Objective: To compare the frequency of abnormal fetal heart rate in continuous versus discontinuous use of oxytocin infusion for augmentation of labour. Study Design: Comparative cross sectional study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Combined Military Hospital Lahore, from Feb to Aug 2018. Methodology: After fulfilling the inclusion criteria, 76 patients were equally divided in two groups A and B. In both groups, at 3 cm dilatation, intravenous infusion of 5 IU oxytocin in 500 cc normal saline was initiated at infusion rate 3.3mIU/minute Carditocography was initiated 10 minutes before infusion and then continued. An increment in infusion of 3.3mIU/minute was done every 20 minutes till 4 to 5 contractions in 10 minutes were achieved. After this, no more increment was done. The maximum rate was 30mIU/minute. Once cervix was 5 cm dilated, infusion was continued in group A and discontinued in group B for 2 hours. Fetal heart rate was noted on cardiotocography from 20 minutes before initiation of infusion till 2 hours after 5cm. Results: Age of the patients was 25.4 ± 3.5 years in group A and 26.1 ± 2.4 years in group B. Mean gestation age was 39.2 ± 1.1 weeks in group A and 38.6 ± 1.3 weeks in group B. Group A had significantly more abnormal fetal heart rate compared to group B (p=0.016). Conclusion: Discontinuous oxytocin infusion in labour showed significantly less abnormal fetal heart rate compared to continuous oxytocin infusion (p=0.016).
Aim: To investigate the reference values of Doppler indices for umbilical artery and Middle Cerebral Artery as well as Cerebro-placental Ratio and specifically, to evaluate the quality of methodology used on which these reference values are grounded, with the help of already established quality standards for research design, statistical analysis as well as methods of results reporting. Methodology: The methodological quality of the full-text versions of eligible studies was assessed independently by the same reviewers and a medical statistician (E.S.U.). Disagreements were resolved by consensus or consultation with two other reviewers (A.T.P. and E.F.). Quality criteria for evaluation methodologies of the published articles was developed which was based on the already available research publication25,36,37. The methodology evaluation criteria was segregated into two levels, one is study design and the other one is statistics used as well as its reporting methods. Total no. of criteria of quality were 24 to be evaluated. Results: Generally, methodological quality score was parallel for the research articles designed to evaluate umbilical artery range (median 42%; range 13.8–63.8%). For the studies focusing on middle cerebral artery range showed a median of 48% with a Class interval of 22.1–72.1% whereas the median score of cerebroplacental ratio was 47.1% with a Class interval of 34.6–55.5%. Conclusion: Rigorous methodology of this review study is the major strength, which is consisted of a standard and well developed methodology of scoring the quality of studies according to their methodology selection as well as the statistical analysis and the level of its interpretation. Keywords: Umbilical artery, Middle Cerebral Artery, Cerebro-placental Ratio, Doppler indices
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