Labour, Prolonged
Tony Hollingworth in Differential Diagnosis in Obstetrics and Gynaecology: An A-Z, 2015
If delay in the established first stage of labour is suspected, amniotomy should be considered for all women with intact membranes, following explanation of the procedure and advice that it will shorten her labour by about an hour and may increase the strength and pain of her contractions. The management of inadequate uterine activity is by oxytocin augmentation following spontaneous or artificial rupture of the membranes, and women should be informed that the use of oxytocin will bring forward the time of birth but will not influence the mode of birth or other outcomes.2 It is important that the oxytocin infusion be given at an adequate dose to cause regular and strong contractions with relaxation in between. If the woman becomes dehydrated and develops ketones in her urine, then fluid replacement can very often positively affect the efficiency of her contractions. Progress should be assessed by abdominal and vaginal examination after strong, regular uterine contractions are established.
Induction Of Labor
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
Amniotomy—artificial rupture of the membranes—is another technique used in labor induction. There is insufficient evidence to assess the effectiveness of amniotomy alone [78]. No trials compared amniotomy alone with intracervical prostaglandins. If performed without cervical ripening or achieving a favorable cervix, amniotomy may be followed by long intervals before onset of labor. In induced patients, early amniotomy is associated with a shorter duration of labor and no increase in CD in a meta-analysis of four trials [79]. The rate of intrapartum fever is mixed in RCTs and warrants additional research [79].
EMQ Answers
Justin C. Konje in Complete Revision Guide for MRCOG Part 2, 2019
Q Rotational Ventouse deliveryFor a nulliparous woman, suspect delay in the second stage if progress in terms of rotation and or descent of the presenting part is inadequate after 1 h of active second stage. Offer such a patient a vaginal examination and then offer amniotomy if membranes are intact or instrumental delivery. (Intrapartum Care for Healthy Women and Babies. NICE 2014 Clinical Guideline [CG190], Published date: December 2014, Last updated: November 2016)
Effects of the time of pregnant women’s admission to the labor ward on the labor process and interventions
Published in Health Care for Women International, 2021
Melek Balcik Colak, Hafize Ozturk Can
In another study, 49.8% of the pregnant women were administered oxytocin. Of the women who were administered oxytocin, 4.5% had cesarean sections (Bergqvist et al., 2012). The rate of oxytocin induction in the present study was similar to the rates in other studies. While the rate of amniotomy and anti-spasmolytic drug administration were higher in the active phase group, the rate of oxytocin application was higher in the latent phase group. Amniotomy is usually performed in the last part of the active phase. Contractions are thought to accelerate due to regular and strong pregnancy amniotomy and anti-spasmodic treatment. Because, it is not possible to assess the duration of the first stage of labor as the pregnant women come to hospital in the active phase, and thus it may be necessary to accelerate birth. It was also stated that amniotomy and oxytocin administration in the early period caused a moderate decrease in cesarean rates and shortened the duration of birth (Wei et al., 2013).
Comparative evaluation of normal saline, 1/3-2/3, and ringer's lactate infusion on labour outcome, PH, bilirubin, and glucose level of the umbilical cord blood in nulliparous women with labour induction: a randomised clinical trial
Published in Journal of Obstetrics and Gynaecology, 2022
Ladan Haghighi, Fatemeh Jahanshahi, Mojgan Mokhtari, Zahra Rampisheh, Mina Momeni
In this double-blind trial, the subjects and the specialist who performed vaginal examinations were unaware of the allocation status of the three groups. After obtaining informed consent, the participants were randomly (with a random number table) divided into three groups, and a peripheral intravenous angiocatheter with an attached two-way stopcock was inserted. For labour induction, oxytocin was infused through one of the ducts at a 0.2 ml/min rate. This rate was increased by 0.2 ml every 15 minutes until induction of adequate uterine contractions (3-5 uterine contractions in 10 min with a duration of 40–60 seconds) or any indication of caesarean delivery. Through the other duct, for hydration, the first group received normal saline, the second 1/3-2/3, and the third Ringer's lactate fluid, each at a rate of 125 mL/h. All participants were examined every 4 hours during the latent phase and every two hours during the active phase by one specialist. With the beginning of the active phase (cervical dilation of ≥5 min the presence of adequate uterine contractions), amniotomy was performed, and patients received epidural analgesia for pain relief.
Second trimester uterine rupture and repair followed by morbidly adherent placenta: a case report
Published in Journal of Obstetrics and Gynaecology, 2021
Claire Pintault, Aurore Bleuzen, Franck Perrotin, Caroline Diguisto
In any case, such rupture early in pregnancy can be difficult to distinguish from other causes of acute abdominal pain (e.g. appendicitis or ovarian torsion), due to both its rarity and the lack of specificity of its clinical signs, mainly intense abdominal pain, vaginal bleeding and shock (Surico et al. 2016). Two different methods of management have been reported – either hysterectomy or uterine repair. Management should be decided based on the woman's background, her hemodynamic status, the integrity of the amniotic sac, and the continued development of the pregnancy. The occurrence of a stillbirth may change the choice of management. Different types of uterine repair have been reported: separate sutures, patch or fibrin glue (Sugawara et al. 2014; Surico et al. 2016). Surgeons must be aware of the risks of iatrogenic amniotomy while suturing (Hawkins et al. 2018).
Related Knowledge Centers
- Amniotic Fluid
- Breech Birth
- Cephalic Presentation
- Meconium
- Prostaglandin
- Vagina
- Uterus
- Midwife
- Obstetrics
- Labor Induction