الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Background: Induction of labor (IOL) refers to the process of artificially initiating uterine contractions, prior to their spontaneous onset, with the intention to the effect progressive effacement and dilatation of the cervix and, ultimately, delivery of a baby. Common reasons for induction include: Post-term pregnancy, i.e. if the pregnancy has gone past the 42 weeks gestation, intrauterine fetal growth restriction (IUGR), when there are health risks to the woman in continuing the pregnancy (e.g. she has pre-eclampsia), premature rupture of the membranes (PROM); this is when the membranes have ruptured, but labor does not start within a specific time, scheduling concerns fetal death in utero, twin pregnancy continuing beyond 38 weeks. An induction is most likely to result in successful vaginal delivery when a woman is close to or in the early stages of labor. of the cervix, dilatation and increasing frequency or intensity of contractions. The success of amniotomy is dependent upon the state of the cervix (dilatation and effacement), the parity of the woman and the station of the presenting part at the time of intervention. Amniotomy, with the commencement of an early oxytocin infusion (commonly within 2-6 hours if prostaglandins have been used for cervical ripening), produces a significant reduction in the number of women remaining undelivered at 24 hours compared with those managed expectantly.
Objectives: The aim of this study was to compared between the effect of amniotomy followed by immediate oxytocin infusion (immediate group) versus amniotomy and delayed oxytocin infusion 4 hours lag (delayed group), for induction of labor in term primigravidae.
Patients and methods: This randomized control study was carried out in Obstetrics and Gynecology Department, Zagazig University Hospitals. One hundred and twelve (112) pregnant women were included in this study, assessing the effect of amniotomy followed by immediate oxytocin infusion (immediate group) versus amniotomy and delayed oxytocin infusion 4 hours lag (delayed group), for induction of labor in term primigravidae (37-42 weeks). Pregnant women included in this study were randomized into two equal groups, each group comprised fifty six pregnant women: In group I, 56 women had amniotomy and immediate oxytocin infusion once Bishop score > 6. In group II, 56 women had amniotomy and delayed oxytocin infusion (4 hours lag) once Bishop score > 6.
Results: There was a non-significant difference between subjects of the two groups concerning age, gestational age and past medical history. The amniotomy-to-active phase and amniotomy-to-delivery intervals were significantly longer in women of delayed group when compared to women of immediate group. However, there were no significant differences between both groups concerning the oxytocin-to-active phase, oxytocin-to-delivery and active phase-to-delivery intervals.
Conclusion: Induction of labor by amniotomy and immediate oxytocin infusion shortened both amniotomy to active phase interval and amniotomy to delivery interval with more maternal satisfaction. It was not associated with increased adverse neonatal outcomes. Immediate oxytocin infusion together with amniotomy is preferable to delayed oxytocin infusion. The results of the current study needs to be replicated in a larger, multicentric, randomised- controlled trial with a larger sample size. Another study on multigravid women need to be performed.