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F Goffinet

Publications and source records attributed to F Goffinet.

At least 55 records · Page 3Linked to original sources
PubMed1999

Pregnancy rates after in-vitro fertilization in cases of tubal infertility with and without hydrosalpinx: a meta-analysis of published comparative studies.

This meta-analysis was intended to evaluate differences in pregnancy rates after in-vitro fertilization (IVF) in tubal fertility with and without hydrosalpinx. It examined nine published retrospective comparative series and five series published as abstracts for which additional information was obtained. In all, these studies involved 5592 patients (1004 with hydrosalpinx and 4588 with tubal infertility without hydrosalpinx). The main outcome measures were rates of pregnancy, implantation, live delivery, and early pregnancy loss. Pregnancy rates were significantly lower in the presence of hydrosalpinx: 31.2% for the tubal sterility group without hydrosalpinx and 19.7% for the group with hydrosalpinx (odds ratio: 0.64; 95% confidence interval: 0.56, 0.74). Similarly, the implantation rate and the delivery rate per transfer in the hydrosalpinx group were only slightly more than half those of the non-hydrosalpinx group (implantation: 8.5 and 13.7%, respectively; delivery: 13.4 and 23.4%). The incidence of early pregnancy loss was also higher in the hydrosalpinx group (43.7%) than in the control group (31.1%). This meta-analysis makes it clear that hydrosalpinx present during IVF-embryo transfer has negative consequences on the rates of pregnancy, implantation, live delivery, and early pregnancy loss. It would be premature, nonetheless, to conclude that routine salpingectomy should be performed on all patients with hydrosalpinx.

Body Fluids↗
PubMed1999

Newborn shoulder width: a prospective study of 2222 consecutive measurements.

OBJECTIVES: To relate maternal and infant characteristics to newborn shoulder width and to evaluate the predictive value of newborn shoulder width measurement in cases of shoulder dystocia. DESIGN: Newborn shoulder width was systematically measured at birth during a period of 18 months. SETTING: Department of Obstetrics and Gynaecology of Saint-Antoine University Hospital, Paris, France. POPULATION: A total of 2222 newborn shoulder width measurements were performed and 22 cases of true shoulder dystocia occurred during the study period. METHODS: Newborn shoulder width measurements were reviewed and correlated with maternal age, parity, nonpregnant weight, weight gain during pregnancy, height, race, fasting glucose and one hour glucose levels, gestational age, birthweight and sex of the neonate. A receiver-operating characteristics curve was constructed to evaluate newborn shoulder width as a test for predicting shoulder dystocia. RESULTS: The mean newborn shoulder width was 122.06 mm (10.50 SD). Stepwise multiple regression showed that newborn shoulder width was significantly associated with birthweight (P < 0.001), parity (P = 0.04), and nonpregnant weight (P = 0.04). We estimated that the best cut off for shoulder dystocia prediction was a newborn shoulder width measurement with a low false positive rate (< 10%) in association with a high sensitivity rate. Therefore, newborn shoulder width measurement > or = 140 mm was selected. This measurement should have a low sensitivity of 27.27%, a specificity of 91.82%, a positive predictive value of 4.02%, and a negative predictive value of 99.01% for shoulder dystocia prediction. Nevertheless, birthweight > or = 4000 g should have a better predictive value retrospectively for shoulder dystocia. CONCLUSIONS: Newborn shoulder width measurement, which is strongly correlated with birthweight, still remains a poor predictor for shoulder dystocia, even when this evaluation is correct antenatally.

Adult↗
PubMed1999

[Clinical importance of fetal pulse oximetry. I. Methodological evaluation. Multicenter study. French Study Group on Oximetry of Fetal Pulse].

