Department of Obstetrics & Gynaecology, University of Malaya, Kuala Lumpur, Malaysia.
Obstet Gynecol. 2013 Feb;121(2 Pt 1):253-259. doi: 10.1097/AOG.0b013e31827e7fd9.
To compare immediate with delayed (4 hours) oxytocin infusion after amniotomy on vaginal delivery within 12 hours and patient satisfaction with the birth process.
Parous women with favorable cervixes after amniotomy for labor induction were randomized to immediate titrated oxytocin or placebo intravenous infusion in a double-blind noninferiority trial. After 4 hours, study infusions were stopped, the women were assessed, and open-label oxytocin was started if required. Maternal satisfaction with the birth process was assessed with a 10-point visual numerical rating scale (lower score, greater satisfaction).
Vaginal delivery rates at 12 hours were 91 of 96 (94.8%) compared with 91 of 94 (96.8%) (relative risk 0.98, 95% confidence interval [CI] 0.92-1.04, P=.72), and maternal satisfaction on a visual numerical rating scale (median [interquartile range]) was 3 [3-4] compared with 3 [3-5], P=.36 for immediate compared with delayed arm, respectively). Cesarean delivery, maternal fever, postpartum hemorrhage, uterine hyperactivity, and adverse neonatal outcome rates were similar between arms. The immediate oxytocin arm had a shorter amniotomy-to-delivery interval of 5.3±3.1 compared with 6.9±2.9 hours (P<.001) and lower epidural analgesia rate of 2.9% compared with 9.9% (relative risk 0.3, 95% CI 0.1-1.0, P=.046), but fetal heart rate abnormalities on cardiotocogram were higher, 28.6% compared with 16.8% (relative risk 1.7 95% CI 1.0-2.9, P=.048). In the delayed arm, oxytocin infusion was avoided by 35.6%.
Immediate or delayed oxytocin infusions are reasonable options after amniotomy for labor induction in parous women with favorable cervixes. The choice should take into account local resources and the woman's wish.
ISRCTN Register, http://isrctn.org, ISRCTN51476259.
I.
比较羊膜穿刺术后 4 小时（延迟）与即刻（即刻）滴注催产素对 12 小时内阴道分娩的影响，并比较产妇对分娩过程的满意度。
在羊膜穿刺术引产的产妇中，选择宫颈条件良好的经产妇，进行随机、双盲、非劣效性试验，比较即刻滴定催产素与安慰剂静脉滴注。4 小时后停止研究输液，评估产妇，并根据需要开始开放标签催产素。采用 10 分制视觉数字评分量表评估产妇对分娩过程的满意度（评分越低，满意度越高）。
12 小时内阴道分娩率分别为 96 例中的 91 例（94.8%）和 94 例中的 91 例（96.8%）（相对风险 0.98，95%置信区间[CI]0.92-1.04，P=.72），即刻组和延迟组的视觉数字评分量表中位数[四分位距]分别为 3[3-4]和 3[3-5]（P=.36）。剖宫产、产妇发热、产后出血、子宫过度活跃和不良新生儿结局发生率在两组间相似。即刻催产素组的羊膜穿刺术至分娩间隔时间为 5.3±3.1 小时，短于 6.9±2.9 小时（P<.001），硬膜外镇痛率为 2.9%，低于 9.9%（相对风险 0.3，95%CI 0.1-1.0，P=.046），但胎儿心电图异常率较高，为 28.6%，高于 16.8%（相对风险 1.7，95%CI 1.0-2.9，P=.048）。在延迟组中，有 35.6%的产妇避免了催产素输注。
在宫颈条件良好的经产妇中，羊膜穿刺术后即刻或延迟滴注催产素都是合理的选择。选择应考虑当地资源和产妇的意愿。
ISRCTN 注册，http://isrctn.org，ISRCTN51476259。
I 级。
