Abdulrahim Gari, Saeed Baradwan, Afaf Tawfiq, Ghaidaa Hakeem, Alya Alkaff, Bandr Hafedh, Fahad Algreisi, Hassan M Latifah, Mohammad Alyafi, Hanin Hassan Abduljabbar, Nabigah Alzawawi, Hussein Sabban, Alaa Edrees, Ahmed Abu-Zaid
{"title":"Early versus late amniotomy for induction of labor: a systematic review and meta-analysis of randomized controlled trials.","authors":"Abdulrahim Gari, Saeed Baradwan, Afaf Tawfiq, Ghaidaa Hakeem, Alya Alkaff, Bandr Hafedh, Fahad Algreisi, Hassan M Latifah, Mohammad Alyafi, Hanin Hassan Abduljabbar, Nabigah Alzawawi, Hussein Sabban, Alaa Edrees, Ahmed Abu-Zaid","doi":"10.1159/000544831","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluated the efficacy and safety of early amniotomy, performed before the active phase of labor, versus late amniotomy, conducted during the active phase.</p><p><strong>Methods: </strong>Six data sources were screened until April 2024 for relevant randomized controlled trials (RCTs). Outcomes were pooled using risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) in fixed or random-effects models.</p><p><strong>Results: </strong>Sixteen RCTs involving 3,378 patients were included. Four RCTs had a low risk of bias, and 12 had some concerns. There was no significant difference in cesarean section rates (RR=1.00, 95% CI [0.79, 1.27], p=0.99) or normal vaginal delivery (RR=1.01, 95% CI [0.93, 1.10], p=0.81) between early and late amniotomy. However, early amniotomy reduced time-to-delivery by 2.42 hours (95% CI: -3.06, -1.54, p<0.0001) but increased the risk of chorioamnionitis (RR=1.46, 95% CI [1.06, 2.01], p=0.02). There was no difference in other maternal or neonatal outcomes, including endometritis, maternal fever, postpartum hemorrhage, cord prolapse, uterine hyperstimulation, APGAR score, neonatal sepsis, NICU admission, or meconium-stained amniotic fluid Conclusion: Early amniotomy significantly reduced time-to-delivery without increasing cesarean section rates but was associated with a higher risk of chorioamnionitis. Further research is needed to determine the optimal IOL protocol.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-17"},"PeriodicalIF":2.0000,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Gynecologic and Obstetric Investigation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000544831","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: This study evaluated the efficacy and safety of early amniotomy, performed before the active phase of labor, versus late amniotomy, conducted during the active phase.
Methods: Six data sources were screened until April 2024 for relevant randomized controlled trials (RCTs). Outcomes were pooled using risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) in fixed or random-effects models.
Results: Sixteen RCTs involving 3,378 patients were included. Four RCTs had a low risk of bias, and 12 had some concerns. There was no significant difference in cesarean section rates (RR=1.00, 95% CI [0.79, 1.27], p=0.99) or normal vaginal delivery (RR=1.01, 95% CI [0.93, 1.10], p=0.81) between early and late amniotomy. However, early amniotomy reduced time-to-delivery by 2.42 hours (95% CI: -3.06, -1.54, p<0.0001) but increased the risk of chorioamnionitis (RR=1.46, 95% CI [1.06, 2.01], p=0.02). There was no difference in other maternal or neonatal outcomes, including endometritis, maternal fever, postpartum hemorrhage, cord prolapse, uterine hyperstimulation, APGAR score, neonatal sepsis, NICU admission, or meconium-stained amniotic fluid Conclusion: Early amniotomy significantly reduced time-to-delivery without increasing cesarean section rates but was associated with a higher risk of chorioamnionitis. Further research is needed to determine the optimal IOL protocol.
期刊介绍:
This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.