Effect of Acceleration of Labour on
Mothers
Chauhan Prabha1*, Kashyap Sashikala2,
Bansal A.K.3, Mohan R. S.4, Shrivastava PK4 and Chauhan
V.K.S.4
1Dept. of Obstetrics and Gynaecology,
Govt. Medical College, Jagdalpur (Bastar)
494001
2Dept. of Pathology, Govt. Medical College, Jagdalpur (Bastar) 494001
3Prof. and HOD, Department of Community
Medicine, Govt. Medical College, Jagdalpur (Bastar) 494001
4Dept. of Community Medicine, Govt. Medical
College, Jagdalpur (Bastar)
494001
ABSTRACT:
Because of
shortening of labour, the incidence of prolonged labour, forceps delivery has been reduced considerably. In
study group, no patients required manual removal of placenta in comparison to 2
% in control group. In study group no mother required manual removal of
placenta in comparison to 2% in control group. The growing reward is obstetric
experience of patients who has no bitter hang over at all.
INTRODUCTION:
In effect of
today’s jet age both the obstetrician as well as the women in labour would like to accomplish the delivery in the
shortest possible time compatible with the safety of mother and foetus. Any measure that would hasten labour
without adding to the maternal or perinatal mortality
and morbidity are most welcome.
Labour is
that processes by which products of conception are expelled from uterus. The
mechanism of this expulsion consist of forceps that effects and dilate the
cervix and then propel the foetus through birth canal.
Amniotomy acts either by the direct stimulation of
the lower segment by the presenting part or removing the abnormal adherence of
membranes considered that amniotomy reduces the
resistance of the cervix as the shape and size of uterus is altered by the
escape of liquor. Prostaglandins present in amniotic fluid are thought to be
observed from the lower genital tract .It is also used to induce the process of
labour.
The labour is prolonged in two ways. If the amnione
is ruptured in presence of a firm long closed cervix or in myometrium
not ready for full activity, labour could be expected
to be longrt, also it has been shown that stretch myometrium has a higher membrane potential. Amniotomy would diminish the streatch,
lowering the membrane potential and thereby making the cell refractory to and
less effective management would be expected. Cervix does not dilate properly
and might become oedematous. Contraction ring may
form and patient is prone to uterine atony due to
exhaustion and nervousness, so operative interference was more common but on
the other hand after amniotomy neither there was
increase operative interference nor increase in maternal and foetal mortality and morbidity was noted.
In 1957 as per
recommendation of the study group of World Health Organization (WHO) has
expressed the view that in order to get a comprehensive picture of disease (any
health problem) more and more studies should be carried out, Garg Narendra K. By keeping in
mind this study was undertaken to know the impact of acceleration of labour effect on the health of mother.
MATERIALS AND
METHODS:
Present study
was undertaken in Deptt. of Obstetrics and Gynaecology of Gandhi Medical College, Bhopal (M.P.) in the
year 1978-79 .In this study 200 cases were included, out of these 200 cases
,100 were in study group i.e. amniotomy with Pitocin drip as per indication performed and in rest 100
cases belong to control group i.e. natural course of labour
were studied. Careful watch during third stage and puerperiun
was kept on the mother. Complications in third stage, postportam
Hemorrhage, cervical tear + puerperal and lacerations, retention of placenta
sepsis’s any were noted in both the group.
OBSERVATION AND
DISCUSSIONS:
On analysis of
the collected data it has been revealed that in 95 % of the cases in study
group no complication was noticed as compared to 88 % cases on control group.
In study group 2 % cases had postpartum haemorrhage
(P.P.H.) and (3 %) mothers had pyrexia with chills and Rigor and one case it
was due to urinary tract infection while in control group there was manual
removal of placenta in 2 % mothers, 7 % mothers had postpartum hemorrhage (5 %
had mild and 2 % had moderate P.P.H.) and 3 % mothers had pyrexia with chills.
TABLE – I: MATERNAL
COMPLICATION IN STUDY GROUP
(n = 100)
|
COMPLICATIONS |
NO. OF MOTHERS |
PERCENTAGE |
|
No
Complication |
95 |
95
% |
|
Post
Partum Haemorrhage |
02 |
2 % |
|
Pyrexia |
03 |
3 % |
|
Total |
100 |
100.00 % |
TABLE – II: MATERNAL
COMPLICATION IN CONTROL GROUP (n = 100)
|
COMPLICATIONS |
NO. OF MOTHERS |
PERCENTAGE |
|
No
Complications |
88 |
88
% |
|
Manual
Removal of Placenta |
02 |
2 % |
|
Post
Partum Haemorrhage |
07 |
7 % |
|
Pyrexia |
03 |
3 % |
|
Total |
100 |
100.00 % |
It was further
noticed that duration of 2nd stage of labour was more
prolonged in cases of control group as compared to study group. No forcep was applied for occipit
post position in study group as one forcep out of was
applied for occipi post position. In control group,
long internal rotation was occurred in most of the cases by pitocin
drip. One case of cervical dystosia and failed pitocin and one case of high floating head with foetal distress ended into a caesarian section as compared
to control group in which two cases had caesarian section because of foetal distress. By this observation it was concluded that
active management of labour, there was no ill effect
on 2nd stage of labour. As far as 3rd stage of labour was concerned, neither the duration nor Blood loss
was increased. In study group only 2 % mother have post partum Haemorrhage (PPH) which was mild in nature in comparisons 7
% mothers have PPH in control group out of this 7 %, 5 % had mild and 2 %
moderate PPH. Thus authors reached to the conclusion that in 3rd stage Blood
loss was minimum in the study group as compared to
control group. The Author further noted that in study group cervix was intact
after delivery.1 % of the mother had cervical tear at 3 0 clock and 9 0 clock
position of about 2” in depth, while in study there was no such cases. Stitched
with catgut, cow mid cavity forceps was applied in this case and probably the
cervical tear was due to instrumentation, Same happened in one case in control
series in which cervical tear was at 3 0 clock position about half inch in
depth, stitched with catgut and the tear extended from vagina. In one case of
control group there was second degree perineal tear
in spite of episiotomy which was given for applying perineal
forceps and this may be due to the rigid perineum.
Therefore, it can be concluded that, there was no increased
chances of cervical tear with active management of labour.
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Received on 30.08.2010
Accepted on 20.09.2010
© A &V Publication all right reserved
Research
J. Science and Tech. 2(5): Sept –Oct.
2010: 108-109