Benefits of preserving the intact amniotic sac during labor: a narrative systematic review

Background: Artificial rupture of membranes (AROM) has long been considered a routine intervention in labor management, aimed at accelerating progress and facilitating fetal monitoring. However, emerging evidence challenges this paradigm, suggesting that preserving the amniotic sac intact throughout labor may confer significant maternal and neonatal benefits. Methods: We performed a narrative systematic review of studies published up to July 2025, identified through PubMed, Embase, the Cochrane Library, and Web of Science. Eligible studies included randomized controlled trials, cohort studies, case series, and reviews comparing outcomes of intact membranes with AROM. Maternal outcomes included duration of labor, mode of delivery, need for augmentation, perineal trauma, and infection. Neonatal outcomes included fetal heart rate (FHR) stability, Apgar scores, neonatal infection, and respiratory adaptation. Data heterogeneity precluded meta-analysis; therefore, findings were synthesized narratively. Results: Evidence consistently indicates that intact membranes are associated with reduced risk of severe perineal trauma, lower rates of maternal infection, decreased need for oxytocin augmentation, and fewer cesarean deliveries for “failure to progress.” Neonatal benefits include reduced intrapartum stress, more stable FHR patterns, enhanced protection against ascending infection, and a smoother respiratory transition at birth. Historical analysis reveals that routine AROM emerged as part of mid-20th-century active management of labor but is increasingly being replaced by selective, indication-based use. Conclusion: Maintaining the amniotic sac intact during labor supports physiological birth, minimizes unnecessary interventions, and optimizes maternal and neonatal outcomes. Embracing this evidence-based, respectful approach to childbirth represents a paradigm shift away from routine AROM towards individualized, less interventional care.