Amniotomy Group Research Articles

Early vs delayed amniotomy following transcervical Foley balloon in the induction of labor: a randomized clinical trial

The optimal timing of amniotomy during labor induction is a topic of ongoing debate due to the potential risks associated with both amniotomy and prolonged labor. As such, individuals in the field of obstetrics and gynecology must carefully evaluate the associated benefits and drawbacks of this procedure. While amniotomy can expedite the labor process, it may also lead to complications such as umbilical cord prolapse, fetal distress, and infection. Therefore, a careful and thorough examination of the risks and benefits of amniotomy during labor induction is essential in making an informed decision regarding the optimal timing of this procedure. This study aimed to determine if an amniotomy within 2 hours after Foley balloon removal reduced the duration of active labor and time taken to achieve vaginal delivery when compared with an amniotomy ≥4 hours after balloon removal among term pregnant women who underwent labor induction. This was an open-label, randomized controlled trial that was conducted at a single academic center from October 2020 to March 2023. Term participants who were eligible for preinduction cervical ripening with a Foley balloon were randomized into 2 groups, namely the early amniotomy (rupture of membranes within 2 hours after Foley balloon removal) and delayed amniotomy (rupture of membranes performed more than 4 hours after Foley balloon removal) groups. Randomization was stratified by parity. The primary outcome was time from Foley balloon insertion to active phase of labor. Secondary outcomes, including time to delivery, cesarean delivery rates, and maternal and neonatal complications, were analyzed using intention-to-treat and per-protocol analyses. Of the 150 participants who consented and were enrolled, 149 were included in the analysis. In the intention-to-treat population, an early amniotomy did not significantly shorten the time between Foley balloon insertion and active labor when compared with a delayed amniotomy (885 vs 975 minutes; P=.08). An early amniotomy was associated with a significantly shorter time from Foley balloon placement to active labor in nulliparous individuals (1211; 584-2340 vs 1585; 683-2760; P=.02). When evaluating the secondary outcomes, an early amniotomy was associated with a significantly shorter time to active labor onset (312.5 vs 442.5 minutes; P=.02) and delivery (484 vs 587 minutes; P=.03) from Foley balloon removal with a higher rate of delivery within 36 hours (96% vs 85%; P=.03). Individuals in the early amniotomy group reached active labor 1.5 times faster after Foley balloon insertion than those in the delayed group (hazard ratio, 1.5; 95% confidence interval, 1.1-2.2; P=.02). Those with an early amniotomy also reached vaginal delivery 1.5 times faster after Foley balloon removal than those in the delayed group (hazard ratio, 1.5; 95% confidence interval, 1-2.2; P=.03). A delayed amniotomy was associated with a higher rate of postpartum hemorrhage (0% vs 9.5%; P=.01). No significant differences were observed in the cesarean delivery rates, length of hospital stay, maternal infection, or neonatal outcomes. Although an early amniotomy does not shorten the time from Foley balloon insertion to active labor, it shortens time from Foley balloon removal to active labor and delivery without increasing complications. The increased postpartum hemorrhage rate in the delayed amniotomy group suggests increased risks with delayed amniotomy.

Impact of Early versus Late Amniotomy on Induction of Labor in Nulliparous Women after Vaginally Administered Misoprostol: A Randomized Clinical Trial

Abstract Objective: To investigate the effect of early versus late amniotomy after induction of labor (IOL) with vaginally administered misoprostol. Methods: This randomized clinical trial was conducted at the Department of Obstetrics and Gynecology, Menoufia University, from May 2019 to March 2020, and included 120 nulliparous women at term (≥ 37 weeks' gestation) undergoing IOL. Computer-generated randomization was used to randomize the participants into either the early amniotomy group (3 cm cervical dilatation; n = 60) or the late amniotomy group (7 cm cervical dilatation; n = 60). All participants received misoprostol (25 μg) vaginally to induce labor. The primary outcome was the induction-to-delivery interval, defined as the time from the initiation of IOL to the time of delivery. Results: Women in the early amniotomy group had a shorter duration of labor (12.60 ± 5.36 h) than those in the late amniotomy group (16.67 ± 7.26 h). The mean time from rupture of the fetal membrane to delivery was significantly shorter in the late (2.51 ± 0.36 h) than in the early amniotomy group (3.1 ± 0.89 h). There was no statistically significant difference between the groups in terms of maternal complications (fever, nausea, vomiting, and uterine hyperstimulation) or neonatal complications (meconium-stained liquor, APGAR score <7 at 1 and 5 min, and neonatal intensive care unit admission). Conclusions: IOL using vaginally administered misoprostol followed by early amniotomy was accompanied by a shorter duration of labor and decreased use of oxytocin. There was no significant difference between the early and late amniotomy groups in terms of the rate of cesarean section or maternal and neonatal complications.

