Amniotomy followed by Foley catheter removal increased faster child birth

Amniotomy within one hour of Foley catheter removal resulted in a 2.3-fold quicker birth than expectant management, says an article published in American Journal of Obstetrics & Gynecology.

Although early amniotomy reduces the duration of spontaneous labor, there is no clear data on the best time to do amniotomy after cervical softening. There have been just a few high-quality studies on the use of early amniotomy intervention after labor induction. As a result, Helen B. Gomez Slagle and colleagues undertook this study to see if amniotomy within 1 hour of Foley catheter expulsion shortens labor length in persons having combination misoprostol and Foley catheter labor induction at term.

From November 2020 to May 2021, a randomized clinical trial compared amniotomy within 1 hour of Foley catheter ejection (early artificial rupture of membranes) versus expectant care. Parity was used to stratify the randomization. Participant labor management was standardized. Individuals who needed cervical ripening and were having induction at 37 weeks with a singleton pregnancy were suitable. The main outcome of this study was delivery time. Pearson chi-square, Wilcoxon rank sum, and Cox survival analyses were done with intent-to-treat principles, correcting for age, BMI, parity, method of delivery, Bishop score, and the interactions between randomization group and parity. To detect a 4-hour decrease in delivery time, a sample size of 160 was intended.

The key findings of this study were as follow:

1. A total of 160 individuals were randomized (79 for early artificial rupture of membranes and 81 for expectant management).

2. The median time to delivery was quicker with early artificial rupture of membranes than with expectant treatment.

3. A higher proportion of people in the early artificial rupture of the membrane group had birth within 24 hours.

4. The cesarean delivery rate did not differ between the two groups. Patients delivered 2.3 times quicker after early artificial membrane rupture.

5. There were no statistically significant differences in maternal and newborn outcomes.

In conclusion, in people having mechanical cervical ripening at term, early artificial membrane rupture should be explored.

Reference:

Gomez Slagle, H. B., Fonge, Y. N., Caplan, R., Pfeuti, C. K., Sciscione, A. C., & Hoffman, M. K. (2022). Early vs expectant artificial rupture of membranes following Foley catheter ripening: a randomized controlled trial. In American Journal of Obstetrics and Gynecology. Elsevier BV. https://doi.org/10.1016/j.ajog.2021.11.1368