Amniotomy, or opening of the amniotic sac, is an operation quite often used in maternity hospitals.
Some patients regard it as a necessity, while others are categorically against such a procedure, considering it dangerous for the child. In any case, for an amniotomy, the doctor must obtain consent from the expectant mother.
Functions of the amniotic sac
The amniotic sac plays an important role not only during pregnancy, but also during childbirth. In the first phase of the birth process, it actively helps to open the cervix. During contractions, the pressure inside the uterus rises, and under its influence, amniotic fluid moves down, rests against the membranes and puts pressure on the cervix. After the cervix opens to its maximum, the membranes rupture and the baby's head moves into the pelvis. Such processes occur during the normal course of childbirth.
Symptoms and signs
When and how the amniotic sac bursts, a pregnant woman can determine on her own.
The following symptoms are typical for this condition:
- secretion of large amounts of fluid from the genital tract;
- fluid pours out of their vagina, and not from the urethra;
- decrease in the height of the uterine fundus and lowering of the abdomen;
- the beginning of labor.
If the bladder ruptures from the side, the clinical picture will be slightly different. The symptoms in this case are not so pronounced and the woman does not immediately notice the problem.
A high lateral rupture of the membranes is characterized by the following signs:
- vaginal discharge becomes more voluminous when lying down;
- vaginal discharge is watery;
- pain in the lower abdomen;
- bloody issues.
If you diagnose yourself with such symptoms, you need to get to a perinatal center as soon as possible under 24-hour medical supervision.
The essence of amniotomy
But sometimes it happens that the membranes of the fetus do not burst on their own, or there is an urgent need to induce artificial labor - in such situations, intervention in the form of amniotomy is required.
The operation to puncture the amniotic sac is performed by a doctor using a special instrument with a sharp hook at the end. By making an incision on the amniotic sac, he controls the outflow of water located immediately in front of the fetal head. Carrying out this procedure is a good incentive to intensify or cause contractions.
Causes of premature rupture of membranes
Premature rupture of the membranes is provoked by a number of external factors and influences.
Reasons for opening a bladder:
- Pathologies of the structure of the tissues from which the bladder is formed. They are not flexible and durable enough. Consequently, as the fetus grows, the tissues of the bladder cannot withstand the tension force and burst.
- Inflammatory processes occurring in the vagina can cause thinning of the bladder membranes. This causes the bladder to begin to leak amniotic fluid.
- The presence of a narrow pelvis in the mother.
- Incorrect and pathological presentation of the fetus. In this case, excessive stretching of any one area of the bubble occurs, and it bursts.
- Cervical insufficiency.
- Medical intrusion during the analysis of amniotic fluid or umbilical cord blood.
- Lack of vitamins and minerals in the mother's body.
- Pregnant woman smoking.
- Several fetuses in the uterine cavity.
- Pathologies and anomalies of the structure and functioning of the uterus.
- Mechanical injuries and lifting heavy objects.
Sometimes the opposite situation happens and women do not understand why the amniotic sac does not burst.
This is not a pathology, and doctors artificially pierce it with a special thin needle. This procedure is painless and safe for mother and her baby.
Indications for amniotomy
At its core, amniotomy is an operation, although it is painless and does not require general or even local anesthesia. Such manipulation is carried out only in case of justified indications - before the onset of labor, if the reasons for this arise during pregnancy, or already during the birth process.