OBJECTIVE: To evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relation with the neonatal outcome in a population with an abnormal fetal heart rate (FHR). STUDY DESIGN: A prospective multicenter observational study, from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded using a Nellcor N-400 fetal pulse oximeter in case of abnormal FHR during labor. Simultaneous readings of fetal oxygen saturation and of fetal blood analysis (FBA) were obtained at inclusion and before birth. Feasibility, adverse effects, distribution of fetal oxygen saturation values and relation with neonatal outcome were assessed. RESULTS: 74 patients were included. From 172 attempted sensor placements, the procedure was impossible in three cases and fetal oxygen saturation values were obtained in 164 cases (95.3%). Physicians considered sensor placement an easier task than FBA attempt (easy in 87.5% vs 78.9% for FBA, p = 0.03). The mean reliable signal time (+/- SD) was 64.7 +/- 32% during the first stage. There were no serious adverse effects in the study population. The mean fetal oxygen saturation during the first stage of labor was 42.2 +/- 8.0% (10th-90th centile range: 30-53%). Fetal oxygen saturation was significantly correlated with scalp pH (r = 0.29; p = 0.01) but not with neonatal umbilical artery pH or gas values. There was a significant association between a low fetal oxygen saturation (< 30%) and a poor neonatal condition. CONCLUSION: The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.

Adult↗
PubMed1999

[Clinical importance of fetal pulse oximetry. II. Comparative predictive values of oximetry and scalp pH. Multicenter study].

OBJECTIVE: To compare the predictive value of intrapartum fetal pulse oximetry to that of fetal blood analysis for an abnormal neonatal outcome in case of abnormal fetal heart rate (FHR). STUDY DESIGN: A prospective multicenter observational study, from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded using a Nellcor N-400 fetal pulse oximeter in case of abnormal FHR during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis obtained before birth, i.e. either at full dilatation, or before cesarean section when indicated, were compared with the neonatal status. The criteria for an abnormal neonatal outcome were 1) an umbilical arterial blood pH < or = 7.15 and 2) a combined variable including: 5 min. Apgar score < or = 7, umbilical arterial pH < or = 7.15, secondary respiratory distress, transfer in a neonatal care unit, or neonatal death. RESULTS: At a 7.20 threshold for fetal scalp pH, and 30% for fetal oxygen saturation (i.e. the tenth centile in the study population), the predictive value of fetal pulse oximetry was similar to that of fetal blood analysis for an arterial umbilical pH < or = 7.15, and for an abnormal neonatal outcome (positive predictive value 56% vs 55%, negative predictive value 81% vs 82%, sensitivity 29% vs 35%, and specificity 93% vs 91% respectively). The receiver operating curve showed similar performance of either technique for cut-off values < or = 7.20 for fetal blood pH and < or = 30% for fetal oxygen saturation, whereas fetal pulse oximetry became superior at higher thresholds. CONCLUSION: The predictive value of intrapartum fetal pulse oximetry can be favorably compared with that of fetal blood analysis. Randomized controlled management trials can now be performed to assess potential clinical benefits of this new tool.

Female↗
PubMed1999

[Comparison of the Bishop score, of sonographic measurement of the cervical length and fibronectin determination in predicting time to delivery and the type of delivery at term].

Our aim was to compare the Bishop score, FNf assays, and the sonographic measurement of cervical length, in order to assess the best marker for time until spontaneous labor at term and risk of cesarean, especially for lack of progress of dilatation. This prospective study included 128 singleton vertex pregnancies with no clinical evidence of membrane rupture or regular contractions and a prenatal consultation between 39 weeks 4 days and 40 weeks 3 days. We successively assayed FNf, determine the Bishop scored, and measured cervical length by transvaginal ultrasound. The end points were the percentage of patients with a spontaneous onset of labor in the week following these tests and the type of delivery. The spontaneous onset of labor within a 7-day period was closely associated with a Bishop score > or = 6 and especially with a cervical length < or = 26 mm, but not with a positive FNf assay. On the other hand, vaginal delivery was significantly associated with the fibronectin assay but not with either the Bishop score or cervical length. Ultrasound measurement of cervical length and the fetal fibronectin assay provide different physiological data useful for different purposes: cervical length is more valuable than the Bishop score for predicting the onset of spontaneous labor within 7 days (when these assessments are performed close to term) and the FNf assay is very useful for evaluating the risk of cesarean.

Adult↗
PubMed1999

[National survey on the use of induced labor by obstetricians. Study Group on Induced Labor].

