Early amniotomy. Useful video about childbirth in a maternity hospital. Weakness of generic forces

Hearing this medical term, like “amniotomy,” expectant mothers begin to wonder what it means and often find cautionary and even frightening reviews from “experienced women in labor” about this procedure. Often after this, a woman develops a fear of childbirth and begins to mistrust doctors. In our material, we will clearly explain what the concept of “amniotomy” actually means, determine when such manipulation is prescribed and what risks exist.

What does the term mean?

So, amniotomy - what is it? This is an artificial rupture of the membranes using a special medical instrument.

As is known, unborn child in the womb of a woman it is located in a dense bladder filled with amniotic fluid. Thus the fetus is protected from external negative impact and intrauterine infection. In addition, they participate in metabolic processes, contain various useful substances.

With normal flow labor activity The membranes rupture under the pressure of the uterus during contractions, after which amniotic fluid flows out. And only then does the child move along the birth canal.

But not in all cases everything goes so smoothly. In some situations, it is necessary to tear the protective tissue artificially. Then the woman is prescribed an amniotomy. What it is and what medical indications exist for such manipulation will be discussed below.

Indications for amniotomy

The procedure is carried out to solve such medical problems, as artificial stimulation of labor or assistance in delivery.

In what cases is amniotomy prescribed even before the natural process of birth of the baby begins:

confirmed diagnostic studies post-term pregnancy;
gestosis in late pregnancy;
the presence of Rh conflict;
detection in the expectant mother serious pathologies from the heart muscle, kidneys, lungs, metabolic and autoimmune processes;
abruption of a normally located placenta later pregnancy;
fetal diagnosis;
prolonged failure of labor;
prolapse amniotic sac(protrusion into the cervix);
over 28 weeks.

That is, the amniotomy procedure is carried out when necessary for medical indications call urgently artificially generic activity. Usually, within 12 hours after the manipulation, the woman begins to experience contractions. If labor has not begun after the specified time, doctors decide on the need to use medications or performing an operation caesarean section.

An amniotomy is often performed during childbirth. The doctor will recommend such manipulation in the following cases:

the fetal bladder did not rupture on its own when the cervix was 8 cm dilated;
multiple pregnancy;
lack of amniotic fluid (oligohydramnios);
excess intrauterine fluid (polyhydramnios);
long;
placental presentation;
weak labor, lack of contractions or pushing;
post-term pregnancy;
high blood pressure in a woman.

Mandatory conditions for conducting

Even if there are medical indications, it is not always possible to perform an amniotomy. In order to perform the manipulation, certain conditions must be present:

there should be only one fruit;
the position of the child in the uterus is cephalic;
pregnancy is 38 weeks or more;
fetal weight no more than 3 kg;
women meet established standards;
missing ;
the birth canal is ready for the advancement of the baby (examination confirms shortening of the cervix).

Types of amniotomy

In medicine, it is customary to classify the procedure depending on the period of its implementation:

Prenatal. This procedure is carried out to induce labor. ahead of schedule. For example, when a woman is diagnosed with a pathology such as prolapsed membranes, the doctor may decide to artificially induce labor.
Early amniotomy is performed when a woman has contractions and incomplete (up to 6 cm) dilatation of the cervix. The purpose of this manipulation is to speed up labor.
Timely amniotomy - what is it? This type of procedure is performed when the cervix is fully opened to intensify or intensify contractions.
A delayed amniotomy is performed already at the pushing stage, if the amniotic sac has not ruptured by this point naturally. What is the danger of having a baby in the membranes or, as people call it, “in the shirt”? This situation is considered a deviation from the norm, this is fraught with complications such as bleeding in a woman or the development of hypoxia in a child.

Contraindications

Amniotomy is prohibited in cases where all of the above conditions are not met or natural delivery is contraindicated, for example, when:

incorrect presentation of the fetus;
genital herpes;
large child;
the presence of scars on the wall of the uterus and vagina;
intrauterine hypoxia.

