Goffinet F, Fraser W, Marcoux S, Bréart G, Moutquin J M, Daris M
Unité 149, INSERM, Paris, France.
Br J Obstet Gynaecol. 1997 May;104(5):548-53. doi: 10.1111/j.1471-0528.1997.tb11530.x.
To determine whether early amniotomy, when practised as an isolated intervention, increases the hourly rate of fetal heart rate record abnormalities.
This is a secondary analysis of the results of a multicentre randomised trial of early versus late amniotomy in labour.
Secondary and tertiary level teaching hospitals.
Early amniotomy versus an attempt to conserve the amniotic membranes.
The hourly rates of early, mild variable, severe variable and late decelerations; caesarean section rates.
Severe variable decelerations, when classified as categorical events (> or = 1/h to 2/h, > or = 2/h to < 4/h, > or = 4/h), were more frequent in the amniotomy group (chi2 for trend = 5.7, P = 0.017). The mean hourly rates of severe variable and late fetal heart rate decelerations were increased in the amniotomy group (severe variable: amniotomy group 1.4/h, control 0.7/h, P = 0.021; late: amniotomy group 3.3/h, control 2.3/h, P = 0.011). Although the overall rate of caesarean was similar in the two groups (OR 1.2; 95% CI 0.8-1.8), there was an increase in caesarean section for fetal distress (OR 2.3; 95% CI 1.1-4.5) associated with amniotomy.
Our data suggest that early amniotomy increases the hourly rate of severe variable fetal heart rate decelerations without evidence of an adverse effect on neonatal outcome. In settings where the diagnosis of fetal compromise is based primarily on electronic monitoring, caesarean section for fetal distress may be increased by early amniotomy.
确定单独实施早期人工破膜时，是否会增加胎儿心率记录异常的每小时发生率。
这是一项对产程中早期与晚期人工破膜多中心随机试验结果的二次分析。
二级和三级教学医院。
早期人工破膜与尝试保留胎膜。
早期、轻度变异、重度变异和晚期减速的每小时发生率；剖宫产率。
当将重度变异减速分类为分类事件（≥1次/小时至2次/小时、≥2次/小时至<4次/小时、≥4次/小时）时，人工破膜组更为常见（趋势检验卡方值=5.7，P=0.017）。人工破膜组重度变异和晚期胎儿心率减速的平均每小时发生率有所增加（重度变异：人工破膜组1.4次/小时，对照组0.7次/小时，P=0.021；晚期：人工破膜组3.3次/小时，对照组2.3次/小时，P=0.011）。尽管两组的总体剖宫产率相似（比值比1.2；95%可信区间0.8 - 1.8），但人工破膜与因胎儿窘迫行剖宫产的比例增加有关（比值比2.3；95%可信区间1.1 - 4.5）。
我们的数据表明，早期人工破膜会增加重度变异胎儿心率减速的每小时发生率，且无证据显示对新生儿结局有不良影响。在主要基于电子监测诊断胎儿窘迫的情况下，早期人工破膜可能会增加因胎儿窘迫行剖宫产的比例。