INTRODUCTION: A strong rise in the use of induced labor has been observed in France. The aim of this work was to analyze the different methods used for achieving induction of labor and their implications. METHODS: One out of four French obstetricians were randomly selected to answer a questionnaire on their practice for achieving induction of labor. Four hundred of the 997 obstetricians answered the questionnaire. Univariate and multivariate analysis was applied. RESULTS: A high rate of induced labor was correlated with some areas of the country and with private practice. Certain methods were used in spite of opposing advice by experts in the field: elective induction of labor with unfavorable cervix, use of prostaglandins in elective induction of labor, induction of labor in cases of scarred uterus or breech presentation, use of misoprostol. Some methods were still used in spite of their poor efficacy: intravenous oxytocin used with unfavorable cervix, use of intravensou PGE2. CONCLUSION: This study would show that theory and practice are often distinctly different. Induction of labor is currently used on a far wider scale than ever before. We obviously need studies for careful assessment of the circumstances in which induction of labor is used in order to improve methods and indications of such a clinical practice.

Analysis of Variance↗
PubMed1998

Treating ectopic pregnancy with the combination of mifepristone and methotrexate: a phase II nonrandomized study.

OBJECTIVE: Our goal was to compare the use of a combination of methotrexate and mifepristone with methotrexate alone in the medical management of ectopic pregnancy. STUDY DESIGN: This was a preliminary nonrandomized phase II study. All patients with progressing ectopic pregnancy meeting criteria for medical management were included. Treatment consisted of 50 mg/m2 of methotrexate injected intramuscularly and 600 mg of mifepristone, administered orally, compared with a previous group who received only 50 mg/m2 of methotrexate injected intramuscularly. RESULTS: Of the 30 patients treated with the combination, there was only 1 failure, whereas medical treatment had failed for 11 of 42 patients treated with methotrexate alone. CONCLUSIONS: The combination of mifepristone and methotrexate decreased the risk of failure in medical treatment of ectopic pregnancy.

Abortifacient Agents, Steroidal↗
PubMed1998

[Stripping membranes at term. Review of randomized trials].

Stripping the membranes at term is a method for inducing labor. This method is currently performed but not well analyzed. Most trials were published after 1990 and the half of them since 1996. Seven of the nine randomized trials recently published showed the efficacity of stripping of the membranes performed between 38 and 42 weeks. It seems to become more efficient after 40 weeks. In these trials, increased of maternal (cesarean section rate, chorioamniotitis, premature rupture of membranes) or neonatal morbidity cannot be found. However, in these trials included populations are not enough large to conclude. Given the absence of large studies, it seems unjustified to repeat this intervention.

Female↗
PubMed1998

[Limits of ambulatory medical treatment of ectopic pregnancies by intramuscular methotrexate: prospective study on 54 patients].

OBJECTIVE: To evaluate the limits of ambulatory treatment of ectopic pregnancy with an intramuscular injection of 50 mg/m2 methotrexate. METHOD: Non randomised prospective study from october 1993 and april 1996 at Poissy Hospital. 100 ectopic pregnancies were diagnosed: 54 were treated medically and 46 had a surgical treatment. RESULTS: The mean hCG for the ectopic pregnancies treated medically was 7,273 Ul/ml +/- 12,548 (90-68,220), an ectopic mass was seen in 74% and to precise the diagnosis a currettage was done in 24 cases (44%) if the initial hCG was below 2,000 Ul/ml. The medical treatment was a success for 37 (68.5%) ectopic pregnancies with a mean time of resolution of hCG of 31.9 days +/- 18 (4-90) (with a positive correlation between initial hCG titer and time to resolution of 0.5, p = 0.001). For 15 (27%) patients a second dose of methotrexate was necessary with a 73% success rate and 17 (32%) patients were operated (8 salpingectomies). Sixteen of 20 (80%) demonstrated tubal patency at follow-up hysterosalpingogram and within 7.5 +/- 4 months 26 of 30 (87%) conceived and there was no recurrence of ectopic pregnancy. CONCLUSIONS: The medical treatment of ectopic pregnancies with methotrexate has its limits. In our series, if we treat ectopic pregnancies without cardiac activity, with a mass below 35 mm and a hCG below 10,000 Ul/ml the success rate is 81%.

