Publication:

Impact of planned amniotomy on perinatal outcome: a randomized control trial

Background O’Driscoll and Meagher (1968) introduced amniotomy as a component of active management of labour. Several institutions have implemented components of this management scheme with varying results. There is a risk of cord prolapse, variability in fetal heart rate, increased chances of ascending infection which may culminate in chorioamnionitis. As per certain studies, fetal outcome is similar in case of Amniotomy and spontaneous ruptured membranes. As source of great controversy, the active management of labor, as classically defined, is routinely misunderstood and misapplied in many clinical settings. Some previous randomized trials suggest Amniotomy as an effective and safe method for induction and augmentation of labour without altering rate of cesarean section while some disagree. Hence, the study was designed to evaluate the effect of amniotomy on perinatal outcome.

Methods As per the selection criteria, 250 women with singleton uncomplicated pregnancy with spontaneous onset of labour admitted in labour ward were enrolled in the study. All cases were randomized and allotted to either study group (ARM group) or control group (SRM group) equally according to random number table generated by computer. Women of study group offered amniotomy at 4cm dilatation of cervix. Before doing Amniotomy, fetal lie and presentation, engagement of head and fetal heart sounds were conformed. The results were then recorded.

Results Planned amniotomy is recommended where the clinician suspects fetal compromise as early detection of MSL in planned amniotomy improves the neonatal outcome. Planned amniotomy does not adversely affect the neonatal outcome in terms of low Apgar score at 5 min, neonatal resuscitation and NICU admission. The incidence of neonates born with MSL in planned amniotomy group is better as compared to neonates born with MSL in SRM group.

Conclusions T Planned amniotomy does not have any adverse effect on the perinatal outcome as compared to SRM group. The incidence of neonates born with MSL in planned amniotomy group is better as compared to neonates born with MSL in SRM group.