Does Early Artificial Rupture of Membranes Speed Labor in Preterm Inductions?

Abstract

Objective In full-term patients, early artificial rupture of membranes (AROMs) decreases time in labor. We assessed the impact of early AROM in preterm patients undergoing indicated induction of labor.

Study Design We conducted a retrospective cohort study of all patients undergoing indicated preterm induction (23–34 weeks) at a single tertiary care center from 2011 to 2014. Early AROM was defined as <4 cm and late AROM was defined as ≥4 cm. The primary outcomes evaluated were cesarean delivery and time in labor. Secondary outcomes were chorioamnionitis and a composite of maternal and neonatal adverse outcomes.

Results Of the 149 women included, 65 (43.6%) had early AROM. Early AROM was associated with an increased time from the start of induction to delivery (25.7 ± 13.0 vs. 19.0 ± 10.3 hours, p < 0.01) and with an increase in the risk of cesarean (53.4 vs. 22.6%, adjusted odds ratio: 3.5, 95% confidence interval: 1.60–7.74). Early AROM was not associated with an increased risk of chorioamnionitis or adverse maternal or fetal outcomes.

Conclusion In this observational cohort, early AROM was associated with an increased risk of cesarean. A randomized controlled trial is necessary to determine the optimal timing of AROM in preterm patients requiring delivery.

Keywords

early amniotomy - preterm - indicated induction of labor

• References

• 1 Recent Declines in Induction of Labor by Gestational Age. Centers for Disease Control and Prevention. Available at: http://www.cdc.gov/nchs/products/databriefs/db155.htm . Published June 18, 2014. Reviewed November 6, 2015. Accessed September 14, 2016
• 2 Smyth RM, Markham C, Dowswell T. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 2013; (06) CD006167
• 3 Mitchell MD, Flint AP, Bibby J. , et al. Rapid increases in plasma prostaglandin concentrations after vaginal examination and amniotomy. BMJ 1977; 2 (6096): 1183-1185
• 4 Cunningham FG, Kenneth JL, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. New York: McGraw Hill; 2010
• 5 Sellers SM, Mitchell MD, Anderson AB, Turnbull AC. The relation between the release of prostaglandins at amniotomy and the subsequent onset of labour. Br J Obstet Gynaecol 1981; 88 (12) 1211-1216
• 6 Dale PO, Tanbo T, Bendvold E, Moe N. Duration of the latency period in preterm premature rupture of the membranes. Maternal and neonatal consequences of expectant management. Eur J Obstet Gynecol Reprod Biol 1989; 30 (03) 257-262
• 7 Melamed N, Hadar E, Ben-Haroush A, Kaplan B, Yogev Y. Factors affecting the duration of the latency period in preterm premature rupture of membranes. J Matern Fetal Neonatal Med 2009; 22 (11) 1051-1056
• 8 Macones GA, Cahill A, Stamilio DM, Odibo AO. The efficacy of early amniotomy in nulliparous labor induction: a randomized controlled trial. Am J Obstet Gynecol 2012; 207 (05) 403.e1-403.e5
• 9 Ghafarzadeh M, Moeininasab S, Namdari M. Effect of early amniotomy on dystocia risk and cesarean delivery in nulliparous women: a randomized clinical trial. Arch Gynecol Obstet 2015; 292 (02) 321-325
• 10 Wei S, Wo BL, Qi HP. , et al. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev 2013; (08) CD006794
• 11 Gagnon-Gervais K, Bujold E, Iglesias MH. , et al. Early versus late amniotomy for labour induction: a randomized controlled trial. J Matern Fetal Neonatal Med 2012; 25 (11) 2326-2329