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Background: Oxytocin infusion prior to confirmation of delay in labor is discouraged by the World Health Organization. However, evidence from the Cochrane library seems to support early amniotomy and oxytocin to reduce the rates of cesarean sections (CS)., Objectives: To investigate differences in mode of delivery among parturient receiving early versus delayed oxytocin infusion following amniotomy as a mean for augmentation of labor., Search Strategy: We searched Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials and Google Scholar databases from inception till February 2020. Selection criteria: Randomized controlled trials., Data Collection and Analysis: Data were collected using a modified Cochrane data collection form for intervention reviews. Meta-analysis was performed using the meta function in RStudio., Main Results: Five studies were included that involved 1.232 parturient. The meta-analysis did not reveal significant differences in the mode of delivery among women that were randomized to receive immediate oxytocin infusion and those that received delayed oxytocin infusion (operative vaginal delivery OR 1.14, 95% CI 0.48, 2.69) and CS OR 0.81, 95% CI 0.53, 1.25)). The interval from amniotomy to delivery was significantly smaller in the immediate oxytocin infusion group; however, prediction intervals were not significant., Conclusions: The results of our meta-analysis suggest that there is no difference in the mode of delivery and interval from amniotomy to delivery when oxytocin is delayed for at least one hour following amniotomy. Taking in mind this information as well as current recommendations drawn from the WHO physicians should consider withholding oxytocin infusion at least until protracted labor is confirmed.

Objective: To determine whether artificial rupture of membranes (AROM) during active phase of labor augments uterine contractility using Electrical Uterine Myography (EUM)., Study Design: A prospective study of 31 women with term singleton pregnancy during active phase of labor. Using a non-invasive EUM technique, electrical uterine activity was recorded in the 30 min preceding AROM and in the immediate 30 min thereafter. Augmentation was defined as >5% increase in EUM index between the basal and post-AROM states, representing the mean EUM increase of the entire cohort. Low basal uterine contraction was defined as EUM index of less than the entire cohort median result prior AROM (3.5 micro-Watt-Second (mWS))., Results: Mean dilatation in which AROM was preformed was 5.5 ± 1.8 cm. There was a significant increase in mean EUM measurement in the post-AROM compared to the basal state (3.59 ± 0.39 versus 3.42 ± 0.47 mWS, p < 0.001). In multivariate analysis, low BMI and low basal uterine contractions were the only significant predictors for augmentation following AROM (OR 0.69, 95% C.I 0.45-0.97, p = 0.009 and OR 16.03, 95% CI 1.90-134.69, p = 0.003, respectively)., Conclusion: Myometrial electrical activity was significantly enhanced following AROM. Augmentation was mostly pronounced in patients with lower BMI and initial lower basal uterine contraction.

Unlabelled: More than 50 percent of preterm neonates below 28 gestational weeks in our institution are delivered by cesarean section (CS)., Aim: To present advantages of less used method of delivery of premature and/or very low birth weight (VLBW) neonates by Amnion Protective Cesarean Section (APCS) when indicated and to review our experience with the method. It can be used in all deliveries by CS with unruptured amniotic membranes, at all gestational ages., Materials and Methods: Including criteria were singleton pregnancies, gestation of 26 to 35 weeks and birth body weight between 700 to 1500 g. According to the criteria, during the studied period 10 neonates were delivered by APCS. We compared the outcomes of APCS neonates with ones delivered by coventional CS who matched them in mentioned criteria., Results: Compared to CS cases, APCS neonates had statistically significant better first minute AS. Stay in NICU was shorter for APCS neonates but not statistically significant. From our experience APCS neonates had clinically better appearance (less bruises and hematomas)., Conclusion: APCS is promising method for delivery of preterm and/or VLBW neonates when indicated, although prospective studies are needed in order to prove its effectiveness compared to conventional CS.

Amniotomy has become a routine part of obstetrical care. It was added along with other procedures adopted 50+ years ago without strong evidence. The scientific data supporting this procedure is poor while there is data suggesting it may increase the frequency of cord prolapse, neonatal GBS infection, pain and fetal blood loss if placental blood vessels are punctured. The incidence of cord prolapse overall reported in the literature ranges from 0% to 0.7%. The rate at which cord prolapse immediately follows amniotomy has not been directly studied but is reported in 4 case controlled studies.

Objective: To evaluate the impact of early vs. late amniotomy on delivery mode in women undergoing induction of labor., Study Design: 143 women admitted for induction were randomized to early amniotomy (EA, concomitant with the beginning of oxytocin infusion; n = 71) or to late amniotomy (LA, four hours after the beginning of oxytocin; n = 72). Randomization was stratified by parity. The primary outcome was the rate of cesarean. Secondary outcomes were duration of labor and intrapartum fever., Results: The cesarean rate was similar between groups (18% vs. 17% among nulliparous; and 3% vs. 0% among parous women, in EA and LA group, respectively). However, EA was associated with shorter oxytocin-to-delivery interval (12 vs. 15 h) and a non-significant decrease in intrapartum fever (3% vs. 25%) than LA in nulliparous women (p = 0.05)., Conclusion: For women undergoing oxytocin induction, early amniotomy is associated with shorter labor in nulliparous women with no effect on the risk of cesarean section in both nulliparous and multiparous women.

