Ruamsap Kachol, Panichkul Prisana
J Med Assoc Thai. 2017 Feb;100(2):125-32.
Comparison effect of early versus late amniotomy on the duration time of first and second stage of labor, the cesarean section rate and analgesic use during labor.
Randomized control trial study.
Labor unit, Department of Obstetrics and Gynecology, Phramongkutklao Hospital.
120 term singletons, nulliparous with cephalic presentation pregnant women who had spontaneous labor and came to labor room from June 1st, 2013 to October 31th, 2013.
After signed the consent form, the selected pregnant women were divided into two groups by random number table. The early amniotomy which performed when patients entered the active phase of labor (cervical dilatation 3-5 cm., n=60), and the late amniotomy which membrane was left intact and amniotomy was reserved for specific indications (n=60). The outcome of labor was recorded by the attending physicians. Main outcome measures: Compare the duration of labor between two groups.
The time of first stage of labor was not different between early and late amniotomy groups (560.0 vs. 637.5 min; p<1.0; time difference 77.5 minutes). There was statistically significant difference between women in the early amniotomy and control groups in cesarean section rate (43.3% vs. 20%; p = 0.006).
The amniotomy should not be introduced routinely as the standard labor management, because it was not proven to shorten the course of labor. The authors recommend that the women be informed about the results of the amniotomy, then the decisions were made between the women and their caregivers.
比较早期破膜与晚期破膜对第一产程和第二产程时长、剖宫产率及产程中镇痛药物使用的影响。
随机对照试验研究。
诗里拉吉医院妇产科产房。
2013年6月1日至2013年10月31日期间自然临产并进入产房的120例足月单胎、初产妇、头先露孕妇。
签署知情同意书后，入选孕妇通过随机数字表分为两组。早期破膜组在产妇进入产程活跃期（宫颈扩张3 - 5厘米）时进行破膜（n = 60），晚期破膜组胎膜保持完整，仅在有特定指征时进行破膜（n = 60）。由主治医生记录分娩结局。主要观察指标：比较两组产程时长。
早期破膜组和晚期破膜组第一产程时间无差异（560.0分钟对637.5分钟；p < 1.0；时间差77.5分钟）。早期破膜组与对照组产妇在剖宫产率上存在统计学显著差异（43.3%对20%；p = 0.006）。
破膜不应作为常规标准产程管理方法推行，因为尚无证据表明其能缩短产程。作者建议应将破膜结果告知产妇，然后由产妇及其医护人员共同做出决定。