Adult↗
PubMed1998

[Anatomical study of Cooper's ligament. Value in the surgical cure of urinary incontinence in women].

The objective of the study was to measure Cooper's ligament thickness in the middle and at 1, 2, 3, 4 cm and to find the best place to fix the stitches of colposuspension. This study was performed on fresh cadavers. Sixteen Cooper's ligaments were studied (8 women, mean age 78 +/- 6 years). The length, the width and thickness of Cooper's ligament at 0, 1, 2, 3, 4 cm from the middle were measured. The limits of Cooper's ligament are indefinite. This ligament is significantly thicker (p < 0.01) in the middle and at 4 cm from the middle (2.2 +/- 0.4 mm) than 1 cm (1.4 +/- 0.5), 2 cm (1.4 +/- 0.5 mm) and at 3 cm (1.9 +/- 0.3 mm) from the middle. Cooper's ligament is used to fix the stitches for colposuspension derived from Burch colposuspension (non-incision percutaneous colposuspension to Cooper's ligament, laparoscopic colposuspension...) and sometime help to fix meshes in frondes procedures and the vagina in the Bologna procedure. This study showed the best point to fix the stitches (by its thickness) for colposuspension on this ligament at 4 cm from the middle (the fixation at the origin exposing to periostitis).

Aged↗
PubMed1997

Multicenter study on the clinical value of fetal pulse oximetry. I. Methodologic evaluation. The French Study Group on Fetal Pulse Oximetry.

OBJECTIVE: Our purpose was to evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relationship with the neonatal outcome in a population with an abnormal fetal heart rate. STUDY DESIGN: A prospective multicenter observational study was performed from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with use of a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis were obtained at inclusion and before birth. Feasibility, adverse effects, distribution of fetal oxygen saturation values, and relationship with neonatal outcome were assessed. RESULTS: One hundred seventy-four patients were included. From 172 attempted sensor placements, the procedure was impossible in three cases and fetal oxygen saturation values were obtained in 164 cases (95.3%). Physicians considered sensor placement an easier task than an attempt at fetal blood analysis (easy in 87.5% vs 78.9% for fetal blood analysis, p = 0.03). The mean reliable signal time (+/- SD) was 64.7% +/- 32% during the first stage. There were no serious adverse effects in the study population. The mean fetal oxygen saturation during the first stage of labor was 42.2% +/- 8.0% (10th to 90th percentile range 30% to 53%). Fetal oxygen saturation was significantly correlated with scalp pH (r = 0.29, p = 0.01) but not with neonatal umbilical artery pH or gas values. There was a significant association between low fetal oxygen saturation (< 30%) and poor neonatal condition. CONCLUSION: The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.

Adult↗
PubMed1997

Multicenter study on the clinical value of fetal pulse oximetry. II. Compared predictive values of pulse oximetry and fetal blood analysis. The French Study Group on Fetal Pulse Oximetry.

OBJECTIVE: Our purpose was to compare the predictive value of intrapartum fetal pulse oximetry with that of fetal blood analysis for an abnormal neonatal outcome in case of an abnormal fetal heart rate. STUDY DESIGN: A prospective multicenter observational study was conducted from June 1994 to November 1995. Fetal oxygen saturation was continuously recorded with a Nellcor N-400 fetal pulse oximeter in case of an abnormal fetal heart rate during labor. Simultaneous readings of fetal oxygen saturation and fetal blood analysis obtained before birth (i.e., either at full dilatation or before cesarean section when indicated) were compared with the neonatal status. The criteria for an abnormal neonatal outcome were (1) an umbilical arterial blood pH < or = 7.15 and (2) a combined variable including 5-minute Apgar score < or = 7, umbilical arterial pH < or = 7.15, secondary respiratory distress, transfer in a neonatal care unit, or neonatal death. RESULTS: At a 7.20 threshold for fetal scalp pH and 30% for fetal oxygen saturation (i.e., the 10th percentile in the study population), the predictive value of fetal pulse oximetry was similar to that of fetal blood analysis for an arterial umbilical pH < or = 7.15 and for an abnormal neonatal outcome (positive predictive value 56% vs 55%, negative predictive value 81% vs 82%, sensitivity 29% vs 35%, and specificity 93% vs 91%, respectively). The receiver-operator characteristic curve showed similar performance of either technique for cutoff values < or = 7.20 for fetal blood pH and < or = 30% for fetal oxygen saturation, whereas fetal pulse oximetry became superior at higher thresholds. CONCLUSION: The predictive value of intrapartum fetal pulse oximetry can be favorably compared with that of fetal blood analysis. Randomized controlled management trials can now be performed to assess potential clinical benefits of this new tool.