How is amniotomy performed?

The amniotomy procedure is performed by an obstetrician-gynecologist in a maternity hospital. A special medical instrument is used, which is called a “branch” and has the shape of a hook. The doctor makes a hole in the membrane with an instrument and then uses his fingers to widen the hole. At the same time, the specialist controls the volume of amniotic fluid leakage.

After this, the woman needs to lie down for half an hour. During this period, doctors monitor the condition of the woman and her fetus: monitor the heartbeat, record the appearance of contractions, analyze general indicators. Depending on how the body expectant mother reacted to the procedure, doctors are drawing up a plan for further actions.

Amniotomy: consequences

Usually the amniotomy takes place without any complications. But if not correct implementation manipulation, it is possible to develop such conditions as:

prolapse of the umbilical cord or parts of the baby’s body (legs or arms), which complicates further management of childbirth;
bleeding caused by rupture of a large vessel;
weak labor activity;
disturbances in the condition of the fetus as a result of sudden changes in living conditions;
excessive activation of the birth process;
infection of the mother or child.

Most often, labor after amniotomy begins within a few hours and proceeds rapidly.

When a woman is due to give birth, but her water has not yet broken and she is already having contractions, the gynecologist performs an amniotomy, accelerating the woman’s labor. This is a simple manipulation that should not cause concern. In any maternity hospital, such a procedure is routine, and doctors and patients treat it calmly and without anxiety.

How is amniotomy performed?

The obstetrician uses a special tool - a holder and a small hook. With this device he punctures the bladder. In this case, the woman in labor does not feel anything, since the procedure is absolutely painless. After stimulation, the expectant mother can feel her water break. This operation is performed when the membrane of the bladder is clearly visible, which usually happens during intense contractions. This is the best and safest moment for the baby's health.

Types of amniotomy

There are four types of amniotomy:

Prenatal amniotomy. This manipulation is done to start the birth process.
Early. It is done when the cervix reaches 7 cm.
Timely. The uterus reached a diameter of 8-10 cm.
Late. It is carried out when the baby’s head drops into the pelvic area.

Many women are distrustful and fearful of such intervention; most of them are confident that they will give birth on their own, but this approach to the situation is illiterate and dangerous. You shouldn’t risk your health, especially your baby’s.

Indications for the procedure

There are situations when amniotomy is necessary to save the fetus and the woman in labor. These include:

Preeclampsia. About 80% of women experience puffiness and swelling during pregnancy. Preeclampsia is accompanied by increased blood pressure. A lot of protein appears in the urine. This is an important indication for piercing the bladder. Although it should be noted that gestosis in later months is much less common. It usually appears in the early stages.
Post-term pregnancy. On average, a normal pregnancy lasts 38-40 weeks. If the 41-42nd week has passed, there is a reason to think about opening the bubble. With a long gestation period of 42-43 weeks, the placenta begins to age and ceases to perform its functions, and this is very unhealthy for the baby. If the cervix is ready, that is, it is soft, short and allows a finger to pass through, do not hesitate to pierce the bladder, since a lack of oxygen in the fetus can lead to asphyxia.
Generic weakness. This is when contractions are present, but they are weak and unproductive. Sometimes women in labor themselves cannot stand it and ask to speed up the process through this procedure.
. In this case, the uterus does not work 100% due to large quantity amniotic fluid. It contracts incorrectly and contractions are weak.
Refusal of amniotomy can provoke placental abruption, which will lead to bleeding and all sorts of complications. Of course, expectant mothers can be understood; most want to give birth naturally, but the interests of the child must come first.

