Systemic Review and Meta-analysis: Evaluating the Role of Early Amniotomy in Labour Induction

Abstract Objective: The objective of the study was to evaluate early amniotomy (EA) in labour induction in terms of its duration, maternal/neonatal effects and assess the risks/side effects. Methodology: This is a systematic review of 32 studies that follow the PRISMA guidelines. The research question was structured using the population, intervention, comparison and outcome framework, which guided the search strategy. The search term combinations included ‘early amniotomy’, ‘late amniotomy’, ‘spontaneous amniotomy’, ‘pregnant women’, ‘labour duration’ and ‘caesarean section rates’. These terms were used to when searching on databases including PubMed, Embase and Cochrane Library without a date range. Rayyan search tool came in handy to screen titles and abstracts for eligibility, with full-text review conducted for articles meeting the inclusion criteria. Study Design: A total of 32 randomized controlled trial (RCT) studies are included in the analysis, with a sample total of 9120 patients. The maximum value was 1540 and minimum value was 20. These studies are composed of 32 RCTs. Sample sizes varied significantly across studies, ranging from fewer than 50 to over 1000 participants, reflecting a wide spectrum of clinical settings and populations. Outcomes assessed included efficacy, safety and quality of life, with the majority of studies demonstrating statistically significant results favouring the interventions. The randomisation in several studies helps reduce selection bias, but the lack of blinding in some studies may introduce performance and detection bias. This a systematic review focused on RCTs only, offering a higher quality of study design choice. Sample sizes also varied, with some studies being adequately powered and others not. RCTs generally provide high-level evidence. The level of evidence ranges from moderate to high based on study quality. Results: The pooled results of the RCT studies have shown that EA induction consistently decreased the duration of labour in comparison to spontaneous/late amniotomy, achieving higher chances of vaginal delivery within 24 h. No significant difference was noted regarding the caesarean rates and maternal/neonatal outcomes.