Induction of labour (IOL) is defined as the process of artificial initiation of uterine contractions, prior to their spontaneous onset with intention to make progressive effacement and dilatation of the cervix. There are many ways of induction of labour like Pharmacological methods as prostaglandins, non-pharmacological methods for an example hot baths, enemas and surgical method like amniotomy. In this study amniotomy has been used with the aid of oxytocin. Induction of labour is useful to reduce maternal and fetal mortality and morbidity. Early amniotomy is defined as rupture of membrane when the cervix dilatation is (≥
4cm) whereas late amniotomy when cervix dilatation is (<
4 cm).According to most literatures late amniotomy is safer to the mother and fetus, because it reduces the mortality and morbidity rates more than early amniotomy.
Aims of the study
. To study the effect of early and late amniotomy on success of induction of labour in postdated nulliparous women.
. To explore relation between the time of rupture membrane and mode of delivery.
. To find out an association between the time of rupture of membrane and fetal heart abnormality and early neonatal outcome (Apgar score).
Patients and methodology: This is an Observational study performed at Sulaymaniyah Maternity Teaching Hospital from December 2014 to June 2015. Two hundred nulliparous ladies with postdated pregnancy had been admitted to labour room for induction of labour by oxytocin who were randomly assigned and consented verbally to either early amniotomy group (EA) or late amniotomy group (LA).
Inclusion criteria: For this clinical study were nulliparity, singleton, postdated pregnancy (>40 completed weeks), vertex presentation, bishop score5≤.
Exclusion criteria: Include preterm labor, premature rupture of membrane (PROM), IUGR, chronic or pregnancy induces illness, intrauterine death and multiple pregnancies.
Results: The majority of postdated nulliparous women were (40-40+6d) weeks gestational age EA group 64% and LA group 67%. Most of the ladies had no history of (abortion, infertility, gestational diabetes and gestational hypertension).The mean age was 25 years in both groups. Bishop score mean is 6.0 in both groups. Duration of the 1st stage mean was 12.6 in LA group and 11.1 in EA group it was statistically significant, p=0.003.Duration of 2nd stage mean was the same in both group 1.8.The majority had no meconium staining of liquor, no postpartum hemorrhage. The mode of delivery was normal vaginal 59.0% in EA group and 81.0% in LA group; Cesarean section 38.0% of EA group and 17.0% of LA group the effect on mode of delivery was statistically significant. The most common indication of C/S in EA group was abnormal fetal heart tracing and primary failure of progress 39.4% and Secondary failure of progress in LA group 47. Apgar score at 1 minute <7 was 47.0% in EA group and 7.0% in LA group.
. Early and late amniotomy had effect on the success of induction of labour.
. Late amniotomy is promoting vaginal delivery while in early amniotomy the possibility of cesarean section is more.
. Early neonatal outcome is better in early amniotomy than late amniotomy.