114 Early versus delayed amniotomy following combination foley catheter-misoprostol for term labor induction

We sought to assess whether early amniotomy reduces the duration of labor or increases the proportion of women delivered within 24 hours among patients undergoing combined Foley Catheter-Misoprostol (FC-M) labor induction at term. This was a planned secondary analysis of a randomized controlled trial. Women with a term (≥37 weeks), singleton pregnancy undergoing FC-M cervical ripening were included. Early amniotomy was defined as artificial rupture of membranes prior to or at 4cm cervical dilation. Amniotomy beyond 4cm was categorized as delayed. Our primary outcome was time from induction initiation to delivery. Cox proportional hazard models were used, accounting for maternal age, race, gestational age, and route of misoprostol administration. 215 women were included: 116 (54%) in the early amniotomy group and 99 (46%) in the delayed group. Demographic and clinical characteristics were similar between the two groups. Delayed amniotomy was associated with shorter time to delivery after adjusting for confounders (hazard ratio [HR] 1.43, 95% confidence interval [CI] 1.09-1.89; p=0.01). Women in the delayed group spent a significantly shorter time in labor (20.4 hours vs 23.1 hours, p=0.03). There was no difference in the proportion of women who delivered within 12 or 24 hours. We found no difference in the rate of cesarean delivery between the two groups (19.8% vs 19.2%, p=1.0). There were no significant differences in maternal and neonatal outcomes. Delayed amniotomy was associated with shorter length of labor without increasing maternal or neonatal adverse events. Delaying amniotomy beyond 4cm dilation should be preferred in women undergoing term labor induction with FC-M.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Early Amniotomy After Cervical Ripening for Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Objective Data Timing of artificial rupture of membranes (ie, amniotomy) in induction of labor is controversial, because it has been associated not only with shorter labors, but also with fetal nonreassuring testing, at times necessitating cesarean delivery. The aim of this systematic review and metaanalysis of randomized trials was to evaluate the effectiveness of early amniotomy vs late amniotomy or spontaneous rupture of membranes after cervical ripening. Study The search was conducted with the use of electronic databases from inception of each database through February 2019. Review of articles included the abstracts of all references that were retrieved from the search. Study Appraisal and Synthesis Methods Selection criteria included randomized clinical trials that compared early amniotomy vs control (ie, late amniotomy or spontaneous rupture of membranes) after cervical ripening with either Foley catheter or prostaglandins at any dose. The primary outcome was the incidence of cesarean delivery. The summary measures were reported as summary relative risk with 95% of confidence interval with the use of the random effects model of DerSimonian and Laird. Results Four trials that included 1273 women who underwent cervical ripening with either Foley catheter or prostaglandins and then were assigned randomly to either early amniotomy, late amniotomy, or spontaneous rupture of membranes (control subjects) were included in the review. Women who were assigned randomly to early amniotomy had a similar risk of cesarean delivery (31.1% vs 30.9%; relative risk, 1.05; 95% confidence interval, 0.71–1.56) compared with control subjects and had a shorter interval from induction to delivery of approximately 5 hours (mean difference, –4.95 hours; 95% confidence interval, –8.12 to –1.78). Spontaneous vaginal delivery was also reduced in the early amniotomy group, but only 1 of the included trials reported this outcome (67.5% vs 69.1%; relative risk, 0.78; 95% confidence interval, 0.66–0.93). No between-group differences were reported in the other obstetrics or perinatal outcomes. Conclusion After cervical ripening, routine early amniotomy does not increase the risk of cesarean delivery and reduces the interval from induction to delivery.

