Background

Amniotomy (also referred to as artificial rupture of membranes [AROM]) is the procedure by which the amniotic sac is deliberately ruptured so as to cause the release of amniotic fluid. Amniotomy is usually performed for the purpose of inducing or expediting labor or in anticipation of the placement of internal monitors (uterine pressure catheters or fetal scalp electrodes). It is typically done at the bedside in the labor and delivery suite.

Indications and Contraindications

Amniotomy is indicated in the following situations:

When internal fetal or uterine monitoring is needed^[1]
For induction of labor, usually in conjunction with an oxytocin infusion^{[2, 3, 4, 5, 6, 7]}; a meta-analysis showed that routine early amniotomy after cervical ripening does not increase the risk of cesarean delivery^[8]
For augmentation of labor, in that amniotomy leads to an increase in plasma prostaglandins^[9]; data on the effectiveness of labor augmentation are mixed^{[10, 11]}

Amniotomy may be contraindicated in the following situations:

Known or suspected vasa previa
Any contraindications to vaginal delivery
Unengaged presenting part (although this obstacle may be overcome with the use of a controlled amniotomy or the application of fundal or suprapubic pressure)

Periprocedure

Cunningham, Levano, Bloom, Hauth, Rouse, Spong. Abnormalities of the Placenta, Umbilical Cord and Membranes. Williams Obstetrics. 23rd. United States: McGraw-Hill; 2010. Chapter 27.
Nachum Z, Garmi G, Kadan Y, Zafran N, Shalev E, Salim R. Comparison between amniotomy, oxytocin or both for augmentation of labor in prolonged latent phase: a randomized controlled trial. Reprod Biol Endocrinol. 2010. 8:136. [QxMD MEDLINE Link].
Bricker L, Luckas M. Amniotomy alone for induction of labour. Cochrane Database Syst Rev. 2000. CD002862. [QxMD MEDLINE Link].
Cooley SM, Geary MP, O'Connell MP, McQuillan K, McParland P, Keane D. How effective is amniotomy as a means of induction of labour?. Ir J Med Sci. 2010 Sep. 179(3):381-3. [QxMD MEDLINE Link].
Cunningham, Lenevo, Bloom, Hauth, Rouse, Spong. Labor Induction. Williams Obstetrics. 23rd. United States: McGraw-Hill; 2010. Chapter 22.
Howarth GR, Botha DJ. Amniotomy plus intravenous oxytocin for induction of labour. Cochrane Database Syst Rev. 2001. CD003250. [QxMD MEDLINE Link].
Selo-Ojeme DO, Pisal P, Lawal O, Rogers C, Shah A, Sinha S. A randomised controlled trial of amniotomy and immediate oxytocin infusion versus amniotomy and delayed oxytocin infusion for induction of labour at term. Arch Gynecol Obstet. 2009 Jun. 279(6):813-20. [QxMD MEDLINE Link].
De Vivo V, Carbone L, Saccone G, et al. Early amniotomy after cervical ripening for induction of labor: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2020 Apr. 222 (4):320-9. [QxMD MEDLINE Link].
Mitchell MD, Flint AP, Bibby J, Brunt J, Arnold JM, Anderson AB. Rapid increases in plasma prostaglandin concentrations after vaginal examination and amniotomy. Br Med J. 1977 Nov 5. 2(6096):1183-5. [QxMD MEDLINE Link].
Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev. 2007. (4):CD006167. [QxMD MEDLINE Link].
Wei S, Wo BL, Xu H, Luo ZC, Roy C, Fraser WD. Early amniotomy and early oxytocin for prevention of, or therapy for, delay in first stage spontaneous labour compared with routine care. Cochrane Database Syst Rev. 2009 Apr 15. CD006794. [QxMD MEDLINE Link].
Battarbee AN, Palatnik A, Peress DA, Grobman WA. Association of Early Amniotomy After Foley Balloon Catheter Ripening and Duration of Nulliparous Labor Induction. Obstet Gynecol. 2016 Sep. 128 (3):592-7. [QxMD MEDLINE Link].
Ray A, Ray S. Antibiotics prior to amniotomy for reducing infectious morbidity in mother and infant. Cochrane Database Syst Rev. 2014 Oct 1. CD010626. [QxMD MEDLINE Link].

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Amniotomy

Background

Indications and Contraindications

References

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