Contraindication to amnitomy

A competent doctor always knows what to do in a given situation, but the expectant mother should also know everything about upcoming birth. Puncture of the bladder is impossible if:

Disagreement of the mother in labor. Specialists cannot carry out any intervention without the patient’s permission. The woman in labor has the right to refuse the procedure, but the responsibility rests entirely on her shoulders. The refusal is documented.
. If a pregnant woman is expecting two or more children.
Impossibilities natural birth. Sometimes the cervix does not open, being in a sacral state. In this case, rupture of the bladder is impossible, and there is every reason for a cesarean section.
Incorrect position of the fetus. If the child is positioned non-standardly, the procedure is not used.
Fetal weight less than 3 kg.

Consequences and risks of amniotomy

Amniotomy during childbirth does not pose any danger to the mother or baby. Usually everything goes smoothly and without problems. The only thing is that the procedure should be carried out carefully, since the bubble itself is covered blood vessels. There is always a risk of damaging the vessel and thereby causing it. Doctors usually pierce the bladder when the baby’s head is already in the pelvis, as it compresses the blood vessels and protects against undesirable consequences.

If the rupture of amniotic fluid does not produce any results and the woman cannot give birth, there is a risk of infection of the uterus and baby, since the amniotic fluid served as a barrier for the small organism. In such a situation, special stimulant drugs are used. The most recent variant of the development of such births is. Sometimes such a measure is necessary to complete the process. It will help the baby to be born without complications.

What is amniotomy during childbirth? This question is asked by almost every pregnant woman who has heard such a definition.

Artificial opening of the amniotic sac is not a rare event in obstetric practice. Approximately 7% of all births are accompanied by this procedure.

Despite its apparent simplicity, amniotomy is performed only for medical reasons. As a rule, it is carried out to activate labor.

What are the indications for amniotomy? What to do if the baby was born in the amniotic sac?

What it is

Amniotomy or puncture of the amniotic sac is a procedure artificial violation integrity of the fetal membrane during childbirth.

As a rule, this process occurs independently during the normal course of labor. The outpouring of water is accompanied by full disclosure uterine cervix. This serves as a signal that the baby is beginning to move along the birth canal.

However, in some cases the bubble does not burst on its own. In this case, medical attention is required.

Using a special tool that resembles a hook, the bubble is pierced.

The procedure does not cause painful sensations woman. For a child, amniotomy is usually also safe.

Types of punctures:

prenatal;
early amniotomy;
timely;
belated.

When necessary

The amniotomy procedure is performed solely for medical reasons.

These include:

post-term pregnancy beyond 42 weeks;
diagnosing a woman severe forms who threaten the child;
presence in mother and fetus;
insufficient activity of labor;
insufficient amount of amniotic fluid, oligohydramnios;
during pregnancy;
pathological preliminary period, which refers to prolonged and irregular contractions.

The decision on the need for artificial autopsy amniotic sac taken by the doctor after examining the woman. Without good reasons do this procedure it is forbidden.

How it goes

The procedure for puncturing the amniotic sac is quite simple. It does not require additional anesthesia or complex medical equipment.

As a rule, amniotomy is performed in an obstetric chair.

The doctor uses a special gynecological instrument that resembles appearance hook.

It is inserted through the vagina and cervix into the uterine cavity, the bladder is pierced and thus removed from the woman’s body.

During the procedure, the woman does not experience discomfort. There is also no pain felt.

Once the integrity of the bladder has been compromised, amniotic fluid begins to leak.

Based on their appearance, the doctor assesses the condition of the woman and child, and determines the further plan of action.

The next stage after the puncture is the onset of contractions and the transition of labor to the active phase.

Possible complications

The amniotomy procedure is practically safe for mother and child. Serious complications and pathologies are very rare.

There is a possibility of the following risks:

Thus, the procedure can be performed exclusively in a hospital setting and under strict medical supervision.

Currently, control over amniotomy has been significantly tightened. Doctors decide on its necessity only in extreme cases.

Feel

For a woman, the procedure for puncturing the amniotic sac is painless and does not cause discomfort. In rare cases, a woman may experience minor discomfort.

A doctor can pierce the amniotic sac only with the woman’s consent.

