Battarbee Ashley N, Vaz Sharon, Stamilio David M
University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, United States.
University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, United States.
Eur J Obstet Gynecol Reprod Biol. 2020 Apr;247:85-89. doi: 10.1016/j.ejogrb.2020.02.002. Epub 2020 Feb 5.
To assess if delayed amniotomy during labor induction is associated with adverse delivery outcomes.
Retrospective cohort study of women with a viable, singleton gestation who underwent labor induction at a tertiary-care hospital (4/2014-3/2017). Women were excluded if oxytocin was not used or if spontaneous rupture of membranes (ROM) occurred ≤8 h after oxytocin initiation. The primary outcome was cesarean delivery, and secondary outcomes included postpartum hemorrhage, maternal infectious morbidity, neonatal 5-min Apgar score <7, and neonatal intensive care unit admission. Women were compared by timing of amniotomy: delayed (ROM > 8 h after oxytocin initiation) versus not delayed. Multivariable logistic regression was used to estimate the association between delayed amniotomy and study outcomes.
Of 2081 women who met inclusion criteria, 1125 (before 54%) had delayed amniotomy. Women with delayed amniotomy had ROM 12.7 h (IQR 10.0, 17.9) after oxytocin versus 5.0 h (IQR 3.7, 6.5) without delayed amniotomy. In multivariable regression, delayed amniotomy was associated with increasingly higher odds of cesarean as maternal obesity severity increased (aOR 1.58, 95 %CI 1.24-2.03 at BMI 30 kg/m; aOR 2.15, 95 %CI 1.45-3.21 at BMI 40 kg/m; aOR 2.93, 95 %CI 1.54-5.57 at BMI 50 kg/m).
Delayed amniotomy >8 h after starting oxytocin for labor induction was associated with higher odds of cesarean delivery. Significant delay in ROM should be avoided during labor induction.
评估引产期间延迟破膜是否与不良分娩结局相关。
对一家三级医疗机构（2014年4月至2017年3月）中进行引产的单胎活产孕妇进行回顾性队列研究。若未使用缩宫素或在缩宫素开始使用后≤8小时发生胎膜早破（ROM），则将孕妇排除。主要结局为剖宫产，次要结局包括产后出血、产妇感染性疾病、新生儿5分钟阿氏评分<7分以及新生儿重症监护病房入住情况。根据破膜时间对孕妇进行比较：延迟破膜（缩宫素开始使用后ROM>8小时）与未延迟破膜。采用多变量逻辑回归来估计延迟破膜与研究结局之间的关联。
在2081名符合纳入标准的孕妇中，1125名（占54%）为延迟破膜。延迟破膜的孕妇在使用缩宫素后ROM时间为12.7小时（四分位间距10.0，17.9），而未延迟破膜的孕妇为5.0小时（四分位间距3.7，6.5）。在多变量回归中，随着产妇肥胖严重程度增加，延迟破膜与剖宫产几率的增加相关（BMI为30kg/m²时，调整后比值比1.58，95%置信区间1.24 - 2.03；BMI为40kg/m²时，调整后比值比2.15，95%置信区间1.45 - 3.21；BMI为50kg/m²时，调整后比值比2.93，95%置信区间1.54 - 5.57）。
引产开始使用缩宫素后>8小时延迟破膜与剖宫产几率增加相关。引产期间应避免胎膜破裂出现显著延迟。