There are a number of indications for the use of amniotomy:
- Post-term pregnancy
. It happens that all the deadlines have expired, but the baby is in no hurry to be born. Post-term pregnancy is fraught with aging of the placenta, which no longer performs the functions assigned to it by nature, and this, in turn, threatens the normal development of the fetus. This diagnosis is the most common indication for amniotomy. - Late gestosis
. Late gestosis is a serious complication, which often leads to dysfunction of the internal organs of a pregnant woman and can lead to oxygen starvation of the fetus. If gestosis progresses, eclampsia or preeclampsia may occur - diseases that are even more dangerous for both the child and the mother. Therefore, if signs of gestosis appear against the background of a ready birth canal and a full-term pregnancy, the doctor may decide on the need for amniotomy. - Polyhydramnios
. With a pronounced diagnosis of “polyhydramnios”, there is a danger of the baby’s umbilical cord, leg or arm prolapse into the vagina at the time of profuse and spontaneous discharge of water. In this case, injuries and fetal hypoxia occur. In this case, amniotomy is indicated at the very beginning of labor, with a slight opening of the cervix. The doctor, having opened the amniotic sac, controls the process and prevents such complications. - Weak labor
. If labor is insufficient, this can be very easily eliminated by puncturing the amniotic sac. The release of amniotic fluid has a great effect on dilating the cervix and intensifying contractions. - Flat amniotic sac
. When the amniotic sac, for various reasons, does not fulfill its functions of helping to open the cervix, this can lead to a gradual weakening of labor. In this case, only opening the amniotic sac can help intensify contractions and allow the child to move through the birth canal correctly. - Low location of the placenta
. With pathologically low placentation in the uterine cavity, there is a danger to the health and even life of both mother and child. If childbirth occurs without urgent surgical intervention, naturally, uterine bleeding and premature placental abruption may occur. Amniotomy early in labor will help minimize this threat. After the outpouring of water, the baby presses the placenta with his head, preventing it from detaching ahead of time. - Rhesus conflict
. In the event of the development of hemolytic disease (a pathology that occurs when the blood of the mother and child is incompatible), the indication for the use of amniotomy is unconditional. In the last stages of pregnancy, only childbirth can save the baby.
Premature amniotomy
A so-called premature amniotomy is one way to end a pregnancy before spontaneous labor begins. The use of amniotomy for the purpose of inducing labor means the immediate onset of labor: once the membranes are opened, there is no turning back. During pregnancy, the obstetrician is forced to induce labor most often ahead of schedule, at different stages of pregnancy, including in the last week before the onset of spontaneous labor on the part of the mother and fetus - this is induced labor . Indications for amniotomy may include:
- severe form of late gestosis in pregnant women, when edema, high blood pressure, changes in urine tests cannot be corrected with medications, the condition of the mother and fetus remains unsatisfactory, despite treatment;
- maternal diseases (cardiovascular pathology, diabetes mellitus, liver disease, chronic lung diseases, etc.);
- post-term pregnancy;
- acute increasing polyhydramnios with symptoms of cardiopulmonary failure in a pregnant woman;
- deterioration of the fetus for various reasons.
In other cases, premature amniotomy for the purpose of inducing labor is performed at term without medical indications, when the fetus has reached full maturity and there are no signs of spontaneous labor. Such preventive induction of labor with amniotomy during normal pregnancy is called programmed childbirth .
One of the possible conditions for the use of amniotomy for the purpose of inducing labor is the presence in a woman of optimally expressed signs of readiness for childbirth. In 70-80% of cases with full-term pregnancy, when the cervix is “ripe” (it is short, soft, slightly open, located in the center of the small pelvis), labor can be induced by amniotomy alone without the use of medications that stimulate uterine contractions (oxytocin, prostaglandins).
Premature amniotomy in the absence or insufficient expression of signs of readiness for childbirth does not always lead to the development of adequate labor - as a rule, labor is protracted, requires drug-induced labor, there is a danger of an increase in the anhydrous interval, infection of the birth canal and fetus, asphyxia (cessation of oxygen access ) and birth trauma in the fetus.
Widespread in the 90s, programmed childbirth is now practiced less frequently due not only to possible complications (anomaly of head insertion, impaired contractility of the uterus, bleeding after childbirth), but primarily due to the tendency for the natural course of pregnancy and childbirth.
How is amniotomy performed?
The doctor can perform this operation on a gynecological chair during an examination of the patient. The procedure takes place in compliance with all antiseptic rules to avoid infection from the outside. The doctor inserts fingers into the cervix to be able to tactilely control the puncture of the bladder and the release of amniotic fluid.
