Maternal and Neonatal Outcomes Associated with Amniotomy among Nulliparous Women Undergoing Labor Induction at Term

Ashley N. Battarbee; Grecio Sandoval; William A. Grobman; Uma M. Reddy; Alan T.N. Tita; Robert M. Silver; Yasser Y. El-Sayed; Ronald J. Wapner; Dwight J. Rouse; George R. Saade; Suneet P. Chauhan; Jay D. Iams; Edward K. Chien; Brian M. Casey; Ronald S. Gibbs; Sindhu K. Srinivas; Geeta K. Swamy; Hyagriv N. Simhan; for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network

doi:10.1055/s-0040-1709464

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(S 01): e239-e248
DOI: 10.1055/s-0040-1709464

Original Article

Maternal and Neonatal Outcomes Associated with Amniotomy among Nulliparous Women Undergoing Labor Induction at Term

Ashley N. Battarbee

¹Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

,

Grecio Sandoval

²Department of Obstetrics and Gynecology, The George Washington University Biostatistics Center, Washington, District of Columbia

,

William A. Grobman

³Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois

,

Uma M. Reddy

⁴The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland

,

Alan T.N. Tita

⁵Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama

,

Robert M. Silver

⁶Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah

,

Yasser Y. El-Sayed

⁷Department of Obstetrics and Gynecology, Stanford University, Stanford, California

,

Ronald J. Wapner

⁸Department of Obstetrics and Gynecology, Columbia University, New York, New York

,

Dwight J. Rouse

⁹Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island

,

George R. Saade

¹⁰Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas

,

Suneet P. Chauhan

¹¹Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas

,

Jay D. Iams

¹²Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio

,

Edward K. Chien

¹³Department of Obstetrics and Gynecology, MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio

,

Brian M. Casey

¹⁴Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas

,

Ronald S. Gibbs

¹⁵Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado

,

Sindhu K. Srinivas

¹⁶Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania

,

Geeta K. Swamy

¹⁷Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina

,

Hyagriv N. Simhan

¹⁸Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania

,

for the Eunice Kennedy Shriver National Institute of Child Health Human Development Maternal-Fetal Medicine Units (MFMU) Network

› Author Affiliations

Abstract

Objective The aim of the study is to evaluate the association between amniotomy at various time points during labor induction and maternal and neonatal outcomes among term, nulliparous women.

Study Design Secondary analysis of a randomized trial of term labor induction versus expectant management in low-risk, nulliparous women (2014–2017) was conducted. Women met inclusion criteria if they underwent induction ≥38 weeks' gestation using oxytocin with documented time and type of membrane rupture. Women with antepartum stillbirth or fetal anomaly were excluded. The primary outcome was cesarean delivery. Secondary outcomes included maternal and neonatal complications. Maternal and neonatal outcomes were compared among women with amniotomy versus women with intact membranes and no amniotomy at six 2-hour time intervals: before oxytocin initiation, 0 to <2 hours after oxytocin, 2 to <4 hours after, 4 to <6 hours after, 6 to <8 hours after, and 8 to <10 hours after. Multivariable logistic regression adjusted for maternal age, body mass index, race/ethnicity, modified Bishop score on admission, treatment group, and hospital (as a random effect).

Results Of 6,106 women in the parent trial, 2,854 (46.7%) women met inclusion criteria. Of these 2,340 (82.0%) underwent amniotomy, and majority of the women had amniotomy performed between 2 and <6 hours after oxytocin. Cesarean delivery was less frequent among women with amniotomy 6 to <8 hours after oxytocin compared with women without amniotomy (21.9 vs. 29.7%; adjusted odds ratio 0.61, 95% confidence interval 0.42–0.89). Amniotomy at time intervals ≥4 hours after oxytocin was associated with lower odds of labor duration >24 hours. Amniotomy at time intervals ≥2 hours and <8 hours after oxytocin was associated with lower odds of maternal hospitalization >3 days. Amniotomy was not associated with postpartum or neonatal complications.