Effect of early amniotomy on labor outcome in nulliparous women: a randomized clinical trial

Abstract Early amniotomy is one of the main interventions to enhance the labor progress and prevent dystocia in pregnant women. However, the efficacy of amniotomy has not been approved via labor-related indices and outcomes and has remained a subject for debate and future research. The present study was conducted to evaluate the effect of early amniotomy on labor indices and outcomes in nulliparous women. This randomized clinical trial was performed on 151 singleton pregnant women who were referred to Besat Hospital in Sanandaj, Iran, from March 2016 to March 2018. Participants were randomly divided into an early amniotomy (EA) group and a control group. Duration of the first and second phases of labor, corioamionit, dystocia rate, Apgar score at the first and fifth minutes, prolonged labor and post-partum haemorrhage were evaluated and compared between the two groups. Data were recorded in a checklist and analysed using SPSS Version 23. The p value <0.05 was considered significant. Results showed that labor indices such as duration of the first and second phases, Apgar score one and five minutes after delivery and frequency of prolonged labor, foetal distress and postpartum haemorrhage were significantly improved in patients of the early amniotomy group, compared with the control group (p≤0.05). Early amniotomy significantly decreased the total labor duration without significant increase in the rate of maternal and neonatal complications.

Randomized controlled trial of the effect of amniotomy on the duration of spontaneous labor.

To investigate the effect of amniotomy on the duration of spontaneous labor. In the present randomized controlled trial, women in spontaneous labor with singleton pregnancies presenting at a tertiary teaching hospital in South India between August 1, 2014, and October 31, 2015, were randomized in a 1:1 ratio to undergo amniotomy or conservative management. The primary outcome was the duration of labor. Per-protocol analyses were performed and the duration of labor was compared between the groups of patients. There were 144 patients randomized to each group. The median duration of labor was 235minutes (interquartile range 117-355) in the amniotomy group and 364minutes (interquartile range 201-580) in the conservative management group (P<0.001). Amniotomy was associated with a shorter duration of labor in comparison with conservative management in patients with singleton pregnancies experiencing spontaneous labor. Clinical Trials Registry-India: (CTRI) (CTRI/2014/12/005264).

Measuring women’s experience of induction of labor using prostaglandin vaginal gel

ObjectiveTo describe and examine the EXIT (EXperiences of Induction Tool), and report on the experience of women undergoing PGE2 vaginal gel IOL, who were participants in a randomized controlled trial comparing early amniotomy with repeat-PGE2. Study designFollowing an evening dose of PGE2 vaginal gel, 245 women with live singleton term pregnancies were randomized to amniotomy or repeat-PGE2. Women’s experience of IOL was a secondary outcome measure, assessed using the self-report EXIT administered by phone at 7–9days post-partum. The 10-item EXIT assessed women’s experiences in multiple domains using a 5-point agreement scale. Principal components analysis with orthogonal varimax rotation was undertaken to examine the scale structure. Internal consistency, face, content, construct and discriminant validity were also assessed. ResultsThe final 3-component solution comprised 8 of the 10 EXIT items, explained 76.1% of the variance and had a good fit to model (p<0.001). The three resulting components were representative of women’s experience of the time taken to give birth, discomfort with IOL, and subsequent contractions. The items loading to each component showed good internal consistency for time taken to give birth (α=0.88), discomfort with IOL (α=0.78), and experience of subsequent contractions (α=0.87). Women in the repeat-PGE2 group reported a less favorable experience with the time taken to give birth (mean (SD): 3.5 (1.4) vs 3.9 (1.2); p=0.04) and more discomfort with IOL (2.9 (1.1) vs 2.5 (1.0); p=0.04) compared to women in the amniotomy group. At the individual item level, women in the amniotomy group responded more positive about the time taken to have their baby (median (IQR): 4 (3–5) vs 3 (2–5); p<0.01); and less negative to the question about the number of vaginal examinations (2 (1–3) vs 2 (1–4); p=0.05). ConclusionsThe EXIT shows promise as an instrument for assessing women’s experience of IOL. Women undergoing PGE2 vaginal gel IOL reports a more positive experience with an early amniotomy rather than with repeat-PGE2.

Effect of early amniotomy on the outcome of spontaneous labour: a randomized controlled trial of pregnant women in Enugu, South-east Nigeria.