The expectant mother may feel tension along the puncture and the movement of the instrument along the genital tract.

After the water has poured out, contractions begin and the woman feels muscle contractions and pain.

Puncture of the amniotic bladder is a common procedure in obstetric practice. There are quite a lot of indications for its implementation.

As a rule, with a violation of the integrity of the membranes, amniotic fluid is released and labor is activated.

This manipulation is possible only in case of urgent need and under close medical supervision.

If a woman does not want her bladder to be pierced, then she can refuse.

Useful video: why the amniotic sac is pierced

Amniotomy in a maternity hospital is performed in 7% of cases (approximately) of all births.

It should be especially emphasized that amniotomy is real operation, and it must be carried out strictly according to all the rules.

Before performing an amniotomy, the doctor conducts a thorough check of the validity decision taken about surgical intervention.

Indications for amniotomy

1. Amniotomy during pregnancy is performed to intensify labor. The main reason for amniotomy is post-term pregnancy due to lack of labor.

2. Other indications for amniotomy include a complication of pregnancy - gestosis, distressing normal functioning important organs, including the cardiovascular system.

3. Not so often, the indication for amniotomy is Rh conflict or Rh sensitization.

4. Another indication for intensifying labor is the pathology of the preliminary period. This condition can develop with prolonged (several days) pain in the lower abdomen, accompanied by ineffective and irregular prenatal contractions.

5. An obvious indication for amniotomy is that the membranes of the amniotic sac are too dense and cannot break open on their own.

6. The most common indication for amniotomy is considered to be too weak labor, in which over time labor contractions only weaken rather than intensify. The cervix does not dilate, and the birth process is delayed.

7. An indication for amniotomy is the so-called flat, stretched amniotic sac, when instead of 200 ml of amniotic fluid in front of the fetal head (in in good condition) there is only about 10 ml of amniotic fluid.

8. The rarest indication for amniotomy is low position of the placenta.

Early amniotomy is performed when there is an excessive amount of amniotic fluid (polyhydramnios).

With spontaneous rupture of amniotic fluid, the following complications may occur:

placental abruption;
loss of fetal limbs;
umbilical cord prolapse.

Amniotomy, by reducing the volume of the uterus, prevents the development of complications and promotes further normal flow birth process.

Amniotomy technique

The operation is performed using a special medical hook, which easily pierces the amniotic sac during a gynecological examination.

This procedure is completely painless. Only excess fluid is poured out, and its remnants then leak until the end of labor.

The vast majority of cases of amniotomy for the fetus end successfully.

Thus, it becomes clear that amniotomy is primarily aimed at preserving the life and health of the baby and his mother.

Be healthy!

People abroad have a slightly different opinion. Listen to what M. Oden, an experienced obstetrician-gynecologist, is talking about.

Video: Amniotomy

Approximately 7-10% of women in the maternity hospital undergo an amniotomy. Pregnant women who hear about this manipulation for the first time are frightened by it. Natural questions arise: amniotomy, what is it? Is it dangerous for the child? Not knowing why this procedure is performed, many expectant mothers are negative in advance. Information about the indications, contraindications and possible consequences of amniotomy will help you understand whether your fears are justified.

Amniotomy is an obstetric operation (translated as amnion - water membrane, tomie - dissection), the essence of which is to open the amniotic sac. The amniotic sac and the amniotic fluid that fills it play an important role in normal intrauterine development child. During pregnancy, they protect the fetus from external mechanical influences and microbes.

After opening or natural rupture of the amnion, the uterus receives a signal to expel the fetus. As a result, contractions begin and the baby is born.

The manipulation to open the amniotic sac is carried out with a special tool in the form of a hook at the moment when the bubble is most pronounced, so as not to damage soft fabrics baby's heads. Amniotomy is a completely painless operation, since there are no nerve endings on the membranes.

