Infectious morbidity associated with early amniotomy during labor induction
Author Department
Ob/Gyn
Document Type
Article, Peer-reviewed
Publication Date
11-2025
Abstract
Objective: This study's purpose was to determine if an early amniotomy increased the risk of maternal and neonatal infectious morbidity when compared with late amniotomy.
Study design: This was a single-center retrospective cohort study performed between 1/1/2010 and 3/31/2018. It assessed the relationship between eligible term women undergoing labor induction with early amniotomy, defined as artificial rupture of membranes (AROM) performed less than 12 h from start of cervical ripening, compared with women who do not have an early amniotomy. The primary outcome was a composite of chorioamnionitis and/or neonatal sepsis. Secondary outcomes included isolated maternal fever, composite maternal morbidity, cesarean delivery, amnioinfusion, any transfusion, length of labor induction, cord prolapse, NICU admission, and Apgar score.
Results: Among the 1200 patients, the rate of chorioamnionitis or neonatal sepsis was lowest at 0.4 % for patients with early amniotomy < 12 h, increased to 3.5 % in both the interval to AROM 12 to < 18 h and 18 to < 24 h, and further increased to 5.9 % when AROM occurred after 24 h from start of cervical ripening (p = 0). For the secondary outcomes, the rate of cesarean was significantly lower in the early AROM group < 12 h at 13.9 % compared to all other later periods of AROM, with the highest rate in the >24 h group (34.9 %, p = 0). The mean time from amniotomy to delivery was increased across each time interval, lowest at 11.5 in the < 12-hour interval and highest at 44.6 h for the interval with AROM at 24 h and beyond (p = 0). Composite maternal morbidity also increased across each time interval, lowest in the < 12-hour group at 17.6 % and highest in the group that had AROM occur after 24 h at 31.2 % (p = 0). There were no significant differences in neonatal secondary outcomes.
Conclusion: When amniotomy is performed < 12 h after initiation of cervical ripening, there does not appear to be an increased rate of infectious morbidity. When performing amniotomy in a closer time interval to end of cervical ripening, it appears infectious morbidity may be reduced with shorter duration from amniotomy to delivery while decreasing cesarean and maternal morbidity rates.
Keywords: Amniotomy; Delayed; Induction; Infection; Labor; Timing.
Recommended Citation
Schoen CN, Baker E, Thind R, Shah S, Jan SA, Knee AB. Infectious morbidity associated with early amniotomy during labor induction. Eur J Obstet Gynecol Reprod Biol. 2025 Nov 20;317:114848. doi: 10.1016/j.ejogrb.2025.114848. Epub ahead of print.
PMID
41313863