Early amniotomy is common in obstetric practice but, its effectiveness has not been proven. To determine the effects of early amniotomy on the duration of labour, and other maternal / neonatal outcomes of uncomplicated pregnancies in Enugu, South-east Nigeria. A randomized controlled study of 214 consenting term pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. Intervention group received amniotomy early in active labour while the control group had their membranes conserved. Mean duration of labour for the amniotomy group (279.4 ± 53.7 minutes) was significantly lower than that of control group (354.4 ± 67.5 minutes), (t = -8.988, p <0.001). Three (3.8%) women in amniotomy group needed oxytocin augmentation as against 21 (19.6%) women in the control group RR = 0.14, (CI 95%: 0.04 - 0.46), NNT = 16. The two groups did not vary with respect to cesarean section rate, newborn Apgar scores, and need for new born special care unit admission. Early amniotomy when compared to fetal membrane conservation reduced the duration of labour and need for oxytocin augmentation among term singleton pregnant women in Enugu, Nigeria. Its routine use in well selected cases may reduce prolonged labour and its complications.

Prostaglandin vaginal gel induction of labor comparing amniotomy with repeat prostaglandin gel

The purpose of this study was to compare 2 inductions of labor protocols. Women with live singleton pregnancies at ≥37 + 0 weeks gestation who were booked for prostaglandins 2 (PGE2) vaginal gel induction with a modified Bishop's score of <7 were eligible for inclusion. After an evening dose of PGE2 vaginal gel, women were assigned randomly the next morning into the amniotomy or repeat-PGE2 group. The amniotomy group underwent artificial rupture of membranes (ARM), regardless of modified Bishop's score, and received further PGE2 doses only if ARM was not technically possible. The repeat-PGE2 group received further PGE2 (to a maximum of 3 doses) until a modified Bishop's score ≥7 occurred, when an ARM was performed. In both groups, Syntocinon was commenced once membranes were ruptured. The primary outcome measure was time from commencement of induction until birth. Two hundred forty-five women were assigned randomly into either the amniotomy (n = 121) or repeat-PGE2 group (n = 124). The time for induction of labor-to-birth was >5 hours shorter in the amniotomy group (24.8 vs 30.0 hours; mean difference, 5.2 h; 95% confidence interval, -2.5 to -7.8). Fewer women in the amniotomy group remained undelivered after 24 hours (47.1% vs 67.7%; P < .01). However, the likelihood of an in-hours birth and the length of hospital stay were no different between the groups. There was no difference in the mode of birth or any of the secondary outcomes. After an initial dose of PGE2 vaginal gel, an amniotomy (once technically possible) is associated with a shorter induction of labor-to-birth time compared with the use of repeat doses of PGE2. Administering more PGE2 with the aim of starting contractions or making the cervix "more favorable," appears to have no clinical advantage.

Early amniotomy after vaginal misoprostol for induction of labor: a randomized clinical trial

To test the effectiveness and safety of early amniotomy after vaginal misoprostol for the induction of labor. A randomized clinical trial that included 320 women with medical or obstetric indication for labor induction. They were randomly assigned into two equal groups, amniotomy group and control group. Each participant received vaginal misoprostol 50 μg every 6 h for induction of labor. In amniotomy group, amniotomy was done in the early active phase of labor while in the control group, the membranes were left to rupture spontaneously or as judged by the senior resident in the duty. More subjects in the amniotomy group achieved vaginal delivery within 24 h than in the control group [117 (73.13 %) vs. 105 (65.63 %)]. Subjects in the amniotomy group reported shorter induction to delivery interval (09.72 ± 4.61 h vs. 13.61 ± 5.61, P = .002), and better neonatal outcome compared to the control group. There were no statistically significant differences between both group with regard to number of doses of misoprostol, need for oxytocin, Cesarean Section indication and maternal side effects. Early amniotomy after vaginal misoprostol for labor induction is associated with higher successful vaginal delivery rate, shorter labor duration and better neonatal outcome.

6: The efficacy of early amniotomy in nulliparous labor induction: a randomized controlled trial

