Rates and indicators for amniotomy during labor--a descriptive cross sectional study between primigravidas and gravida 2 and above.

Abstract

ABSTRACTBackground:Artificial rupture of membranes (Amniotomy) is a common obstetric intervention. Its rates and indications had been subjected to criticism in medical literature. The current practices recommend to reduce its rate and keep the birthing process as natural as possible.Aim:This observational study aimed to describe the rates and indicators for practice of artificial rupture of membranes (Amniotomy) during normal labor and to determine if any significant differences existed between women who have had one pregnancy (PG) and women who have already delivered two or more children (G2 and above) on this obstetric interventions: artificial rupture of membranes (ARM).Results:There were no PG participants with ruptured membranes whereas slightly more than half of the G2 and above participants (n = 88) had ruptured membranes. The most frequent cause for ARM was active management of latent phase of labor (PG n = 20 and G2 and above n = 9). Furthermore, slow progress of labor (PG n = 17 and G2 and above n = 7) and concerns with fetal heart rate (PG n = 13 and G2 and above n = 5) had the next highest number of occurrences. Results from the proportions tests revealed that there was one significant difference between gravidity groups on the frequency of APH (p =0.039). That is, G2 and above participants had amniotomy done for APH (5 of 32 = 15.63%) significantly more often than PG participants (4 of 89 = 4.49%). And although not statistically significant (p =0.084), there were 21 cases within the PG group where ARM was performed for no specific reason (21 of 89 = 23.6%) compared to three cases within the G2 and above group (3 of 32 = 9.4%).Conclusions:Although ARM is a commonly performed procedure during labor, there is not much difference between its indications between PG and G2 and above. The only significantly different indication was antepartum hemorrhage which was higher in G2 and above. Amniotomy was also performed without any clear indication in 26.4% of PG and 9.4% of G2 and above. Considering ARM as obstetric intervention efforts should be done to reduce its rates. There is a need for arranging normal labor workshops to revise the indications and reviewing the rates after these workshops to reduce the rates of ARM.