Does amniotomy shorten spontaneous labor or improve outcomes?
Q: Does amniotomy shorten spontaneous labor or improve outcomes? Evidence-based answer: No. Amniotomy neither shortens spontaneous labor nor improves any of the following outcomes: length of first stage of labor, cesarean section rate, maternal satisfaction with childbirth, or Apgar score <7 at 5 minutes (strength of recommendation [SOR]: A, large metaanalyses of randomized controlled trials [RCTs] and a single RCT with conflicting results). Amniotomy does result in about a 55% reduction of pitocin use in multiparous women, a small (5 minutes) decrease in the duration of second-stage labor in primiparous women, and about a 50% overall reduction in dysfunctional labor -- ie, no progress in cervical dilation in 2 hours or ineffective uterine contractions (SOR: A, large meta-analyses of RCTs and a single RCT with conflicting results). Amniotomy doesn't improve other maternal outcomes--instrumented vaginal birth; pain relief; postpartum hemorrhage; serious morbidity or death; umbilical cord prolapse; cesarean section for fetal distress, prolonged labor, antepartum hemorrhage--nor fetal outcomes-- serious neonatal morbidity or perinatal death; neonatal admission to intensive care; abnormal fetal heart rate tracing in first-stage labor; meconium aspiration; or fetal acidosis (SOR: A, large meta-analyses of RCTs and a single RCT with onflicting results).
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