European journal of obstetrics, gynecology, and reproductive biology · 2025
The impact of early amniotomy on delivery outcomes in pregnancies with fetal macrosomia.
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Touval Or, Cohen Gal, Koriat Adi, Heresco Lior, Biron-Shental Tal, Kovo Michal, Schreiber Hanoch
Аннотация
OBJECTIVE: To evaluate the effect of early versus late amniotomy on delivery outcomes in pregnancies complicated by fetal macrosomia.
METHODS: A retrospective cohort study was conducted at a tertiary university-affiliated medical center between 2014 and 2020. The included patients admitted during the latent phase of labor (<6 cm cervical dilatation) who delivered neonates with birthweight ≥ 4,000 g. and underwent amniotomy during labor. Participants were classified into two groups according to cervical dilatation at the time of amniotomy: early amniotomy (≤4 cm) and late amniotomy (>4 cm). Delivery and neonatal outcomes were compared, and multivariable logistic regression was performed to adjust for potential confounders.
RESULTS: A total of 789 patients were included (early amniotomy, n = 353; late amniotomy, n = 436). Baseline estimated fetal weights and neonatal birthweights were similar between groups. Compared with the late amniotomy group, the early amniotomy group had higher rates of nulliparity, diabetes, induction of labor (IOL), epidural use, and intrapartum fever. In a multivariable analysis of the entire cohort, after adjusting for confounders, early amniotomy was independently associated with an increased risk of intrapartum cesarean delivery. However, sub analyses for induced vs. spontaneous labors revealed that this association was only observed in women undergoing IOL (14 % vs. 4 %, p = 0.009), whereas no significant difference was observed among women presenting in spontaneous labor (8.1 % vs. 5.2 %, p = 0.214).
CONCLUSIONS: In pregnancies with fetal macrosomia, early amniotomy was associated with an increased risk of intrapartum cesarean delivery among women undergoing induction of labor. The timing of amniotomy in this population should therefore be carefully considered.
METHODS: A retrospective cohort study was conducted at a tertiary university-affiliated medical center between 2014 and 2020. The included patients admitted during the latent phase of labor (<6 cm cervical dilatation) who delivered neonates with birthweight ≥ 4,000 g. and underwent amniotomy during labor. Participants were classified into two groups according to cervical dilatation at the time of amniotomy: early amniotomy (≤4 cm) and late amniotomy (>4 cm). Delivery and neonatal outcomes were compared, and multivariable logistic regression was performed to adjust for potential confounders.
RESULTS: A total of 789 patients were included (early amniotomy, n = 353; late amniotomy, n = 436). Baseline estimated fetal weights and neonatal birthweights were similar between groups. Compared with the late amniotomy group, the early amniotomy group had higher rates of nulliparity, diabetes, induction of labor (IOL), epidural use, and intrapartum fever. In a multivariable analysis of the entire cohort, after adjusting for confounders, early amniotomy was independently associated with an increased risk of intrapartum cesarean delivery. However, sub analyses for induced vs. spontaneous labors revealed that this association was only observed in women undergoing IOL (14 % vs. 4 %, p = 0.009), whereas no significant difference was observed among women presenting in spontaneous labor (8.1 % vs. 5.2 %, p = 0.214).
CONCLUSIONS: In pregnancies with fetal macrosomia, early amniotomy was associated with an increased risk of intrapartum cesarean delivery among women undergoing induction of labor. The timing of amniotomy in this population should therefore be carefully considered.