Rouse D J, McCullough C, Wren A L, Owen J, Hauth J C
Department of Obstetrics and Gynecology, University of Alabama at Birmingham.
Obstet Gynecol. 1994 Jun;83(6):937-40. doi: 10.1097/00006250-199406000-00007.
To determine whether leaving the membranes intact in active-phase arrest would affect the cesarean delivery rate or the incidence of maternal morbidity secondary to infection.
We conducted a randomized trial of healthy, spontaneously laboring women at term with an intact chorioamnion and active-phase arrest (defined as 1 cm or less of cervical change over 2 hours in the active phase of labor). Patients were assigned to either oxytocin augmentation with intact chorioamnion or oxytocin augmentation with amniotomy and internal monitoring of the fetal heart rate and uterine contractions.
The intact group (n = 58) and the amniotomy group (n = 60) were similar with respect to maternal age, race, parity, labor epidural usage, gestational age, cervical dilatation at randomization, number of vaginal examinations, and infant birth weight. Four patients in the intact group and five in the amniotomy group underwent cesarean delivery (P = 1.0). No patient in the intact group and three in the amniotomy group were diagnosed with chorioamnionitis (P = .24). Endometritis did not occur in the intact group, whereas four cases occurred in the amniotomy group (P = .12). There were no cases of maternal infection in the intact group, versus seven in the amniotomy group (P = .01). The interval between randomization and vaginal delivery was 44 minutes longer in the intact group than in the amniotomy group (P = .11).
In women with active-phase arrest of labor and intact membranes, oxytocin augmentation with elective amniotomy and internal monitoring increases maternal infectious morbidity.
确定在活跃期停滞时保留胎膜是否会影响剖宫产率或继发于感染的孕产妇发病率。
我们对足月健康、自然临产且羊膜完整并处于活跃期停滞（定义为在产程活跃期2小时内宫颈变化小于或等于1厘米）的妇女进行了一项随机试验。患者被随机分为两组，一组为保留羊膜完整的缩宫素引产组，另一组为行人工破膜及胎儿心率和子宫收缩内部监测的缩宫素引产组。
保留组（n = 58）和人工破膜组（n = 60）在产妇年龄、种族、产次、分娩硬膜外使用情况、孕周、随机分组时的宫颈扩张程度、阴道检查次数和婴儿出生体重方面相似。保留组4例患者和人工破膜组5例患者接受了剖宫产（P = 1.0）。保留组无患者被诊断为绒毛膜羊膜炎，人工破膜组有3例（P = 0.24）。保留组未发生子宫内膜炎，而人工破膜组有4例发生（P = 0.12）。保留组无孕产妇感染病例，人工破膜组有7例（P = 0.01）。保留组随机分组至阴道分娩的间隔时间比人工破膜组长44分钟（P = 0.11）。
对于产程活跃期停滞且胎膜完整的妇女，选择性人工破膜及内部监测的缩宫素引产会增加孕产妇感染发病率。