After the operation, it is necessary to observe the fetal heart rate for some time to assess its reaction to the puncture of the amniotic sac. Complications occur very rarely, but still they cannot be completely excluded.
Possible complications:
- violation of the general condition of the fetus;
- disturbance of placental blood flow;
- rapid labor;
- weakness of the birth process.
The causes of such complications may be a significant change in pressure in the uterus or too rapid discharge of water.
Since such disorders occur extremely rarely, it is generally accepted that amniotomy is the most harmless means of inducing labor and preserving the health of mother and child. Like
How is labor induced?
There are various methods of inducing labor. Some methods can be used repeatedly to achieve results, and some can be used in combination with other tactics for stimulating labor.
Talk to your doctor about what's right for you.
Typically, stimulation methods are offered in the following order:
Detachment of amniotic membranes
What is it?
A procedure called membrane stripping usually stimulates labor to begin and is now offered by some doctors for postterm pregnancies.
What happens when the amniotic membranes detach?
The membranes surrounding your baby (amniotic membranes) are gently peeled away from the lowest parts of the uterus near the inside of the cervix. A midwife or doctor may perform this procedure during a pelvic examination. If the first attempt is not successful, it may be repeated one or two more times before moving on to other stimulation methods.
Risks.
This procedure may be associated with unpleasant sensations. Before the procedure, you will be able to ask any questions or read special materials on this matter. It may take several attempts before it becomes clear whether the procedure is effective.
Prostaglandin
What is it?
Prostaglandin is a hormone-like substance that stimulates uterine contractions.
What happens if I am prescribed prostaglandin?
The doctor or midwife inserts prostaglandin in the form of a pill, ring, or gel into the vagina to help the cervix begin to “ripen” for childbirth. If labor has not started within six hours, you may be given a second tablet or dose of gel. Prostaglandin is released slowly from the uterine ring over 24 hours, so if it is used, one dose is sufficient.
Risks.
Vaginal use of prostaglandin is the most common method of inducing labor because, while surpassing all other methods in effectiveness, it produces fewer side effects.
With vaginal use of prostaglandin, as with oskitocin, there is a very small risk of uterine hyperstimulation. When the uterus is hyperstimulated, the baby's oxygen supply is significantly affected. If this happens, you will be given medications to slow or stop uterine contractions.
Opening the amniotic sac
What is it?
Currently, the procedure of opening the amniotic sac is not a recommended method of inducing labor (unless vaginal use of prostaglandin is impossible for some reason), but in some maternity hospitals it is used for.
What happens when the amniotic sac is opened?
This procedure may be performed during a gynecological examination. The doctor or midwife makes a small puncture in the amniotic sac (the membranes surrounding your baby) using an amnio hook (a long, thin instrument that looks like a small crochet hook). This procedure often results in the cervix being soft and ready to dilate.
Risks.
Puncture of the amniotic sac does not always lead to success, and also creates a risk of infection for the child, who is not protected by amniotic fluid. That is why this procedure is no longer recommended as an independent method. If you show signs of infection, you will be treated with antibiotics.
Oxytocin
What is it?
Oxytocin is prescribed only if the opening of the membranes and prostaglandin did not lead to the onset of labor, or if uterine contractions are not effective enough. The fact is that compared to other methods of stimulation, the administration of oxytocin has a number of disadvantages.
How is oxytocin used?
Oxytocin is administered intravenously using a drip, which ensures that the hormone enters directly into the blood. After the onset of contractions, the rate of drug administration is adjusted so that the strength of the contractions is sufficient for the necessary dilation of the cervix, but does not exceed certain limits.
Risks.
Oxytocin can cause very strong uterine contractions, causing hypoxia in the fetus, so you should be under constant medical supervision when administering oxytocin.
Additionally, some women report that oxytocin-induced contractions are more painful than natural labor, so you may want to consider an epidural for pain relief.