Objective: The purpose of this study was to evaluate the role of transabdominal amnioinfusion in the management of oligohydramnios with the view to improving pregnancy outcome., Methods: The study consisted of a retrospective analysis of 17 pregnant women presenting with oligohydramnios who were treated with amnioinfusion during pregnancy in a period from 2003 to 2006., Results: The mean gestational age at first treatment was 24 weeks. The mean pre-procedure deepest pool of amniotic fluid was 1.8 cm and post-procedure was 3.8 cm. The mean number of infusions was 1.05. The mean first infusion to delivery interval was 31 days. Perinatal mortality was 88% and neonatal mortality was 35%, with only one baby surviving the neonatal period. There were three cases of chorioamnionitis, with one of these cases presenting with premature rupture of the membranes at the time of amnioinfusion., Conclusions: Transabdominal amnioinfusion is a useful procedure to reduce complications that result from oligohydramnios. Although the results show a high perinatal mortality, it must be borne in mind that most of these pregnancies had multiple fetal abnormalities with an already predicted poor outcome. Importantly, as this procedure increases the latency period, it may be useful in preterm pregnancies where prolonging the duration of the pregnancy may result in better perinatal outcome by improving important factors that influence survival including increased birthweight.

Purpose: To evaluate the potential usefulness of a freeze-dried (lyophilized) amniotic membrane transplantation with mitomycin C (MMC) in the maintenance of functioning glaucoma surgery in cases of pediatric glaucoma., Methods: Thirty eyes of pediatric patients with glaucoma were included in this study. Trabeculectomy with amniotic membrane implantation and MMC was done in group 1 (15 eyes), and trabeculectomy with MMC only was done in group 2 (15 eyes). The preserved amniotic membrane was placed over the scleral flap and under the conjunctiva. The mean intraocular pressure (IOP) was measured pre- and postoperatively and bleb appearance was noted. The follow-up time was 18 months after surgery., Results: The mean postoperative IOP was significantly decreased to 15 +/- 1 mm Hg and 17.2 +/- 2.9 mm Hg in the 2 groups, respectively. The bleb was functioning well in the follow-up period in most of the cases, except 5 cases that needed another surgery. Complications such as inflammation, choroidal detachment, or toxic keratopathy were not noted in group 1 but were noted in group 2., Conclusion: Trabeculectomy with amniotic membrane transplantation and MMC can effectively control the elevated IOP in pediatric patients with glaucoma without significant postoperative complications.

This randomised controlled trial of routine amniotomy was carried out in a developing country setting to investigate the effect of this common procedure on the duration of labour, intra-partum interventions and selected newborn and maternal outcomes. In a Jerusalem teaching hospital, 533 multiparous and 157 nulliparous low-risk women were randomised to either amniotomy or intent to conserve membranes. For multiparae, the median duration from randomisation to full dilatation was 95 and 160 min, respectively in the intervention and control arms (p < 0.001); for nulliparae it was 210 and 270 min, respectively (p < 0.001). In both groups, oxytocin was used less in the intervention arms (p < 0.001), and no difference in mode of delivery and immediate outcomes was detected. However, given the risks of this intervention and these study findings indicating an overall short duration of childbirth, amniotomy should be limited to cases of abnormal progress of labour.

The objective of this study is to determine the effect of amniotomy on the outcome of spontaneous labour in uncomplicated pregnancy. A prospective randomised study of low-risk parous women with spontaneous onset of labour at term with singleton fetus in cephalic presentation and intact amniotic membranes and a cervical dilatation between 4 and 5 cm were randomly assigned to have amniotomy (Case) or no amniotomy (Control) during the course of labour. Maternal demographics, labour-delivery data and newborn outcome were compared. A total of 128 women were studied. The duration of labour was significantly shorter in the amniotomy group than the control group (208 vs 292 min; p < 0.05) with the only difference being in the first stage of labour. There was however no difference on the oxytocin requirement for labour augmentation, caesarean section rate, incidence of suspected fetal distress or instrumental delivery in both groups. Newborn outcome measured by Apgar scores at 1 and 5 min showed no significant difference. In conclusion, amniotomy significantly reduced the duration of the first stage of labour without affecting the oxytocin requirement, the rate of caesarean section and newborn outcome.

Prostaglandin E2 was administered orally in doses of 0.5 mg. to 2.0 mg. every 2 hours to 169 women for induction of labour. Induction was successful in 153 women (90%). In 99 of these women, low amniotomy was performed at the beginning. Performance of amniotomy at the beginning of induction did not alter the incidence of successful induction but did lead to a mean induction-delivery interval shorter than that in women who had amniotomy performed in the active phase of labour. Vomiting and/or diarrhoea occurred in 34 women (20%). Uterine hypertonus of only transient nature occurred in 3 women. One woman suffered from atonic post-partum haemorrhage. No adverse effects on the fetus were apparent. The presence of fetopelvic disproportion was associated with a slow rate of cervical dilatation and unsuccessful induction.

A randomised controlled trial was carried out in 50 primigravidae and 50 multigravidae to compare the effectiveness in induction of labour after low amniotomy of prostaglandin E2, given as an oral solution, and oxytocin, given as buccal tablets. The results showed that in dosages recommended by the manufacturers, both oxytocic preparations were almost equally effective. With oral oxytocin, once labour had been established and dosage was left to the discretion of the staff, there appeared to be a potentially dangerous tendency to continue giving large doses despite adequate uterine contractions. The authors comment that this was probably the reason why oxytocin-treated multigravidae having normal deliveries within 24 hours had labours significantly shorter on average than those of other successfully induced patients.