Apgar Score↗
PubMed1997

Evaluating the risk of preterm delivery: a comparison of fetal fibronectin and transvaginal ultrasonographic measurement of cervical length.

OBJECTIVE: Our purpose was to compare the predictive values for preterm delivery of fetal fibronectin and cervical length measured by transvaginal ultrasonography and to determine whether performing both tests improves their separate predictive values. STUDY DESIGN: This prospective blinded study performed both tests on 76 patients hospitalized with signs of premature labor between 24 and 34 weeks of gestation. The outcome measure was delivery before 37 weeks' gestation. RESULTS: The rate of preterm bith was 26.3% (20/76). The predictive values of fetal fibronectin and of a cervical length of < or = 26 mm, considered separately, were approximately equal, and the negative predictive value of each was excellent (86.6% and 89.1%, respectively). This value improved slightly when positive fetal fibronectin, a cervical length < or = 26 mm, or both defined abnormality (negative predictive value 94.4%). The positive predictive values, although less helpful, were still useful (45.2% and 50.0%, respectively). Combining both indicators did not noticeably improve the positive predictive value (52.4%). The risk of preterm delivery for a patient with a positive fetal fibronectin level and a short cervix was high (odds ratio 13.9, 95% confidence interval 3.7 to 52.2). CONCLUSION: Fetal fibronectin and cervical length are approximately equivalent in their ability to distinguish between patients at high and low risk for preterm delivery. For physicians equipped to perform transvaginal ultrasonography, however, the additional information about the fibronectin level provides only slight benefits.

Adult↗
PubMed1997

Predictive value of Doppler umbilical artery velocimetry in a low risk population with normal fetal biometry. A prospective study of 2016 women.

OBJECTIVE: To assess the predictive value of Doppler umbilical artery velocimetry in a low-risk population with normal fetal biometry. STUDY DESIGN: Multicenter prospective study in 17 hospitals with prenatal clinics in France. Two thousand sixteen women who, before 28 weeks gestation were defined as at low risk after routine consultation and after ultrasound. Doppler umbilical artery velocimetry was performed between 28 and 34 weeks gestation. Confounding factors were used to perform multivariate regression. RESULTS: 1903 cases were analysed and 192 (10.1%) had an abnormal Doppler Resistance Index (RI). The abnormal Doppler group contained a significantly higher frequency of severe and moderate small for gestational age infants (SGA), both severe and moderate with a sensitivity of 25.5 and 18.8% respectively. There was no difference in hypertensive disorders or criteria of fetal distress. Mean birth weight was very significantly lower in the abnormal group (162 g). Birth weight was very significantly linked to RI after taking into account confounding variables in the multiple linear regression model (continuous relationship). After multiple logistic regression, the odds ratio associated with an abnormal Doppler result, adjusted for all the confounding factors, was 2.3 (95% CI 1.5-3.7) for moderate SGA and 3.5 (95% CI of 1.8-7.1) for severe SGA. CONCLUSION: Low umbilical Doppler RI is predictive with moderate or severe SGA in a low-risk population with normal fetal biometry, even when the information generally available in clinical practice and ultrasound parameters are taken into account. There is a continuous relationship between RI and birthweight. This predictive value cannot, however, lead to an improvement in neonatal health unless effective measures to prevent SGA exist and umbilical Doppler should not be used in low-risk population on a routine basis.

Birth Weight↗
PubMed1997

Fetal pulse oximetry and fetal heart rate monitoring during stage II of labour.

