Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands.
Department of Epidemiology, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2019 Sep;240:357-363. doi: 10.1016/j.ejogrb.2019.07.036. Epub 2019 Jul 30.
To get a preliminary understanding of the amniotomy-to-delivery interval, patients' experiences and risks by awaiting spontaneous contractions after amniotomy and to explore the need and feasibility for a larger randomised controlled trial.
We performed a randomised controlled pilot trial in a peripheral teaching hospital in Amsterdam, The Netherlands. Women with term, singleton pregnancy in vertex position undergoing labour induction for one of the five following indications: prolonged pregnancy, mild hypertensive disorders, diabetes, expected macrosomia, maternal request, were randomised to amniotomy with 12-hours delayed oxytocin (DO), or amniotomy with immediate oxytocin (IO).
A total of 64 women was included in the analysis. The median amniotomy-to-delivery interval for the DO-group was 15 h (IQR 8-21), and 6 h (IQR 5-11) for the IO-group (HR, 0.41; 95% CI, 0.24-0.70), with equal patient reported childbirth perception in the overall group (P=0.43). Parous women reported a significantly less positive perception of labour (P=0.02) and used pain relief more often (RR, 2.93; 95% CI, 1.05-8.19) in the DO-group. The proportion of women delivered within 24 h was not significantly different between groups (RR, 0.30; 95% CI, 0.05-1.83). Other delivery and neonatal outcomes did not differ significantly between groups, possibly due to being underpowered.
Preliminary results show that amniotomy-to-delivery interval was prolonged with 9 h in the DO-group, with equal patient reported childbirth perception in the overall group. Parous women have a less positive perception of their delivery and used pain relief more often when oxytocin was delayed. Delaying oxytocin infusion after amniotomy should be further investigated in an adequately powered randomised trial.
通过等待羊膜穿刺术后自然宫缩来初步了解羊膜穿刺术至分娩的间隔时间、患者的体验和风险，并探讨更大规模随机对照试验的必要性和可行性。
我们在荷兰阿姆斯特丹的一家外围教学医院进行了一项随机对照试验。入组标准为足月、单胎、头位、因以下五种指征之一行引产的孕妇：过期妊娠、轻度高血压疾病、糖尿病、预计胎儿巨大、孕妇要求。将其随机分为两组：羊膜穿刺后 12 小时给予催产素（DO 组）或羊膜穿刺后立即给予催产素（IO 组）。
共有 64 名妇女纳入分析。DO 组的中位羊膜穿刺至分娩间隔时间为 15 小时（IQR 8-21），IO 组为 6 小时（IQR 5-11）（HR 0.41；95%CI 0.24-0.70），总体组患者报告的分娩感知无差异（P=0.43）。经产妇在 DO 组报告的分娩感知明显较差（P=0.02），且更常使用止痛药物（RR 2.93；95%CI 1.05-8.19）。两组在 24 小时内分娩的比例无显著差异（RR 0.30；95%CI 0.05-1.83）。其他分娩和新生儿结局在两组之间无显著差异，可能是因为效力不足。
初步结果显示，DO 组的羊膜穿刺术至分娩间隔时间延长了 9 小时，总体组患者报告的分娩感知无差异。经产妇对分娩的感知较差，且当催产素延迟时更常使用止痛药物。应在一项充分有力的随机试验中进一步研究羊膜穿刺术后延迟催产素输注。
