时阿氏评分异常的频率。风险包括第二产程胎儿心率异常增加以及剖宫产率可能上升。