To assess whether early amniotomy (AROM at ≤ 4cm dilated) reduces the duration of labor or increases the proportion of subjects delivered within 24 hours in term nulliparous patients undergoing labor induction. We performed a randomized clinical trial to test our hypothesis. Nulliparous patients with singleton, viable pregnancies undergoing labor induction at or beyond 37 weeks were eligible for inclusion. We excluded subjects with PROM, cervical dilation > 4cm at admission, or significant vaginal bleeding. Eligible subjects were randomized to early amniotomy (AROM at ≤ 4cm) or standard management (AROM at > 4cm). Outcomes for this study included duration of labor, % delivered within 24 hours, cesarean rate, maternal infectious complications, and measures of neonatal outcome. A priori sample size was based on the proportion of subjects delivered within 24 hours of randomization. Assuming alpha error of 0.05, 80% power, incidence of delivery within 24 hours of 50% in the standard management group, and a minimum detectable relative risk of 0.75, we estimated that we would need 290 subjects per group. Analysis was performed using bivariate statistics, under the intent to treat principle. We randomized 585 subjects into this clinical trial, 292 into early amniotomy group and 293 into the standard management group. Baseline demographics at randomization, cervical dilation at admission, and methods of induction were similar between the groups. Early amniotomy shortened the time from randomization to delivery by over 2 hours (p=0.04) and increased the proportion of subjects delivered within 24 hours of randomization (Table). There was no effect of early amniotomy on maternal or neonatal infectious complications, or on other measures of neonatal outcome.Tabled 1OutcomeEarly AmniotomyStandard ManagementRR95% CIpRandomization-delivery (hrs)19.021.3--0.04% delivered < 24hours from randomization68%56%1.221.07-1.380.002Cesarean41%40%1.030.85-1.250.75Chorioamnionitis11.5%8.5%1.350.83-2.210.22Postpartum fever10.4%9.4%1.100.67-1.790.70 Open table in a new tab In nulliparous labor inductions, early amniotomy shortens the time to delivery by over 20 percent, and increases the likelihood of delivery within 24 hours, without adversely impacting maternal or neonatal well-being.

The effect of amniotomy on the outcome of spontaneous labour in uncomplicated pregnancy

SummaryThe objective of this study is to determine the effect of amniotomy on the outcome of spontaneous labour in uncomplicated pregnancy. A prospective randomised study of low-risk parous women with spontaneous onset of labour at term with singleton fetus in cephalic presentation and intact amniotic membranes and a cervical dilatation between 4 and 5 cm were randomly assigned to have amniotomy (Case) or no amniotomy (Control) during the course of labour. Maternal demographics, labour-delivery data and newborn outcome were compared. A total of 128 women were studied. The duration of labour was significantly shorter in the amniotomy group than the control group (208 vs 292 min; p < 0.05) with the only difference being in the first stage of labour. There was however no difference on the oxytocin requirement for labour augmentation, caesarean section rate, incidence of suspected fetal distress or instrumental delivery in both groups. Newborn outcome measured by Apgar scores at 1 and 5 min showed no significant difference. In conclusion, amniotomy significantly reduced the duration of the first stage of labour without affecting the oxytocin requirement, the rate of caesarean section and newborn outcome.

Early Amniotomy—High Risk Factor for Cesarean Section

Objective: To evaluate the effect of early amniotomy on mode of delivery and pregnancy outcome in comparison to a group of patients admitted with premature rupture of membranes at term. Study design: The study population consists of all women (n=338) whose labor was induced by amniotomy, between the years 1988 to 1995. The comparison group were all women (n=1865) who were admitted with premature rupture of membranes during the same period. Results: Cesarean section was significantly higher in the amniotomy group than in the comparison group (162 (47.9%) vs. 348 (18.7%), P<0.001). This significant difference was noted only for those who did not had a previous cesarean section (106 (42.4%) vs. 224 (13.8%), P<0.001). Non progressive labor during the first stage was threefold higher in the amniotomy group than in the control group (30.8% vs. 10.9%, P<0.001). Abnormal fetal heart rate patterns were detected during labor in 52 patients (15.4%) of amniotomy group, as compared to 141 cases (7.6%) in the control group (P<0.001). To assess the independent contribution of early amniotomy to having cesarean section in the present delivery, a multiple logistic model was used. Early amniotomy (odds ratio [OR] 3.07, 95% confidence interval [CI] 2.36–4.01), as well as a previous cesarean section (OR 5.04, 95% CI 3.90–6.52) and high parity (OR 1.07, 95% CI 1.03–1.26) were all found as independent risk factors for cesarean section. Conclusions: Early amniotomy appears to be associated with an increased risk for cesarean section.