Types of amniotomy

Opening the amniotic sac, depending on the moment of the manipulation, is divided into four types:

prenatal (premature) amniotomy - performed before the onset of labor for the purpose of inducing labor;
early amniotomy – performed when the cervix is dilated to 7 cm;
timely amniotomy - the amniotic sac is opened at a cervical opening of 8-10 cm;
belated amniotomy - opening of the amniotic sac on the birth table, when the head has already dropped to the bottom of the pelvis.

When is it needed?

Basically, an amniotomy is performed during childbirth if the fetal sac has not ruptured on its own. But there are situations in which urgent delivery is necessary. In this case, puncture of the amniotic sac is performed even in the absence of contractions. Indications for it are:

Post-term pregnancy. Normal pregnancy lasts up to 40 weeks, but if the period is 41 weeks or more, the question arises about the need for labor induction. During a post-term pregnancy, the placenta “grows old” and can no longer perform its functions in full. Accordingly, this affects the child - he begins to experience a lack of oxygen. In the presence of a “mature” cervix (the cervix is soft, shortened, allows 1 finger), the woman’s consent and there are no indications for cesarean section this moment, perform a puncture of the bladder to induce labor. In this case, the fetal head is pressed against the entrance to the pelvis, and the volume of the uterus decreases somewhat, which contributes to the occurrence of contractions.
Pathological preliminary period. The pathological preliminary period is characterized by long, several days of preparatory contractions, which do not develop into normal labor and tire the woman. During this period, the child experiences intrauterine hypoxia, which resolves the issue in favor of prenatal amniotomy.
Rhesus conflict pregnancy. At negative rhesus blood in the mother and positive in the fetus, a conflict arises regarding the Rh factor. At the same time, antibodies accumulate in the blood of the pregnant woman, which destroy the red blood cells of the fetus. When the antibody titer increases and signs appear hemolytic disease the fetus requires urgent delivery. In this case, the amniotic sac is also punctured without contractions.
Preeclampsia. This serious disease pregnant women, characterized by the occurrence of edema, the appearance of protein in the urine and increased blood pressure. IN severe cases preeclampsia and eclampsia are added. Preeclampsia negatively affects the condition of the woman and the fetus, which is an indication for amniotomy.

If labor has already begun, with certain characteristics of the expectant mother’s body, you will also have to resort to opening the fetal sac. Indications for which amniotomy is performed during childbirth:

Flat amniotic sac. The amount of anterior water is approximately 200 ml. A flat amniotic sac is practically the absence of anterior waters (5-6 ml), and the membranes are stretched on the baby’s head, which prevents normal labor and can lead to a slowdown and cessation of contractions.
Weakness ancestral forces. In the case of weak, short and unproductive contractions, the dilation of the cervix and the advancement of the fetal head are suspended. Since in amniotic fluid contains prostaglandins that stimulate the dilatation of the cervix; in order to enhance labor, early amniotomy is performed. After the procedure, the woman in labor is observed for 2 hours and, if there is no effect, the issue of birth stimulation with oxytocin is decided.
Low position placenta. With this position of the placenta, as a result of contractions, its detachment and bleeding may begin. After amniotomy, the fetal head is pressed against the pelvic inlet, thereby preventing bleeding.
Polyhydramnios. Uterus, overstretched big amount water, cannot contract correctly, which leads to weakness of labor. The need for early amniotomy is also explained by the fact that its implementation reduces the risk of prolapse of umbilical cord loops or small parts of the fetus during spontaneous rupture of water.
High blood pressure. Preeclampsia, hypertonic disease, heart and kidney diseases are accompanied by high blood pressure, which negatively affects the course of labor and the condition of the fetus. When the amniotic sac is opened, the uterus, having decreased in volume, frees nearby vessels and the pressure decreases.
Increased density of the amniotic sac. Sometimes the membranes are so strong that they cannot open on their own even with the cervix fully dilated. If an amniotomy is not performed, the baby may be born in the amniotic sac with water and all membranes (in the shirt), where it can suffocate. This situation can also lead to premature detachment placenta and bleeding.

