(898) Early vs. late amniotomy following cervical ripening in individuals undergoing induction of labor: a meta-analysis

A meta-analysis found that early amniotomy shortened the duration of labor without impacting cesarean rates. However, the review was not adequately powered to detect infectious morbidity and included a limited number of women who had Foley balloon for cervical ripening methods. Moreover, two U.S. trials utilizing Foley balloon have been completed since then. Our objective was to perform a systematic review and meta-analysis to evaluate the impact of early amniotomy on outcomes of induction of labor.

Study Design:

A literature search was conducted using various electronic databases from the inception of each database through July 2023. We included all randomized controlled trials (RCTs) that compared early amniotomy with late amniotomy (including spontaneous rupture of membranes) in women who underwent pre-induction cervical ripening by either Foley balloon or prostaglandins (PG). The primary outcome was chorioamnionitis. Secondary outcomes included cesarean delivery, delivery within 24 hours, induction to delivery time, intrapartum fever, neonatal intensive care unit (NICU) admission, and neonatal sepsis. Findings were summarized as relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) using the random effects model of Restricted Maximum Likelihood.

Results:

Eight trials included 1,954 women who underwent induction of labor and cervical ripening by either Foley or PG (5 Foley, 2 PG, and 1 both). Outcomes are presented in Table 1. There were no differences in chorioamnionitis between early and late amniotomy (7.5% vs. 6.9%; RR 1.06 [0.72-1.58]; Figure 1). Similarly, there were no differences in other neonatal and maternal outcomes except for induction to delivery time (weighted MD -4.2 [-7.3 to -1.0] favoring early amniotomy). Heterogeneity was high ( >70%) for many of the outcomes.

Conclusion:

Early amniotomy after cervical ripening in women with singleton gestations and cephalic presentation at term does not decrease cesarean rates but reduces the duration from induction to delivery without impacting neonatal and maternal outcomes.