Early amniotomy – high risk factor for cesarean section

Objective: To evaluate the effect of early amniotomy on mode of delivery and pregnancy outcome in comparison to a group of patients admitted with premature rupture of membranes at term. Study design: The study population consists of all women (n=338) whose labor was induced by amniotomy, between the years 1988 to 1995. The comparison group were all women (n=1865) who were admitted with premature rupture of membranes during the same period. Results: Cesarean section was significantly higher in the amniotomy group than in the comparison group (162 (47.9%) vs. 348 (18.7%), P<0.001). This significant difference was noted only for those who did not had a previous cesarean section (106 (42.4%) vs. 224 (13.8%), P<0.001). Non progressive labor during the first stage was threefold higher in the amniotomy group than in the control group (30.8% vs. 10.9%, P<0.001). Abnormal fetal heart rate patterns were detected during labor in 52 patients (15.4%) of amniotomy group, as compared to 141 cases (7.6%) in the control group (P<0.001). To assess the independent contribution of early amniotomy to having cesarean section in the present delivery, a multiple logistic model was used. Early amniotomy (odds ratio [OR] 3.07, 95% confidence interval [CI] 2.36–4.01), as well as a previous cesarean section (OR 5.04, 95% CI 3.90–6.52) and high parity (OR 1.07, 95% CI 1.03–1.26) were all found as independent risk factors for cesarean section. Conclusions: Early amniotomy appears to be associated with an increased risk for cesarean section.

Randomised Trial Comparing a Policy of Early With Selective Amniotomy in Uncomplicated Labour at Term

Objective To compare two management policies: rupture of the fetal membranes when women are in normal labour or leave them intact as long as feasible. Setting The labour ward of a city university hospital. Design Automated randomised clinical trial. Participants 1540 women in uncomplicated term labour. Data on labour duration, blood loss, oxytocin use and fetal condition were collected from 1132 women. Some data from nulliparous women has been presented earlier by the UK Amniotomy Group. Main outcome measures Duration of labour, Apgar score, fetal morbidity and maternal morbidity including perineal injury, mode of delivery, epidural rates and the total number of vaginal examinations in the first stage of labour after amniotomy. Interventions Amniotomy at the next vaginal examination or amniotomy only if indicated. The median cervical dilatation at membrane rupture was 2 cm greater in the first group. Results A policy of routine amniotomy in labour had no measurable advantage over selective amniotomy for parous women (difference = 4 min) but shortened labour in nulliparous women by 1 h (Mann-Whitney U test: P < 0.05). There was a suggestion of a higher caesarean section rate (OR 1.9; 95% CI 0.9–3.5), and there were more vaginal examinations after membrane rupture in the group allocated routine amniotomy. There were no measurable differences in oxytocin use, fetal condition at birth, retained placenta rates, blood loss, pain or analgesia requirements. Conclusion Routine amniotomy may shorten the first labour but not subsequent ones. There is a suggestion that routine surgical interference may be harmful by increasing the risk of caesarean section, and this agrees with data from other trials (common odds ratio 1.2; 95% CI 0.92–1.6).

Early versus late amniotomy for labor induction: A randomized trial

OBJECTIVE: Our purpose was to determine the impact of early and late amniotomy on labor induction with continuous oxytocin infusion at term. STUDY DESIGN: A total of 209 women admitted for labor induction were randomized to early or late amniotomy. The early amniotomy group ( n = 106) had membranes ruptured as soon as it was deemed safe and feasible. The late amniotomy group ( n = 103) had membrane rupture performed at ≥5 cm dilatation. The first 103 women received a continuous oxytocin infusion with incremental adjustments at 60-minute intervals as required. The next 106 women had adjustments every 30 minutes as required. Statistical analysis was confined to concurrent groups. RESULTS: Early amniotomy was associated with shorter labor (13.3 vs 17.8 hours, p = 0.001), chorioamnionitis (22.6% vs 6.8%, p = 0.002), and significant fetal umbilical cord compression (12.3% vs 2.9%, p = 0.017). The benefit regarding shortening of labor was limited to women having oxytocin increments every 30 minutes as required (13.3 vs 17.8 hours, p = 0.001). Alternatively, the increase in chorioamnionitis was confined to the 60-minute group (39% vs 11%, p < 0.001), which also demonstrated a trend toward increased moderate and severe variable decelerations (19.6% vs 6.4%, p = 0.08). CONCLUSIONS: When a protocol of 60-minute inrements in oxytocin infusion rate is desired, amniotomy should be performed late in labor to reduce chorioamnionitis and significant umbilical cord compression. Alternatively, if early amniotomy is necessary, oxytocin should be adjusted every 30 minutes as tolerated.

