Garite T J, Porto M, Carlson N J, Rumney P J, Reimbold P A
Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange 92668.
Am J Obstet Gynecol. 1993 Jun;168(6 Pt 1):1827-31; discussion 1831-2. doi: 10.1016/0002-9378(93)90697-h.
Our study was designed to evaluate the effects of routine elective amniotomy on the frequency and severity of abnormal fetal heart rate patterns and on the course of labor and the need for oxytocin augmentation.
A randomized, controlled trial was conducted at term in patients in active labor who were randomly selected to undergo elective amniotomy (amniotomy group) or left intact with amniotomy reserved for specific indications (intact group).
Four hundred fifty-nine patients were studied (235 in the amniotomy group vs 224 in the intact group). Average cervical dilatation at rupture was 5.5 cm in the amniotomy group and 8.1 cm in the intact group. Analysis of fetal heart rate revealed more mild and moderate variable decelerations in the active phase of labor in the amniotomy group but no difference in the frequency of more severe decelerations or operative deliveries. In the intact group the need for oxytocin was twice as common (76 in the intact group vs 36 in the amniotomy group, p = 0.000005), and the active phase of labor was considerably longer (5 hours 56 minutes in the intact group vs 4 hours 35 minutes in the amniotomy group). Neonatal outcome was similar in the two groups.
Elective amniotomy appears to increase the likelihood of umbilical cord compression in the active phase of labor and results in more mild and moderate variable decelerations, but it does not result in more severe abnormal fetal heart rate patterns or more operative intervention. Elective amniotomy does, however, shorten the active phase of labor and decreases the need for oxytocin augmentation.
本研究旨在评估常规选择性羊膜穿刺术对异常胎儿心率模式的频率和严重程度、产程以及催产素加强宫缩需求的影响。
对足月处于活跃期的产妇进行一项随机对照试验，将其随机分为接受选择性羊膜穿刺术组（羊膜穿刺术组）或胎膜保持完整，仅在有特定指征时才进行羊膜穿刺术组（胎膜完整组）。
共研究了459例患者（羊膜穿刺术组235例，胎膜完整组224例）。羊膜穿刺术组破膜时平均宫颈扩张为5.5厘米，胎膜完整组为8.1厘米。对胎儿心率的分析显示，羊膜穿刺术组在产程活跃期出现更多轻度和中度可变减速，但在更严重减速或手术分娩的频率上无差异。在胎膜完整组，催产素的使用需求是羊膜穿刺术组的两倍（胎膜完整组76例，羊膜穿刺术组36例，p = 0.000005），且产程活跃期明显更长（胎膜完整组5小时56分钟，羊膜穿刺术组4小时35分钟）。两组新生儿结局相似。
选择性羊膜穿刺术似乎增加了产程活跃期脐带受压的可能性，并导致更多轻度和中度可变减速，但不会导致更严重的异常胎儿心率模式或更多的手术干预。然而，选择性羊膜穿刺术确实缩短了产程活跃期，并减少了催产素加强宫缩的需求。
