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Q&A

Labor

Poster Session 4

(1165) The impact of early amniotomy on delivery outcomes in pregnancies with fetal macrosomia

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Or Touval, MD

    Meir Medical Center, affiliated with Faculty of Medicine, Tel Aviv University
    Tel Aviv, Israel, Israel

    • Coauthor(s)

  • Gal Cohen, MD (she/her/hers)

    OBGYN Resident
    Meir Medical Centerartment of Obstetrics and Gynecology, Meir Medical Center
    Kfar Saba, Israel, Israel

  • Lior Heresco, MD

    Meir Medical Center
    Tel Aviv, HaMerkaz, Israel

  • TB

    Tal Biron-Shental, MD

    Meir, Tel-Aviv University
    Sdeh Warburg, HaMerkaz, Israel

  • Michal Kovo, MD,PhD

    Vice Chair Obstetrics and Gynecology
    Meir Medical Center
    Macabim, HaMerkaz, Israel

  • Hanoch Schreiber, MD

    Meir Medical Centerartment of Obstetrics and Gynecology, Meir Medical Center
    Kfar Saba, Israel

Objective:

The optimal timing for amniotomy during labor is controversial. Early amniotomy (EA), defined as amniotomy performed at cervical dilation < 4 cm, has been shown to shorten labor duration without increasing cesarean delivery (CD) rate, in the general pregnant population. However, its impact in deliveries with fetal macrosomia is unknown. We aimed to investigate the effects of early vs. late amniotomy on delivery outcomes in pregnancies with fetal macrosomia.

Study Design:

A retrospective cohort study of all women who delivered neonates with a birthweight of ≥ 4,000 g., between 01/2014 to 10/2020. We included parturients admitted in latent phase of labor (< 6 cm dilation), that underwent amniotomy during labor. The study cohort was divided into two groups: the early amniotomy (EA group) and the late amniotomy (LA group), based on the cervical dilation at which amniotomy was performed, (≤ 4 cm or > 4 cm, respectively). Delivery and neonatal outcomes were compared between the groups.

Results:

A total of 797 women were included.  There were no differences in the pre-labor fetal-weight estimation between the groups (3,928±273 vs. 3,945±271 g., p=0.61 in the EA and LA group, respectively).  Compared to the LA group (n=438), the EA group (n=359) had higher rates of nulliparity (p< 0.001), diabetes mellitus (p< 0.001), induction of labor (p< 0.001), epidural analgesia (p< 0.001) intrapartum fever (6.1% vs. 2.3%, p=0.006) and CD (13.1% vs. 5.7%, p< 0.001). Neonatal birthweights were similar between the EA and LA groups, (4,185±169 g. vs. 4191±181, p=0.61). Composite adverse neonatal outcome was higher in the EA group compared to the LA group (11.8% vs. 6.9%, p=0.046). A multivariable logistic regression analysis adjusted for confounders (table 1) revealed that EA was independently associated with increased risk for CD (aOR 2.13, p=0.014, 95% CI 1.16-3.9).

Conclusion:

The timing of amniotomy in deliveries of suspected fetal macrosomia should be carefully considered, as early amniotomy may increase the rate of CD.