Are there any contraindications?

Although in many situations opening the amniotic sac facilitates the birth of a child, there are contraindications to this procedure. Amniotomy during childbirth is not performed if:

a pregnant woman has genital herpes in the acute stage;
the fetus is in a leg, pelvic, oblique or transverse presentation;
the placenta is located too low;
umbilical cord loops do not allow the procedure to be performed;
Natural childbirth is prohibited for a woman for one reason or another.

In turn, a contraindication to natural delivery is the incorrect location of the fetus and placenta, the presence of scars on the uterus and structural anomalies birth canal. They are also prohibited in case of severe symphysitis, heart pathologies and other diseases of the mother that pose a threat to her health and life or interfere with the normal birth process.

Technique

Although amniotomy is an operation, the presence of a surgeon and anesthesiologist is not required. The opening of the amniotic sac (puncture) is performed by an obstetrician during a vaginal examination of the woman in labor. The manipulation is absolutely painless and takes a few minutes. A puncture during pregnancy is performed with a sterile plastic instrument that resembles a hook.

The procedure consists of the following steps:

Before amniotomy, the woman in labor is given No-shpa or another antispasmodic drug. After its action begins, the woman should lie down on the gynecological chair.
Then, the doctor, wearing sterile gloves, dilates the woman's vagina and inserts the instrument. Having hooked the amniotic sac with a plastic hook, the obstetrician pulls it out until the membrane is torn. After this, an outpouring of water occurs.
At the end of the procedure, the woman needs to remain in the room for about half an hour. horizontal position. During this time, the child’s condition is monitored using special sensors.

The amniotic sac is opened outside the contraction, which ensures the safety and convenience of the procedure. If a woman is diagnosed with polyhydramnios, the water is released slowly to prevent prolapse of the umbilical cord loops or fetal limbs into the vagina.

Prerequisites

Following a number of rules allows you to avoid complications during manipulation. TO mandatory conditions, without which amniotomy is not performed, include:

cephalic presentation of the fetus;
birth not earlier than 38 weeks;
no contraindications to natural delivery;
pregnancy with one fetus;
readiness of the birth canal.

The most important indicator is the maturity of the cervix. To perform an amniotomy, it must correspond to 6 points on the Bishop scale - be smoothed, shortened, soft, and allow 1-2 fingers through.

Complications and consequences

When performed correctly, amniotomy is a safe procedure. But, in rare cases, childbirth after puncture of the bladder can be complicated. Among the undesirable consequences of amniotomy are:

Prolapse of the umbilical cord or fetal limbs into the vagina of the woman in labor.
Injury to the vessels of the umbilical cord during its membrane attachment, which may be accompanied by massive blood loss.
Deterioration of uteroplacental blood flow after manipulation.
Changes in fetal heart rate.

There is also a risk that opening the amniotic sac will not give the desired result and labor will not become active enough. In this case, the use of drugs that stimulate contractions or a cesarean section will be required, since long stay a child without water threatens his life and health.

Any intervention in the body has its consequences and they are not always positive. But compliance with all conditions for amniotomy allows you to reduce the risk of complications to a minimum. Therefore, if there are indications, you should not refuse to open the amniotic sac and other necessary manipulations during childbirth.

Useful video: the need and possible consequences of amniotomy from the point of view of foreign specialists

Olga Rogozhkina

midwife

Childbirth does not always take place according to classic version, as described in the books. Sometimes amniotomy is necessary - forced opening of the amniotic sac to induce labor. The main condition for the procedure is the physiological readiness of the birth canal (maturity of the cervix) and the professionalism of the obstetrician. For whatever reason, an amniotomy is performed, there is no need to doubt its necessity, since the doctor’s task is to preserve the health of the mother and child. If the indications and requirements for manipulation are observed, the procedure does not have negative consequences.