- Early amniotomy during induction of labor (IOL) speeds time to delivery without increasing perinatal morbidity.
Why this matters
- 25.7% of all deliveries in 2017 were induced.
- The incidence of inductions may increase because of studies demonstrating the safety of IOL after 39 weeks.
- There is debate about the safety of early amniotomy that focuses on concern for cord prolapse, chorioamnionitis, and changes in fetal heart rate patterns.
- Early amniotomy was associated with faster time to delivery (mean difference, −3.62; 95% CI, −6.09 to −1.16 hours).
- In nulliparas, early amniotomy was associated with a (5 hours) shorter labor (mean difference, −5.12; 95% CI, −8.47 to −1.76 hours).
- Early amniotomy was not associated with an increased risk for cesarean delivery, infectious morbidity, or neonatal ICU admission.
- Systematic review and meta-analysis.
- 7 randomized controlled trials (1775 patients) included in final analysis.
- Women with early amniotomy (n=884) were compared with women with late amniotomy (n=891).
- Primary outcomes were cesarean delivery and time to delivery.
- Funding: None disclosed.
- Limitations related to limitations of original studies.
- Definitions of early vs late amniotomy and intrapartum infectious morbidity differed among studies.
- Definitions of active labor have changed since this study was completed.