Role
of Amniotomy plus Pitocin in Shortening of Labor as Per
Cervical Dilation
Prabha
Chauhan1, A. K. Bansal2* and V. K. S. Chauhan1
1Dept. of Obstruct and Gynaecology, Govt.
2Dept. of Community Medicine,
ABSTRACT:
In this present study when amniotomy was
done at 1 cm, 2 cms, 3 cms and 4 cms and more cervical dilatation and pitocin
drip was started, the average time taken for full dilation was 6.36 hrs, 9.34
hrs and 3.03 hrs and 2.65 hrs respectively in comparison to 10.08 hrs, 7.23
hrs, 6.78 hrs and 5.4 hrs, 4.35 hrs in the control group. This shows that
amniotomy and pitocin drip is effective in shortening the duration of labor. It
has been further noted that there was shortening of labor of 48.46 %, 58.17 %,
60.00 % and 65.00 % in 1cm, 2cms, 3cms and 4cms cervical dilation cases
respectively.
KEY
WORDS: Cervical dilation, shortening
labor.
INTRODUCTION:
The role of amniotomy to stimulate the labor
has been a controversial topic since an English midwife. Mary Donally first
ruptured the bag of waters (amnion) in labor. Amniotomy in a two edge sword. In
some conditions amniotomy is successful if all the condition are favorable in
variably, while in other it not only fails but also leads to complications so
much so that even mother or foetals or both may get harm. Use of pitocin I/V in
the induction of labor and acceleration, increase since 1950 – Pitocin infusion
soon after amniotomy has been widely advocated by Broad fast and Gordon et al (1968).
This study was undertaken with the objective
to know the effectiveness of amniotomy + pitocin in shortening of labor.
MATERIAL
AND METHODS:
This study was conducted in Sultania -
There were two group of patient (one study
group and other control group)
Study
group again divided in to four sub groups: -
1. Sub
group “A” Amniotomy done and
Pitocin started when cervical dilatation 1cms.
2. Sub
group “B” When cervical
dilation was 2 cm. Sub Group “C “when cervical dilation was 3 cms.
3. Sub
group “D” Amniotomy Done and
pitocin drip started when cervical dilation was 4 and more cms.
Group
– II or Control Group:-
In this group neither amniotomy was done nor
pitocin drip was started natural course of labor was studied.
Thus total of 200 patients were included in
the study. 100 patients were in “A” group i.e. Study group and 100 in group “B”
i.e. control group.
Amniotomy:
- It includes low rupture
of the membrane. It was carried out with care and cleanliness. The patients
were prepared as for minor operations. They were put in lithotomy position and
with aseptic precautions the cervix was located by digital examination. A
finger was introduced through the canal so as to strip of the membranes from
lower sector.
TABLE –I: DELIVERY INTERVAL IN
STUDY GROUP
|
Cervical
Dilatation in Cms. |
No. of Cases |
Minimum
Interval Time in Hrs. and Minutes |
Maximum Interval Time
in hrs. and minutes |
Average
Interval Time in hrs. and minutes |
Shortening of
Labor in percentage. |
|
|
1 |
5 |
4.30 |
7.15 |
6.36 |
48.46 |
|
|
2 |
9 |
1.40 |
5.45 |
4.35 |
58.17 |
|
|
3 |
32 |
1.30 |
5.30 |
3.03 |
60.00 |
|
|
>4 |
54 |
0.40 |
7.15 |
2.65 |
65.00 |
n = 100
TABLE – II: DELIVERY INTERVAL
IN CONTROL GROUP
|
Cervical
Dilatation in cms. |
No. of Cases |
Minimum
Interval Time in Hrs. and Minutes |
Maximum
Interval Time in Hrs. and Minutes |
Average Time in hrs. and
minutes |
|
1 |
08 |
9.15 |
12.35 |
10.08 |
|
2 |
13 |
6.15 |
10.45 |
07.23 |
|
3 |
20 |
4.45 |
9.15 |
06.78 |
|
>4 |
59 |
0.45 |
13.00 |
05.42 |
n = 100
The membranes were ruptured with cocher’s forceps when
membranes were tense during uterine contractions. Foetal heart sound were
localized again just after the amniotomy.
