Amniotomy for shortening spontaneous labour

Routine early amniotomy— surgical rupture of fetal membranes—has no overall benefit. Since early amniotomy may increase caesarean section rates, non-intervention should be the currently recommended method of membrane management in women who have spontaneous labour and who are at a low-risk of an adverse intrapartum event.

RHL Commentary by Khalid S. Khan

EVIDENCE SUMMARY

This systematic review assesses the effects of routine early amniotomy in the clinical management of spontaneous labour in women at low risk of an adverse intrapartum event. Amniotomy does not reduce caesarean section rate compared to non-intervention. In fact, there is a trend towards an increase in caesarean section rate following amniotomy. There is an associated reduction in the duration of labour, the use of oxytocin and the pain experienced during labour. With regard to neonatal outcomes, fewer babies are born with Apgar scores of less than seven, but no statistically or clinically significant differences have been observed in other measures of neonatal morbidity, such as umbilical artery acid-base disturbances and admission to intensive care units.

With duplicate blind assessments of study quality and extraction of data, this review is methodologically sound, implying that the results are valid.

The full RHL commentary also includes sections on:

Relevance
- Magnitude of the problem
- Feasibility of the intervention
- Applicability of the results of the Cochrane Review
- Implementation of the intervention
- Research

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This document should be cited as: Khalid S. Khan. Amniotomy to shorten spontaneous labour: RHL commentary (last revised: 6 January 2000). The WHO Reproductive Health Library, No 9, Update Software Ltd, Oxford, 2006. www.rhlibrary.com