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Amniotomy for shortening spontaneous labour

  • Review
  • Intervention

Authors


Abstract

Background

Intentional artificial rupture of the amniotic membranes during labour, sometimes called amniotomy or 'breaking of the waters', is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labour. However, there are concerns regarding unintended adverse effects on the woman and baby.

Objectives

To determine the effectiveness and safety of amniotomy alone for routinely shortening all labours that start spontaneously.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 November 2010).

Selection criteria

Randomised controlled trials comparing amniotomy alone versus intention to preserve the membranes. We excluded quasi-randomised trials.

Data collection and analysis

Two authors assessed identified studies for inclusion, assessed risk of bias and extracted data. Primary analysis was by intention to treat.

Main results

We have included 15 studies in this updated review, involving 5583 women. In the current review, data for women with spontaneous normal labour were pooled with data from one trial (involving 61 women) where women had spontaneous, but prolonged labour.

There was no clear statistically significant difference between the amniotomy and control groups in length of the first stage of labour (mean difference (MD) -20.43 minutes, 95% confidence interval (CI) -95.93 to 55.06), caesarean section (risk ratio (RR) 1.27, 95% CI 0.99 to 1.62), maternal satisfaction with childbirth experience (standardised mean difference (SMD) 0.27, 95% CI -0.49 to 1.04) or low Apgar score less than seven at five minutes (RR 0.57, 95% CI 0.31 to 1.06). There was no consistency between papers regarding the timing of amniotomy during labour in terms of cervical dilatation.

Authors' conclusions

On the basis of the findings of this review, we cannot recommend that amniotomy should be introduced routinely as part of standard labour management and care. We recommend that the evidence presented in this review should be made available to women offered an amniotomy and may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

Plain language summary

Amniotomy for shortening spontaneous labour

Evidence does not support the routine breaking the waters for women in spontaneous labour.

The aim of breaking the waters (also known as artificial rupture of the membranes, ARM, or amniotomy), is to speed up and strengthen contractions, and thus shorten the length of labour. The membranes are punctured with a crochet-like long-handled hook during a vaginal examination, and the amniotic fluid floods out. Rupturing the membranes is thought to release chemicals and hormones that stimulate contractions. Amniotomy has been standard practice in recent years in many countries around the world. In some centres it is advocated and performed routinely in all women, and in many centres it is used for women whose labours have become prolonged. However, there is little evidence that a shorter labour has benefits for the mother or the baby. There are a number of potential important but rare risks associated with amniotomy, including problems with the umbilical cord or the baby's heart rate.

The review of studies assessed the use of amniotomy routinely in all labours that started spontaneously. There were 15 studies identified, involving 5583 women, none of which assessed whether amniotomy increased women's pain in labour. The evidence showed no shortening of the length of first stage of labour and a possible increase in caesarean section. Routine amniotomy is not recommended as part of standard labour management and care.

Plain language summary

Amniotomija za skraćivanje spontanog poroda

Amniotomija za skraćivanje spontanog poroda

Dokazi ne idu u prilog rutinskom prokidanju vodenjaka kod žena u spontanim trudovima.

Cilj umjetnog prokidanja vodenjaka (poznat i pod nazivom amniotomija) je da ubrza i pojača trudove te time skrati dužinu trajanja poroda. Vodenjak se probija dugom kukom nalik na iglu za pletenje tijekom vaginalnog pregleda nakon čega plodna voda istječe. Smatra se da probijanje vodenjaka oslobađa kemikalije i hormone koji stimuliraju trudove. Amniotomija je posljednjih godina standardna praksa u mnogim zemljama u svijetu. U nekim bolničkim centrima se savjetuje i provodi na svim ženama dok se u mnogima koristi za žene čiji trudovi traju dugo. Međutim, malo je dokaza da je skraćeni porod koristan za majku ili dijete. Postoji niz potencijalno važnih, no rijetkih rizika povezanih s amniotomijom uključujući probleme s pupčanom vrpcom ili djetetovim otkucajima srca.

Cochrane sustavnim pregledom studija je napravljena ocjena rutinskog korištenja amniotomije za sve porođaje koji su započeli spontano. Pronađeno je 15 studija koje su uključivale 5583 žene. Nijedna od ovih studija nije ispitala povećava li amniotomija bol pri porodu. Dokazi su pokazali da amniotomija ne skraćuje prvu fazu poroda, a može dovesti do povećanja broja carskih rezova. Stoga se rutinska amniotomija ne preporučuje kao dio standardnog postupanja pri porodu.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre
Translation Sponsored by: Ministry of Education, Science and Sports

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