Pitocin Drip: - Dosage and method of administration: 2.5
units of pitocin was mixed with 500 ml of 5% glucose solution. After proper
aseptic care, drip was started in ante cubital vein. The drip was commenced at
20 drops / minutes which was equivalent to 0.05 units / minute. Each uterine
contractions was noted carefully.
OBSERVATIONS AND DISCUSSIONS:
On analysis of collected data, it has been (Table - I)
revealed that when cervical dilatation was 1cm. the minimum time taken in
delivery was 4.30 hrs. While in 4 cms dilatation and more it was only 0.40
minutes in comparison to control group where minimum time taken for
1cm.cervical dilatation was 9.15 hrs. and in 4.0 cms and more cervical
dilatation it was only 0.45 hrs. (Table - II). Regarding maximum time interval
taken in study group was in decreasing order from 1cm. cervical dilation to
3cms. Dilatation, but in 4 cms. or more dilatation it was 7.15 hrs. equivalent to 1cm
dilatation. Similarly in control group it has been noticed that maximum time
interval was in decreasing order from 1cm. cervical dilation case to 3 cms. Cervical
dilation case but in 4cms or more dilation case it was even more than that of
1cm.cervical dilation case (Table-II)
As far as average time taken in delivery in both study
and control group concerned was in decreasing order as the cervical dilatation
goes up, but the average time taken by study group cases were less in
comparison to control group cases for all type of cervical dilatation cases
(Table – I and II).
On further analysis, it has been observed that there
was acceleration of labor after the amniotomy was done and pitocin started.
This acceleration was in increasing order as the cervical dilation increases
i.e. in cases where cervical dilation was 1 cm., it was minimum 48.46% while in
4 cms. or more cervical dilatation cases it was maximum i.e. acceleration of
labor by 65 % (Table - I).
The effect of amniotomy in the acceleration process of
labor was studied by Mahindra N. Parikh, Mehru Han sotia, Rasheeda Companywala
(1927) in the group of 125 patients. Every alternate patient was studied as a
control and the rest formed the acceleration group. Amniotomy was done at and
after 2.5 cms cervical dilatation. 30 patients in control group needed no
amniotomy and 50 patients in accelerative group needed no oxytocin. The
difference in the duration of the two groups was not significant when initial
dilation was 2cms. It was significant when initial dilatation was 3cms. and
highly significant when initial dilation was 4-5cms. The rates of cervical
dilation in the two groups were highly significant when amniotomy was done at
initial dilatation of 3cms. or more.
The Policy of accelerated labor adopted in 1975 at
Friedman (1967) Philpot, Castel (1972) and O’Driscoll
(1972) were of the view that in a primigravida . Labour should be over within
12 hrs. Amniotomy and Oxytocin stimulation are accepted means to achive this.
O’Driscoll in 1969 showed that active management can ensure that every woman is
delivered with in 24 hrs. The period of 24 hrs. is arbitrarily selected as the
maximum time limits for normal labour in many of the studies, but the range
between 18-60 hrs. The optimum safe period was determined by calculation of
foetal mortality or the numbers of operations required rather than a
statistical analysis in a large group of patients and of the other studies
conducted by difference authors in different parts of the word were more or
less similar.
CONCLUSION:
From above observations and discussions the authors
reached to the conclusion that amniotomy and pitocin have helped in reducing
the time interval of labor.
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Received on 14.02.2010
Accepted on 28.02.2010
© A&V Publication all right reserved
Research J. Pharmacology and
Pharmacodynamics 2(1): Jan. –Feb. 2010: 63-65