Early amniotomy after cervical ripening for induction of labor: a systematic review and meta-analysis of randomized controlled trials

Review of Evidence‐Based Methods for Successful Labor Induction

“…In contrast, De Vivo and colleagues published a meta-analysis in 2020 (N = 1273 in 4 trials) that found a similar risk of cesarean birth associated with early amniotomy during IOL (defined as amniotomy after expulsion of a cervical catheter, greater than or equal to 3 cm dilatation, or a Bishop score of ≥5) compared with later rupture of membranes (31.1% vs 30.9%; RR, 1.05; 95% CI, 0.71-1.56). 59 Like the studies by Battarbee et al 58 and Bala et al, 57 De Vivo et al also found shorter labor durations in the early amniotomy group of approximately 5 hours (interval from IOL onset to birth: weighted mean difference, −4.95 h; 95% CI, −8.12 to −1.78). 59 Early amniotomy may advance labor process and shorten time to birth when used after moderate cervical ripening and in combination with oxytocin initiation, but the effect on cesarean birth rates is not consistent across studies.…”

“…59 Like the studies by Battarbee et al 58 and Bala et al, 57 De Vivo et al also found shorter labor durations in the early amniotomy group of approximately 5 hours (interval from IOL onset to birth: weighted mean difference, −4.95 h; 95% CI, −8.12 to −1.78). 59 Early amniotomy may advance labor process and shorten time to birth when used after moderate cervical ripening and in combination with oxytocin initiation, but the effect on cesarean birth rates is not consistent across studies. Women with increased BMI may not gain as much benefit in response to amniotomy compared with women with lower BMIespecially with early amniotomy.…”

American College of Nurse‐Midwives Clinical Bulletin Number 18: Induction of Labor

“…Amniotomy appears to be most effective for increasing uterine activity and reducing the cesarean birth rate during induction of labor when the cervix is dilated at to at least 4 centimeters, 73,84 although recent evidence from a meta-analysis (N = 1273 in 4 trials) supported amniotomy as early as 3 centimeters cervical dilatation following cervical ripening as a safe and effective method of hastening induction of labor. 85 . What is the evidence on turning off synthetic oxytocin infusions after active labor is established to give women more freedom to move during contractions?…”

Induction of labor or expectant management? Birth outcomes for nulliparous individuals choosing midwifery care

“…To that end, newer guidelines encourage cervical ripening for nulliparous individuals until a Bishop's score of 8 or higher is reached to help reduce CB for failed IOL, 32 which would likely increase the duration of the overall admission for IOL unless outpatient cervical ripening is used. Early amniotomy, in an effort to expedite IOL, has not been shown to reduce the risk of CB according to a recently published metaanalysis, 33 despite shortening the interval from admission to delivery. As practice changes occur that may increase elective IOL at earlier gestation, this study may serve as a point of comparison, and also prompt midwifery practices to examine their CB rates for late-term IOL and EM and work toward lowering CB rates through IOL management optimization as needed.…”