The association between delayed amniotomy and adverse outcomes in labor induction.

Abstract

OBJECTIVE:

To assess if delayed amniotomy during labor induction is associated with adverse delivery outcomes.

STUDY DESIGN:

Retrospective cohort study of women with a viable, singleton gestation who underwent labor induction at a tertiary-care hospital (4/2014-3/2017). Women were excluded if oxytocin was not used or if spontaneous rupture of membranes (ROM) occurred ≤8 h after oxytocin initiation. The primary outcome was cesarean delivery, and secondary outcomes included postpartum hemorrhage, maternal infectious morbidity, neonatal 5-min Apgar score <7, and neonatal intensive care unit admission. Women were compared by timing of amniotomy: delayed (ROM > 8 h after oxytocin initiation) versus not delayed. Multivariable logistic regression was used to estimate the association between delayed amniotomy and study outcomes.

RESULTS:

Of 2081 women who met inclusion criteria, 1125 (before 54%) had delayed amniotomy. Women with delayed amniotomy had ROM 12.7 h (IQR 10.0, 17.9) after oxytocin versus 5.0 h (IQR 3.7, 6.5) without delayed amniotomy. In multivariable regression, delayed amniotomy was associated with increasingly higher odds of cesarean as maternal obesity severity increased (aOR 1.58, 95 %CI 1.24-2.03 at BMI 30 kg/m2; aOR 2.15, 95 %CI 1.45-3.21 at BMI 40 kg/m2; aOR 2.93, 95 %CI 1.54-5.57 at BMI 50 kg/m2).

CONCLUSION:

Delayed amniotomy >8 h after starting oxytocin for labor induction was associated with higher odds of cesarean delivery. Significant delay in ROM should be avoided during labor induction.

• Authors: Ashley N Battarbee, Sharon Vaz, David M Stamilio
• Journal: European journal of obstetrics, gynecology, and reproductive biology (Eur J Obstet Gynecol Reprod Biol) Vol. 247 Pg. 85-89 (Apr 2020) ISSN: 1872-7654 [Electronic] Ireland
• PMID: 32078981 (Publication Type: Journal Article)
• Copyright: Copyright © 2020 Elsevier B.V. All rights reserved.

Chemical References

• Oxytocin

Topics

• Adult
• Amniotomy (adverse effects, methods)
• Body Mass Index
• Case-Control Studies
• Cesarean Section (statistics & numerical data)
• Female
• Humans
• Infant, Newborn
• Male
• Oxytocin (administration & dosage)
• Postpartum Hemorrhage (epidemiology, etiology)
• Pregnancy
• Pregnancy Outcome (epidemiology)
• Retrospective Studies
• Time Factors
• Young Adult