Early versus Late Amniotomy for Induction of Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

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 h (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, neonatal intensive care unit 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 induction of labor protocol.