Role of early amniotomy with induced labor: a systematic review of literature and meta-analysis

OBJECTIVE: The aim of the present meta-analysis was to evaluate the efficacy and safety of early amniotomy performed during induction of labor. DATA SOURCES: The Medline, Embase, and Web-of-Science databases (from conception to end-of- search date, Dec. 31, 2018) were systematically searched. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials that compared the performance of early amniotomy (performed before active phase of labor) to spontaneous or late amniotomy were eligible for inclusion. Eligible studies were limited to studies published as full articles available in the English language and included patients with a singleton viable fetus at term undergoing induction of labor for any indication. STUDY APPRAISAL AND SYNTHESIS METHODS: Data were pooled using the randomeffects and fixed-effects models after assessing for the presence of heterogeneity. Risk of bias for each included study was assessed based on the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Primary outcomes were cesarean delivery and time to delivery. Secondary outcomes were intrapartum infectious morbidity, operative delivery, indication for cesarean, cord prolapse, uterine hyperstimulation, meconium-stained amniotic fluid, and neonatal intensive care unit admission. A subanalysis that included only nulliparous patients was performed for the primary outcomes. RESULTS: There were a total of 7 studies identified that met the inclusion criteria and these studies reported on 1775 patients. The early and late/spontaneous amniotomy groups included 884 and 891 patients, respectively. Patients who had an early amniotomy had a shorter time to delivery (mean difference, -3.62 hours; 95% confidence interval, -.09 to -1.16). When limiting the analysis to the 866 nulliparous women, early amniotomy was associated with a 5 hour shorter time to delivery compared with late amniotomy (mean difference, -5.12 hours; 95% confidence interval, -8.47 to -1.76; I-2, 89%). There was no difference in the rate of cesarean delivery (relative risk, 1.09; 95% confidence interval, 0.80-1.49) or intrapartum infectious morbidity (relative risk, 1.42; 95% confidence interval, 0.77-2.61) between the 2 groups. There were no differences in any of the other secondary outcomes evaluated. CONCLUSION: Early amniotomy during induction of labor is associated with faster time to delivery without any evidence of adverse perinatal outcomes.