Dr Ruma Afrose, Junior Consultant (Obs & Gynae) & RS (Obs & Gynae), Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2021 Jan;30(1):6-12.
Intentional artificial rupture of the amniotic membranes during labour, called amniotomy or 'breaking of the water's, is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up uterine contractions and therefore shorten the length of labour. However there are concerns regarding unintended adverse effects on the woman and baby. A prospective observational study was conducted to determine the effectiveness and safety of routine procedure of amniotomy to shorten the duration of labour (prolonged or not) in Mymensingh Medical College & Hospital, Mymensingh, Bangladesh from July 2011 to December 2011. One hundred low-risk women with spontaneous onset of labour at term with singleton fetus in cephalic presentation and intact amniotic membranes and a cervical dilatation between 4 and 5cm were conventionally assigned to have amniotomy during the course of labour. Maternal demographics, duration of labour (prolonged or not), maternal and perinatal outcome were considered as major outcome. Majority (49.0%) of the patients belonged to 21-25 years age group and primigravida was predominant and most of them had middle socio-economic conditions. More the three-fourth (89.0%) of the patients had head engaged. Rh-positive and negative were found 96.0% and 4.0% respectively. The primigravidae required 10.07±2.17 hours in 1st stage of labour and had 1.51±0.5 hours duration of 2nd stage of labour. In case of multi-gravidae it was 6.07±2.06 hours in 1st stage of and 1±0.5 hours in 2nd stage of labour. There was a marked reduction of amniotomy-delivery interval time in this study, which was 3 hours 40 minutes and whereas mean cervical dilatation was 4cm during amniotomy. Almost three fourth (72.0%) cases delivered vaginally among which, with episiotomy in 49.0% and without episiotomy in 23.0%. Instrumental delivery was in 9.0% of which 4.0% by forceps, 5.0% by vaccum extraction and 14.0% underwent LUCS. Still birth was found 2.0%, asphyxiated 3.0% and prenatal death 1.0%. In terms of referral to neonatal care unit it was found that 7.0% were asphyxiated. Asphyxia and low APGAR score was 4.0%, low birth weight 9.0%, instrumental delivery was 5.0%, Rh incompatibility was 2.0%. Only 1.0% babies needed admission to neonatal care unit and were intubated. So, Amniotomy significantly reduced the duration of the first stage of labour without affecting the oxytocin requirement, the rate of caesarean section and newborn outcome.
在分娩过程中，人为地刺破羊膜，称为羊膜穿刺术或“破水”，这是现代产科和助产实践中最常进行的操作之一。羊膜穿刺术的主要目的是加速子宫收缩，从而缩短分娩时间。然而，人们对其对妇女和婴儿产生意外不良影响存在担忧。2011 年 7 月至 12 月，在孟加拉国迈门辛医学院附属医院（Mymensingh Medical College & Hospital）进行了一项前瞻性观察性研究，旨在确定常规羊膜穿刺术缩短分娩时间（延长或不延长）的有效性和安全性。100 名低危孕妇在足月时自然分娩，胎头呈头位，胎膜完整，宫颈扩张 4-5cm，在分娩过程中常规行羊膜穿刺术。产妇人口统计学特征、分娩时间（延长或不延长）、母婴围生期结局被视为主要结局。大多数（49.0%）患者年龄在 21-25 岁之间，初产妇居多，大多数产妇社会经济状况中等。超过四分之三（89.0%）的患者胎头已入盆。Rh 阳性和阴性分别为 96.0%和 4.0%。初产妇在第一产程中需要 10.07±2.17 小时，第二产程需要 1.51±0.5 小时。对于多产妇，第一产程需要 6.07±2.06 小时，第二产程需要 1.0 小时。与既往研究相比，本研究中的羊膜穿刺术-分娩间隔时间明显缩短，为 3 小时 40 分钟，而羊膜穿刺术时的宫颈扩张平均为 4cm。近四分之三（72.0%）的患者经阴道分娩，其中 49.0%行会阴切开术，23.0%未行会阴切开术。器械分娩占 9.0%，其中 4.0%为产钳，5.0%为真空吸引器，14.0%为剖宫产。死胎 2.0%，窒息 3.0%，产前死亡 1.0%。在转新生儿重症监护病房方面，发现 7.0%的患儿有窒息。窒息和低 Apgar 评分 4.0%，低出生体重儿 9.0%，器械分娩 5.0%，Rh 不合 2.0%。只有 1.0%的婴儿需要入住新生儿重症监护病房并接受插管治疗。因此，羊膜穿刺术显著缩短了第一产程的时间，而不影响催产素的需求、剖宫产率和新生儿结局。
