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Obstetrics & Gynecology:
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THE EFFECT OF ROUTINE EARLY AMNIOTOMY ON SPONTANEOUS LABOR: A META-ANALYSIS.

Brisson-Carroll, Gisèle RN, MPH; Fraser, William MD, FRCSC, MSc; Bréart, Gérard MD, PhD; Krauss, Isabelle MD, Msc; Thornton, Jim MD, MRCOG

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Abstract

Objective: To botaini estimates of the effects of amniotomy on the rick of cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar score less than 7 at 5 minutes, admission to neonatal intensive care unit [NICUJ].

Data Sources: Published studies were identified through manual and computerized searches using Medline and the Cochrane Collaboration Pregnancy and Childbirth Data-base.

Methods of Study Selection: Our search identified ten trials, all published in peer-reviewed journals. Trials were assigned a methodological quality score based on a standardized rating system. Three trails were excluded from the analysis for methodological limitations.

Tabulation, Integration, and Results: Data were abstracted by two trained reviewers. Typical odds ratioos (OR) were calculated. Amniotomy was associated with a reduction in labor duration varying from 0.8-2.3 hours. There was a nonstratistically significant increase in the risk of cesarean delivery: OR 1.2, 95% confidence interval (CI) 0.9-1.6. The risk of a 5-minute Apgar score less than 7 was reduced in association with early amniotomy (OR 0.5, 95% CI 0.3-0.9). Groups were jsimilar with respect to othe indicators of neonatal status (arterial cord pH, NICU admissions).

Conclusion: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labor duration and a possible reduction in abnormal 5-minute Apgar scores. This meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of cesarean delivery. An association between early amniotomy and cesarean delivery for fetal distress was noted in one large trial, suggesting that amniotomy should be reserved for patients with abnormal labor progress.

(C) 1996 The American College of Obstetricians and Gynecologists

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