THE EFFECTS OF EARLY VERSUS DELAYED AMNIOTOMY ON THE OUTCOME OF LABOUR IN UNCOMPLICATED PREGNANCIES

Abstract

Introduction: The practice of routine early amniotomy in the management of labour may confer some benefits and at the same time some risks. With several studies indicating that there could be increased Caesarean section rate when amniotomy is routinely performed early in labour, and considering the increased risk of infections to the mother and newborn and other morbidities, the practice of routine early amniotomy needs to be re-examined. This study aims at determining the effects, of early amniotomy when compared to delayed amniotomy, on the outcome of labour in primigravid women with uncomplicated pregnancies who present with spontaneous onset of labour at term. Methodology: This was a prospective, randomized and comparative study carried out in the labour unit of Ahmadu Bello University Teaching Hospital, Shika, Zaria involving 90 primigravid women with uncomplicated pregnancies at term, randomized into either early or delayed amniotomy groups. Two management policies were adopted: early artificial rupture of the fetal membranes for the early amniotomy group or leaving the fetal membranes intact for as long as was feasible for the delayed amniotomy group. Labour was monitored using a partograph for early detection of dysfunctional labour, for appropriate intervention. Labour progress was assessed four hours after admission and subsequently at least every two hours until delivery. The main outcome measures were the need for oxytocin augmentation, the rate of cervical os dilatation, the duration of labour, the Caesarean section rate and the neonatal outcome measured by APGAR scores at 1 and 5 minutes, and admission to neonatal intensive care unit. Results: A policy of early amniotomy shortened the first stage labour duration in primigravid women by 100 minutes (Pearson’s chi square at 1 df and 95% CI was significant at P value < 0.01). The early amniotomy group was less likely to require oxytocin augmentation (22% vs 51%), and progressed at a faster cervical os dilatation rate, differences that were statistically significant (P values < 0.05 and <0.0001 respectively). There were no differences in the duration of the second stage of labour, the mode of delivery, C/S rates, abnormal FHR patterns or the neonatal outcome measured by one-minute and five-minute APGAR scores <7, and admission to neonatal unit(P > 0.5). Conclusion: This study showed that early amniotomy was an effective intervention in reducing labour duration in primigravid parturients with uncompliated pregnancies at term. It reduced the need for oxytocin augmentation, and in a low resource setting, like the site of this study, it did not increase the C/S rate. It should therefore be accorded more widespread use in similar circumstances.

THE EFFECTS OF EARLY VERSUS DELAYED AMNIOTOMY ON THE OUTCOME OF LABOUR IN UNCOMPLICATED PREGNANCIES