Conclusion Among a contemporary cohort of nulliparous women undergoing term labor induction, amniotomy was associated with either lower or similar odds of cesarean delivery and other adverse outcomes, compared with no amniotomy.

Keywords

amniotomy - artificial rupture of membranes - cesarean - induction - labor - nulliparous

Full Text

References

References
1 Osterman MJK, Martin JA. Recent declines in induction of labor by gestational age. NCHS Data Brief 2014; (155) 1-8
2 Grobman WA, Rice MM, Reddy UM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Labor induction versus expectant management in low-risk nulliparous women. N Engl J Med 2018; 379 (06) 513-523
3 Bala A, Bagga R, Kalra J, Dutta S. Early versus delayed amniotomy during labor induction with oxytocin in women with Bishop's score of ≥6: a randomized trial. J Matern Fetal Neonatal Med 2018; 31 (22) 2994-3001
4 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
5 Makarem MH, Zahran KM, Abdellah MS, Karen MA. Early amniotomy after vaginal misoprostol for induction of labor: a randomized clinical trial. Arch Gynecol Obstet 2013; 288 (02) 261-265
6 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
7 Tanno K, Okazaki M, Saito B, Uchibe H. Analytical methods for residues of tetracyclines in the liver of swine. (Studies on analytical methods for residues of antibiotics in livestock products. II). Shokuhin Eiseigaku Zasshi 1982; 23 (03) 259-264
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 Mercer BM, McNanley T, O'Brien JM, Randal L, Sibai BM. Early versus late amniotomy for labor induction: a randomized trial. Am J Obstet Gynecol 1995; 173 (04) 1321-1325
10 Battarbee AN, Palatnik A, Peress DA, Grobman WA. Association of early amniotomy after Foley balloon catheter ripening and duration of nulliparous labor induction. Obstet Gynecol 2016; 128 (03) 592-597
11 Levy R, Ferber A, Ben-Arie A. et al. A randomised comparison of early versus late amniotomy following cervical ripening with a Foley catheter. BJOG 2002; 109 (02) 168-172
12 Pasko DN, Miller KM, Jauk VC, Subramaniam A. Pregnancy outcomes after early amniotomy among class III obese gravidas undergoing induction of labor. Am J Perinatol 2019; 36 (05) 449-454
13 Parrish MM, Kuper SG, Jauk VC, Baalbaki SH, Tita AT, Harper LM. Does early artificial rupture of membranes speed labor in preterm inductions?. Am J Perinatol 2018; 35 (08) 716-720
14 Lee SM, Park JW, Park CW, Yoon BH. “Early rupture of membranes” during induced labor as a risk factor for cesarean delivery in term nulliparas. PLoS One 2012; 7 (06) e39883
15 Bailit JL, Grobman W, Zhao Y. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network. Nonmedically indicated induction vs expectant treatment in term nulliparous women. Am J Obstet Gynecol 2015; 212 (01) 103.e1-103.e7
16 Davis CE. Secondary endpoints can be validly analyzed, even if the primary endpoint does not provide clear statistical significance. Control Clin Trials 1997; 18 (06) 557-560 , discussion 561–567
17 Bostancı E, Eser A, Yayla Abide C, Kılıccı C, Kucukbas M. Early amniotomy after dinoprostone insert used for the induction of labor: a randomized clinical trial. J Matern Fetal Neonatal Med 2018; 31 (03) 352-356
18 Dreifuss J. Oxytocin in reproductive biology: newly discovered sites of production and of action. In: Campana A. ed. Reproductive Health; 1993: 71-74
19 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
20 Keirse MJNC. Natural prostaglandins for induction of labor and preinduction cervical ripening. Clin Obstet Gynecol 2006; 49 (03) 609-626

Supplementary Material

Supplementary Material