Association of re‐amniotomy in prelabor rupture of membranes at term and increased risk of cesarean delivery

Objective To determine delivery outcomes in women diagnosed with prelabor rupture of membranes (PROM) who required re‐amniotomy. Methods This retrospective cohort study included 24 966 women with PROM at a single university‐affiliated tertiary medical center (2011–2023). Labor outcome was compared between women requiring re‐amniotomy during delivery and those who did not. The primary outcome was the rate of cesarean delivery (CD). Secondary outcomes were maternal obstetric complications, including assisted operative vaginal delivery, intrapartum fever, postpartum hemorrhage, need for blood products transfusion and need for re‐admission within 30 days postpartum. Results Re‐amniotomy was required in 5.5% ( n = 1364) of cases and was associated with higher CD rates (10.2% versus 5.6%, P < 0.001). In the adjusted analysis controlling for significant confounders identified in univariate analysis, re‐amniotomy remained independently associated with increased risk for CD (adjusted odds ratio 1.452, 95% confidence interval 1.010–2.080, P = 0.043). For secondary maternal obstetric outcomes (assisted vaginal delivery, intrapartum fever, and postpartum hemorrhage), no independent associations with re‐amniotomy were found after multivariate adjustment. Women requiring re‐amniotomy had significantly longer intervals from PROM to delivery (26:49 ± 19:52 vs. 18:36 ± 14:34 h:min, P < 0.001) and lower rates of achieving active labor within 24 h (62.3% vs. 74.2%, P < 0.001). Conclusions The need for re‐amniotomy during delivery in women with PROM is associated with an increased risk for CD and prolonged labor.