Effect of Early Amniotomy on Delivery Outcome with/without Cervical Ripening: A Systematic Review and Meta‑Analysis

Abstract

Background: Although shorter labors are the benefits of Early Amniotomy (EA), it may lead to risks such as non‑reassuring fetal testing and cesarean delivery. Also, the effect of cervical ripening to induce labor before amniotomy is unknown. This systematic review and meta‑analysis evaluated the effect of EA on the delivery outcome with or without cervical ripening. Materials and Methods: Bibliographic search was conducted without time limit until June 2020. PubMed, Scopus SID Magiran, Cochrane Library Science website, and ISI databases were searched with English and Farsi keywords, including amniotomy, delivery, induced, and pregnancy outcome. Results: The meta‑analysis on ten clinical trials showed that the incidence of cesarean section was lower (0.89% VS 0.94; relative risk, 0.85; 95% confidence interval, 0.55–1.30) compared to the group without cervical ripening, and the time to induce labor was approximately 55 minutes (mean difference, 0.91 hour; 95% confidence interval, ‑1.43 to ‑ 0.33). Conclusions: If EA is performed in women after cervical ripening, the incidence of cesarean section will not increase, and the duration of labor will be reduced. A shorter delivery time is associated with perinatal benefits and greater maternal satisfaction. Furthermore, EA with cervical ripening may reduce monitoring time in busy hospitals with limited medical staff.