Early amniotomy is associated with a faster time to delivery

  • Am J Obstet Gynecol MFM

  • von Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • 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.

Key results

  • 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.

Study design

  • 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

  • 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.