Post on 30-May-2018
transcript
8/9/2019 Journal Reading Fm Dna
1/20
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
8/9/2019 Journal Reading Fm Dna
2/20
Induction
And
Augmentation
8/9/2019 Journal Reading Fm Dna
3/20
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
8/9/2019 Journal Reading Fm Dna
4/20
The Dutch Society of Obstetrics and Gynecology
recommends the use of internal tocodynamometry
in all cases of induction and augmentation of labor
8/9/2019 Journal Reading Fm Dna
5/20
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
8/9/2019 Journal Reading Fm Dna
6/20
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
8/9/2019 Journal Reading Fm Dna
7/20
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
8/9/2019 Journal Reading Fm Dna
8/20
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.
8/9/2019 Journal Reading Fm Dna
9/20
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
8/9/2019 Journal Reading Fm Dna
10/20
8/9/2019 Journal Reading Fm Dna
11/20
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
8/9/2019 Journal Reading Fm Dna
12/20
8/9/2019 Journal Reading Fm Dna
13/20
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)
8/9/2019 Journal Reading Fm Dna
14/20
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
8/9/2019 Journal Reading Fm Dna
15/20
RESULTS
8/9/2019 Journal Reading Fm Dna
16/20
8/9/2019 Journal Reading Fm Dna
17/20
8/9/2019 Journal Reading Fm Dna
18/20
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;
8/9/2019 Journal Reading Fm Dna
19/20
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
8/9/2019 Journal Reading Fm Dna
20/20
THANK YOU