Journal Reading Fm Dna

8/9/2019 Journal Reading Fm Dna

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Journal Reading FM

OUTCOMES AFTER INTERNAL VERSUS EXTERNAL

TOCODYNAMOMETRY FOR MONITORING LABOR

PERBANDINGAN LUARAN IBU DAN BAYI ANTARA

TOKODINAMOMETRI INTERNAL DAN EKSTERNAL UNTUK

PENGAWASAN PERSALINAN

Oleh :Dona Wirniaty

Pembimbing :

Dr. Johny Marpaung, Sp.OG

DEPARTEMEN OBSTETRI DAN GINEKOLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS SUMATERA UTARA

RSUP. H. ADAM MALIK, MEDAN

2010


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Induction

And

Augmentation


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American College of Obstetrician and Gynecologists (ACOG)

and

Society of Obstetrician and Gynecologist of Canada (SOGC)

The use of internal tocodynamometry in selected

circumstances

the mother is obese;

one on one nursing care is not available;

the response to oxytocin is limited


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The Dutch Society of Obstetrics and Gynecology

recommends the use of internal tocodynamometry

in all cases of induction and augmentation of labor


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Internal Tocodynamometry

Improve both maternal and fetal outcomes

allowing better adjusment of oxytocin;

preventing uterine hyperstimulation and fetal

hypoxia;

improving the interpretation of abnormal fetal

heart rate patterns in relation to uterine activity


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Three small randomized clinical trial that compared

internal tocodynamometry ith external monitoring

ith respect to the clinical outcome

None of these studies sho ed a significant reduction in

the rate of operative delivery or a significant improvement

in neonatal outcomes ith internal as compared ith

external monitoring


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STUDY DESIGN The trial as conducted in six hospitals in the Netherlands;

The study protocol as approved by the medical ethics committee;

Women ith singleton pregnancy;

Gestational age of more than 36 eeks;

Fetus in the cephalic position;

Induction or augmentation of labor ith intravenous oxytocin;

No uterine scar;

Negative results on serologic tests for HIV or hepatitis B virus;

No signs of an intrauterine infection;

No signs of fetal distress


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OBSTETRICAL MANAGEMENT

If the attending obstetrician or mid ife judged that contraction

ere insufficient labor as induced ith amniotomy;

1 hour after amniotomy oxytocin as administered;

In cases of arrest of spontaneous labor (defined as failure of

cervical dilatation to progress for at least 2 hours) intravenous

oxytocin as used for augmentation;

Oxytocin as continuously infused through a syringe pump at an

initial dose of 3,3 mU per minute increased every 30 minutes

until three or four contraction occured ithin 10 minute period, up

to maximal infusion rate of 33,3 mU per minute.


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SUBJECTS

Internal tocodynamometry

group

A sensor-tipped intrauterine

Catheter system (Koala,

Clinical Innovations)

as used

External tocodynamometry

group

External tocodynamometer

(He lett-Packard, Philips

Medical Systems)

as used


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Oxytocin administered

Adequate progression

Softening and effacement of the cervix

and dilatation of at least 1 cm per hour

In the external monitoring group intrauterine pressure

catheter administered if cervical progression as absent

for 2 hours, insufficient contraction or considered

caesarean section


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STUDY OUTCOMES

PRIMARY OUTCOMES

Cesarean section or instrumented vaginal delivery

SECONDARY OUTCOMES

Complications from use of the intrauterine pressure

catheter (abruptio placentae, antepartum hemorrhage,

fetal-vessel damage, uterine rupture, or sepsis)


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STUDY OUTCOMES

ADVERSE NEONATAL OUTCOMES

A 5 minute APGAR score belo 7

An umbilical artery pH belo 7.05

Neonatal admission longer than 48 hours


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RESULTS


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DISCUSSION

No significant difference in rates of operative delivery

bet een internal tocodynamometry and external

monitoring of uterine contractions;

No significant difference bet een the t o types of

monitoring in the rates of adverse neonatal outcomes,

rates of use of analgesia or antibiotics, or time to

delivery;


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CONCLUSION

The results of this trial do not support the

routine use of internal tocodynamometry

for monitoring contractions in

omen ith induced or augmented labor


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THANK YOU

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Journal Reading Fm Dna