Interventions for perceived delay in first stage of labour – amniotomy versus expectant management

Bibliographic reference Study type Evidence level Number of women Women’s characteristics Intervention Comparison Length of follow-up Outcome measures Effect size Source of funding Additional comments
Fraser WD;Turcot L;Krauss I;Brisson-Carrol G;

2005537
Systematic review - meta- analysisEvidence level: 1++9 trialswomen requiring augmentationIntervention: amniotomyComparison: an attempt to conserve the membranesFollow-up period: N/AOutcome Measures: Labour events, mode of delivery, maternal complication, neonatal outcomes, maternal satisfaction, duration of labourAmniotomy to shorten spontaneous labour
Cessation of contractions  1trial  925 women  OR 0.33 [0.17, 0.64]
Use of oxytocin
 8 trials
 3908 women
OR 0.79 [0.67, 0.92]

Use of analgesia (epidural/narcotics)
 7 trials
 3459 women
OR 0.99 [0.84, 1.17]

Dystocia
 1 trial
 925 women
OR 0.63 [0.48, 0.82]
Cord prolapse
 1 trial
 925 women
OR 0.14 [0.00, 6.84]

Abnormal or suspect fetal heart rate
 3 trials
 1217 women
OR 1.06 [0.80, 1.42]

Caesarean section
 8 trials
 4008 women
OR 1.26 [0.96, 1.66]

Instrumental vaginal delivery
 8 trials
 3990 women
OR 1.01 [0.85, 1.21]

Third degree tears
 1 trial
 1540 women
OR 0.98 [0.36, 2.64]

Malrotation of the fetal head
 1 trial
 32 women
OR 0.47 [0.12, 1.89]

Apgar score <7 at 5 minutes
 8 trials
 3076 women
OR 0.54 [0.30, 0.96]

Arterial cord pH <7.20
 2 trials
 719 women
OR 1.20 [0.78, 1.85]

Meconium aspiration syndrome
 2 trials
 1022 women
OR 3.09 [0.83, 11.46]

Neonatal jaundice
 4 trials
 2978 women
OR 1.10 [0.76, 1.59]
Admission to special care nursery
 6 trials
 2099 women
OR 1.13 [0.79, 1.61]

Cephalhaematoma
 2 trials
 1022 women
OR 1.66 [0.86, 3.21]

Neonatal infective morbidity
 2 trials
 1817 women
OR 1.32 [0.81, 2.14]

Maternal febrile morbidity
 4 trials
 2369 women
OR 0.86 [0.50, 1.50]

Maternal blood transfusion
 2 trials
 1463 women
OR 0.69 [0.29, 1.63]

Maternal satisfaction favourable
 3 trials
 1283 women
OR 1.15 [0.91, 1.47]

Labour pain unbearable
 3 trials
 1283 women
OR 0.76 [0.60, 0.97]

Randomisation-delivery interval
 3 trials
 156 women
MD −53.71 [−66.46, −40.97]

Randomisation-full dilatation interval
 3 trials
 576 women
MD −39.85 [−49.80, −29.90]

Second stage
 3 trials
 576 women
MD −3.06 [− 6.21, 0.10]

Amniotomy to shorten spontaneous labour in nulliparae

Cessation of contractions
 1 trial
 925 women
OR 0.33 [0.17, 0.64]

Use of oxytocin
 5 trials
 2404 women
OR 0.87 [0.73, 1.04]

Use of analgesia (epidural/narcotics)
 5 trials
 2403 women
OR 0.94 [0.76, 1.15]

Dystocia
 1 trial
 925 women
OR 0.63 [0.48, 0.82]

Cord prolapse
 1 trial
 925 women
OR 0.14 [0.00, 6.84]

Abnormal or suspect fetal heart rate
 1 trial
 694 women
OR 0.93 [0.67, 1.31]

Caesarean section
 5 trials
 2517 women
OR 1.14 [0.85, 1.54]

Instrumental vaginal delivery
 5 trials
 2488 women
OR 1.03 [0.85, 1.24]

Malrotation of the fetal head
 1 trial
 32 women
OR 0.47 [0.12, 1.89]

Apgar score <7 at 5 minutes
 5 trials
 2518 women
OR 0.94 [0.67, 1.33]

Arterial cord pH <7.20
 2 trials
 719 women
OR 1.20 [0.78, 1.85]

Meconium aspiration syndrome
 2 trials
 1022 women
OR 3.09 [0.83, 11.46]

Neonatal jaundice
 3 trials
 2383 women
OR 1.05 [0.70, 1.58]

Admission to special care nursery
 4 trials
 1996 women
OR 1.13 [0.78, 1.62]

Cephalhaematoma
 2 trials
 1022 women
OR 1.66 [0.86, 3.21]

Neonatal infective morbidity
 2 trials
 1353 women
OR 1.43 [0.85, 2.41]

Maternal febrile morbidity
 4 trials
 2369 women
OR 0.86 [0.50, 1.50]

Maternal blood transfusion
 2 trials
 1463 women
OR 0.69 [0.29, 1.63]

Maternal satisfaction favourable
 3 trials
 1283 women
OR 1.15 [0.91, 1.47]

Labour pain unbearable
 3 trials
 1283 women
OR 0.76 [0.60, 0.97]

Randomisation-delivery interval
 2 trials
 117 women
MD −53.67 [−66.50, −40.83]

Randomisation-full dilatation interval
 3 trials
 298 women
MD −39.45 [−50.10, −28.80]

Second stage
 3 trials
 308 women
MD −3.02 [−6.25, 0.21]

Amniotomy to shorten spontaneous labour in multiparae
Use of oxytocin
 1 trial
 940 women
OR 1.22 [0.67, 2.21]

Use of analgesia (epidural/narcotics)
 1 trial
 940 women
OR 1.14 [0.80, 1.63]

Caesarean section
 1 trial
 940 women
OR 2.65 [0.75, 9.29]

Instrumental vaginal delivery
 1 trial
 940 women
OR 1.20 [0.65, 2.21]

Neonatal jaundice
 1 trial
 531 women
OR 3.61 [0.89, 14.75]

Randomisation-full dilatation interval
 1 trial
 269 women
MD −54.00 [−101.37, −6.63]

Second stage
 1 trial
 269 women
MD −3.20 [−14.72, 8.32]
No sources of support supplied

From: Evidence tables

Cover of Intrapartum Care
Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth.
NICE Clinical Guidelines, No. 55.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Sep.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

No part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK [www.cla.co.uk]. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

PubMed Health. A service of the National Library of Medicine, National Institutes of Health.