Discussion
APL, IOL
DILATION, IOL
The main objective of this study was to evaluate the impact of EA on the time to active phase and the duration of labor, maternal and neonatal outcomes during IOL.We observed a significant reduction in the time to APL and the overall duration of labor with EA as compared to LA in IOL. Moreover, the rate of caesareans section for failed IOL was significantly lower in the early amniotomy group, without any significant difference in the overall rate of CS between the two groups. These benefits were associated with no significant difference between both groups regarding maternal and neonatal outcomes.Our study presents several strengths including randomization, the implementation of the CONSORT recommendation, the classification by parity, a well codified oxytocin administration protocol, and a clear description of early and late amniotomy.However, this study has its limitations. The primary outcome measure of our study was the time to the APL, as successful IOL is defined as achieving this phase after oxytocin and unsuccessful IOL is defined as the inability to reach it, even though the aim of IOL is natural childbirth. Nevertheless, there is no consensus on the definition of the APL among international societies, leading to conflicting interpretations of successful IOL. For instance, the American college of obstetricians and gynecologists (ACOG) defines it as cervical dilation greater than 6 cm [Two meta-analyses, focused on the comparison between LA and EA [The assessment of cervical ripeness using the BISHOP score is a crucial aspect in achieving successful IOL. In this study, our aim was to investigate the impact of amniotomy on IOL success by defining a BISHOP score greater than six. By doing so, we could obtain a more precise evaluation of the actual effect of amniotomy on the success of IOL. The use of a specific BISHOP score in our study provided valuable insights into the effectiveness of amniotomy, which could facilitate better interpretation and comparability of results, leading to more robust conclusions.In previous clinical trials, a shorter duration of labor was observed in the EA group in comparison to LA group (5–10), except for the studies conducted by Levy et al and Lee et al which did not demonstrate a significant difference in the duration of labor between the two groups [