There is a very small risk of uterine hyperstimulation due to oxytocin use.
If other methods fail, you may be offered to try again later, or alternatively a caesarean section.
There are indications that when medicinal stimulation of labor occurs, it is somewhat more common to resort to such means as the application of forceps or the use of vacuum extraction. The reason may lie either in complications of pregnancy that caused the need for stimulation, or in problems caused by the stimulation itself.
Why do they puncture the bladder??
I have been tormented by this question since my first birth. Reading stories about childbirth, I see that there are basically 2 scenarios: either the water breaks on its own, quite unexpectedly for the woman in labor, and after that she goes to the maternity hospital to give birth. The second common scenario is that contractions begin first (mild at first), and upon examination, doctors open the bladder and then everything is forced and the contraction begins.
So why are they doing this?
I had the second option: I didn’t even feel the contractions as such, we were going to go to the prenatal appointment, and on the way, apparently, they shook me in the car and something began to shrink in my stomach, completely painlessly. While we were waiting in line, while we were registering... and when it came to the examination, the doctor said that I was already 5 cm dilated. And at the same time, I did not feel any discomfort. And then they took and pierced the bubble, the waters drained... Well, and soon after that, a 12-hour nightmare and horror began. That is, it turned out that the first 5 cm were completely unnoticeable for me, but the second 5 cm after draining the waters were terribly painful. And so I think, if I hadn’t gone to the prenatal appointment, but had walked at home... maybe the dilatation would have happened by itself, and the water would have broken, for example, when it was already 7-8 centimeters, and then I would have to suffer much less... For example, like my mother, whose water broke, after which she gave birth within a couple of hours, without even experiencing almost any pain. She doesn’t even know what contractions are; according to her stories, childbirth is just pushing, like going to the toilet, nothing terrible. And I understand her, for me pushing was also bullshit, 10 minutes and it was over. But 12 hours of contractions before that is fucked up.
So I’m thinking, why do doctors puncture the bladder? Many of my girlfriends and acquaintances had approximately the same scenario, that their bladder was pierced. That is, this is not an exceptional case, but a mass phenomenon. But in nature, no one punctures any bubbles? As I understand it, when the big opening begins, the bubble will burst on its own... And the child will be in the water longer, and the mother will suffer less (until the bubble is punctured, the contractions are not so painful).
But this is all my speculation. But in fact, there must be some reason - why do they puncture the bladder??
PS Well, now I’ll briefly add about how my second birth went. I was nursing again, but I was very afraid to give up on prenatal care. And it was already approaching 42 weeks... And then one fine day I woke up at 4 in the morning, listened to my feelings, it seemed like my stomach was pulling, like before my period. But it seems not. And I decided to get some more sleep. Then she got up, wandered around the apartment, and lay down again. She stood up again. Then it started to seize. I woke up my husband, began to get ready for the maternity hospital, and then the seizure began stronger, even stronger, very strong. In the car I was writhing on all fours in the back seat, we arrived at the maternity hospital - full disclosure. Immediately on the table, and at 6:10 I gave birth. When the bubble burst, I don’t even know, it was probably already on the table, it burst itself or was pierced. In general, my entire labor - from the first suspicion to the birth of the baby - took 2 hours. Gorzado is more pleasant than the first time.
How a puncture is done in pregnant women. Risks for women. How is amniotic fluid puncture performed?
Amniotic fluid is the habitat in which a child grows and develops. It is a kind of “airbag” that protects the fetus from possible injuries. Also, waste products, dead cells and hair are released into the liquid, so at the beginning of pregnancy it is transparent, but in the third trimester it becomes noticeably cloudy.
When the liquid is examined, samples of the scales are taken - they contain DNA, which can be used to judge the child’s genetic diseases. Also, analysis of amniotic fluid makes it possible to detect viruses and bacteria, signs of hemorrhage. The same method is used to determine Rh compatibility between mother and child.
