Effects of routine early amniotomy on labor and health status of foetus and neonate: a meta-analysis / 中华妇产科杂志

ABSTRACT

Objective To analyze the effects of routine early amniotomy on labor and health status of foetus and neonate. Methods The results of “Early amniotomy increases the frequency of fetal heart rate abnormalities, A randomized controlled trial of early amniotomy, Effect of early amniotomy on the risk of dystocia in nulliparous women, The influence of elective amniotomy on fetal heart rate patterns and the course of labor in term patients A randomized study, Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term and A randomized controlled trial and meta-analysis of active management of labour were analyzed using Mantel-Haenszel method (fixed effect model) in meta-analysis. Results (1) The routine early amniotomy can shorten 94.90 min of the first stage of labor, 95% CI (-119.17,-70.52). (2) The OR for cesarean section was 1.25,95%CI (0.99-1.57),for instrumental vaginal delivery was 1.05, 95% CI (0.90-1.24). (3) There was no difference in abnormal fetal heart rate at first stage (OR=0.95, 95% CI 0.75-1.21), but there was increased abnormal fetal heart rate at second stage(OR=1.28, 95% CI 1.02-1.61). (4) The frequency of stained amniotic fluid and abnormal Apgar scores at 1 minute was not different significantly [ OR=1.17,95% CI (0.78-1.73);OR=0.71,95%CI (0.49-1.03)]. Conclusions Routine early amniotomy appears to be associated with both benefits and risks. Beneficial effects include reductions in labor duration and possible decrease in frequency of abnormal Apgar score at one minute. Risks include increase in abnormal fetal heart rate at second stage and possible rise in cesarean section rate.