OBJECTIVE: This study was designed to assess the changes in fetal oxygen saturation (FSpO2) using fetal pulse oximetry when the fetal heart rate (FHR) monitoring became abnormal during stage II of labour. STUDY DESIGN: FSpO2 was recorded with the Nellcor N400 Oximeter (FS-14 sensor) and was averaged over the last 10 min of the second stage of labour. Second stage FHR patterns were assessed according to Melchior's classification. RESULTS: In terms of FHR patterns, FSpO2-10" measured 41.4% in type 0 (n = 5), 42.4% in type 1 (n = 19), 43.3% in type 2 (n = 6), 34.0% in type 3 (n = 4) and 27.6% in type 4 (n = 7) (P = 0.03). CONCLUSIONS: FSpO2-10" decreases in cases of severe FHR abnormality during the second stage of labour and could help to decide whether to perform an instrumental extraction.

Female↗
PubMed1997

Umbilical artery Doppler velocimetry in unselected and low risk pregnancies: a review of randomised controlled trials.

OBJECTIVE: Meta-analysis of data from controlled trials performed in populations at high risk have shown that umbilical artery Doppler velocimetry (umbilical Doppler) can reduce perinatal mortality. The individual published trials among unselected or low risk populations have found no beneficial effect. Our objective was to evaluate the effect of routine use of the umbilical Doppler in unselected or low risk pregnancies by reviewing all published and unpublished randomised controlled trials. STUDY DESIGN: Systematically reviewing published and unpublished trials, we selected trials for the overview only if they were completed randomised trials of umbilical Doppler in unselected or low risk pregnancies. Of the seven trials examined, three were not included in the meta-analysis because of methodological problems or because they did not meet the inclusion criteria. We therefore included four trials: two in unselected and two in low risk populations. These four groups were comparable in their degree of maternal and perinatal risk. Using the Mantel-Haenzel statistical method and pooling the data, we considered 11,375 women in the meta-analysis. RESULTS: Systematic use of the Doppler umbilical artery velocimetry had no statistically significant effect on perinatal deaths in unselected populations (odds ratio [OR] 1.28; 95% confidence interval [CI] 0.61-2.67), low risk populations (OR 0.51; 95% CI 0.20-1.29) or overall for the four trials (OR 0.90; 95% CI 0.50-1.60); nor was there any significant effect on stillbirths (global OR 0.94; 95% CI 0.42-1.98). However, the number of participants remain insufficient and further information is required to arrive at a definite conclusion on the absence of effect. The meta-analysis showed no significant difference between the Doppler groups and the control groups for antenatal hospitalisation, obstetric outcome or perinatal morbidity. CONCLUSION: Based on the results of the published trials, routine use of the umbilical Doppler cannot be recommended.

Blood Flow Velocity↗
PubMed1997

Early amniotomy increases the frequency of fetal heart rate abnormalities. Amniotomy Study Group.

OBJECTIVE: To determine whether early amniotomy, when practised as an isolated intervention, increases the hourly rate of fetal heart rate record abnormalities. DESIGN: This is a secondary analysis of the results of a multicentre randomised trial of early versus late amniotomy in labour. SETTING: Secondary and tertiary level teaching hospitals. INTERVENTION: Early amniotomy versus an attempt to conserve the amniotic membranes. MAIN OUTCOME MEASURES: The hourly rates of early, mild variable, severe variable and late decelerations; caesarean section rates. RESULTS: Severe variable decelerations, when classified as categorical events (> or = 1/h to 2/h, > or = 2/h to < 4/h, > or = 4/h), were more frequent in the amniotomy group (chi2 for trend = 5.7, P = 0.017). The mean hourly rates of severe variable and late fetal heart rate decelerations were increased in the amniotomy group (severe variable: amniotomy group 1.4/h, control 0.7/h, P = 0.021; late: amniotomy group 3.3/h, control 2.3/h, P = 0.011). Although the overall rate of caesarean was similar in the two groups (OR 1.2; 95% CI 0.8-1.8), there was an increase in caesarean section for fetal distress (OR 2.3; 95% CI 1.1-4.5) associated with amniotomy. CONCLUSION: Our data suggest that early amniotomy increases the hourly rate of severe variable fetal heart rate decelerations without evidence of an adverse effect on neonatal outcome. In settings where the diagnosis of fetal compromise is based primarily on electronic monitoring, caesarean section for fetal distress may be increased by early amniotomy.

Adult↗