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The Impact of Early Versus Late Amniotomy on Duration of Labor, Maternal and Neonatal Outcomes in Iraqi Primigravida with Spontaneous Labor

Faris Anwer Rasheed, Alyaa Aziz Ahmed, Saad Abdulrahman Hussain.

Abstract
Amniotomy is defined as the artificial rupture of the amniotic membrane for a primary aim to speed up contraction and shorten the length of labor. The present study aims to evaluate the impact of early vs. late amniotomy on duration of labor, neonatal and maternal outcomes in Iraqi primigravida with spontaneous labor. In this randomized, single blinded prospective study, carried out in Al-Elweyia Maternity Teaching Hospital from March to December 2011, 210 women admitted for spontaneous labor were randomized to either early amniotomy (EA; n=105) or to late amniotomy (LA; n=105) groups. Augmentation with oxytocin was performed in both groups when inefficient uterine contractions present 1.0 hr after amniotomy. The primary outcome includes duration of labor and the rate of cesarean section, secondary outcomes included both maternal and neonatal outcomes. The results shows that EA shortens significantly the duration of 1st stage of labor (5.1 vs. 7.8 hr), increases C/S rate (33.3% vs. 15.2%) and the rate of chorioamnionitis (12.38% vs. 3.81%), with increase in frequency of oxytocin augmentation compared to LA group. Other parameters are not significantly affected. In conclusion, although early amniotomy was associated with increase in C/S and chorioamnionitis rates, it significantly decreases the total duration of labor compared to late amniotomy.

Key words: Amniotomy, labor induction, maternal outcome, neonatal outcome



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