Sompolinsky Yishai, Guedalia Joshua, Vilk-Ayalon Naama, Cohen Sarah M, Greenbaum Shirley, Kabiri Doron, Yagel Simcha, Lipschuetz Michal
Obstetrics & Gynecology Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Henrietta Szold Hadassah Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel.
Front Med (Lausanne). 2025 Oct 2;12:1612947. doi: 10.3389/fmed.2025.1612947. eCollection 2025.
Artificial rupture of membranes (AROM) is a common intervention during delivery, usually done in order to expedite delivery. Studies to determine optimal timing of AROM according to cervical dilation were inconclusive. However, other important factors, which are known to be associated with timing of delivery were ignored. One of these factors is fetal head station (FHS). We sought to investigate the association between FHS during AROM and time to delivery and other obstetrical outcomes.
A retrospective cohort study encompassing data from labors during a 12-year period were analyzed. All cases of singleton, term pregnancy with documented AROM time were included. The study population was stratified by parity.
This study cohort included 45,898 singleton, term vaginal delivery parturients with time stamp at time of AROM and delivery. Stratification by parity yielded 11,947 primiparas (26%) and 33,951 multiparas (74%). Across all sub-cohorts, as fetal head station decreased at AROM the duration from ROM to delivery was shorter. This trend seems to be stronger for multiparas than primiparas. Rates of cesarean delivery, postpartum hemorrhage, neonatal intensive care unit admission, and low 5-min Apgar scores were also negatively associated with decrease in fetal head station at AROM across all cervical dilations.
Lower fetal head station at AROM is associated with shorter time to delivery as well as lower rates of cesarean delivery, postpartum hemorrhage, NICU admission, and 5-min Apgar ≤ 7. Fetal head station should be considered alongside cervical dilation during AROM. Our findings underscore the necessity for personalized timing of AROM, especially in multiparous women, to enhance maternal and neonatal health outcomes.
人工破膜（AROM）是分娩过程中常见的干预措施，通常是为了加速分娩。根据宫颈扩张程度来确定AROM最佳时机的研究尚无定论。然而，其他已知与分娩时机相关的重要因素却被忽视了。其中一个因素是胎头位置（FHS）。我们试图研究AROM时的胎头位置与分娩时间及其他产科结局之间的关联。
对一项涵盖12年分娩数据的回顾性队列研究进行了分析。纳入所有记录了AROM时间的单胎足月妊娠病例。研究人群按产次分层。
本研究队列包括45,898例有AROM和分娩时间标记的单胎足月阴道分娩产妇。按产次分层后得到11,947例初产妇（26%）和33,951例经产妇（74%）。在所有亚队列中，随着AROM时胎头位置下降，从破膜到分娩的时间缩短。这种趋势在经产妇中似乎比初产妇更明显。在所有宫颈扩张程度下，剖宫产率、产后出血率、新生儿重症监护病房入院率以及5分钟Apgar评分低的发生率也与AROM时胎头位置下降呈负相关。
AROM时较低的胎头位置与较短的分娩时间以及较低的剖宫产率、产后出血率、新生儿重症监护病房入院率和5分钟Apgar评分≤7相关。在AROM期间，应将胎头位置与宫颈扩张程度一并考虑。我们的研究结果强调了个性化AROM时机的必要性，特别是在经产妇中，以改善母婴健康结局。