A multicentre randomised trial of amniotomy in spontaneous first labour at term

The UK Amniotomy Group 1994). The caesarean section rates in both the United Kingdom and the United States have risen despite different approaches to our management of labour. The adoption of more aggressive regimes of oxytocin administration in the United States may not be the answer to their problems, and it is likely that we may have to look elsewhere for the solution on both sides of the Atlantic.

A randomized prospective trial comparing single dose prostaglandin E2 vaginal gel with forewater amniotomy for induction of labour

A prospective randomized parallel-group study was carried out to compare the efficacy of a single dose vaginal prostaglandin E2 gel with forewater amniotomy for induction of labour at term in 260 parturients (110 primigravid and 150 parous women) with low risk pregnancy and favourable cervix. In the prostaglandin E2 (PGE2) managed group, the primigravidae were treated with 2 mg PGE2 gel and parous patients with 1 mg PGE2 gel. Forewater amniotomy was performed 4 h later, or sooner if women requested analgesia. In the amniotomy group, artificial forewater amniotomy was carried out and a repeat cervical assessment done 4 h later, or sooner if women requested analgesia. In both groups, intravenous oxytocin was established if there was evidence of disordered uterine activity, 6 h after the start of initial intervention. An assessment of consumers' views was carried out by using a standardized questionnaire completed 48 h after delivery. There was a significant reduction in the requirement for oxytocin augmentation in women treated with PGE2: primigravidae, odds ratio (OR), 0.27 and 95% confidence interval (CI), 0.12-0.61; multiparae, OR, 0.19 and 95% CI, 0.08-0.45. Fewer primigravidae managed with PGE2 gel required epidural analgesia (OR, 0.16; 95% CI, 0.06-1.00). Fewer parous women managed with PGE2 gel required parenteral opiates (OR, 0.44; 95% CI, 0.23-0.85) and more women required inhalation analgesia or no analgesia (OR, 2.22; 95% CI, 1.76-2.79). The intervention to delivery intervals were shortened in PGE2 groups independent of parity but the differences were not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Active-Phase Labor Arrest

To determine whether leaving the membranes intact in active-phase arrest would affect the cesarean delivery rate or the incidence of maternal morbidity secondary to infection. We conducted a randomized trial of healthy, spontaneously laboring women at term with an intact chorioamnion and active-phase arrest (defined as 1 cm or less of cervical change over 2 hours in the active phase of labor). Patients were assigned to either oxytocin augmentation with intact chorioamnion or oxytocin augmentation with amniotomy and internal monitoring of the fetal heart rate and uterine contractions. The intact group (n = 58) and the amniotomy group (n = 60) were similar with respect to maternal age, race, parity, labor epidural usage, gestational age, cervical dilatation at randomization, number of vaginal examinations, and infant birth weight. Four patients in the intact group and five in the amniotomy group underwent cesarean delivery (P = 1.0). No patient in the intact group and three in the amniotomy group were diagnosed with chorioamnionitis (P = .24). Endometritis did not occur in the intact group, whereas four cases occurred in the amniotomy group (P = .12). There were no cases of maternal infection in the intact group, versus seven in the amniotomy group (P = .01). The interval between randomization and vaginal delivery was 44 minutes longer in the intact group than in the amniotomy group (P = .11). In women with active-phase arrest of labor and intact membranes, oxytocin augmentation with elective amniotomy and internal monitoring increases maternal infectious morbidity.

Effect of early amniotomy on the risk of dystocia in nulliparous women

Background Early amniotomy has been advocated as a means of preventing dystocia, but its efficacy has not been studied prospectively. The purpose of this multicenter study was to determine whether routine early amniotomy reduces the risk of dystocia for nulliparous women in spontaneous labor. Methods We studied 925 nulliparous women in labor, who were stratified according to the degree of cervical dilatation (<3 cm vs. ≥ 3 cm) and randomly assigned to either early rupture of the membranes (amniotomy group) or conservative management of labor (conservative-management group). Dystocia was defined as a period of at least four hours after dilatation of the cervix to 3 cm had been reached during which the mean rate of cervical dilatation was less than 0.5 cm per hour. Results Dystocia was significantly less frequent in the amniotomy group than in the conservative-management group (34 percent vs. 45 percent; relative risk, 0.8; 95 percent confidence interval, 0.6 to 0.9). The median length of time from randomiz...