What is amniotomy during childbirth and why is the bladder punctured?

During labor or even before labor begins, doctors may give the woman an amniotomy. It is believed that it has a beneficial effect on the speed of the birth process, and in some cases it is considered a necessary measure. In this material, we will consider what kind of manipulation it is and why it can be used during childbirth.

A bit of theory

During the period of intrauterine development, the child is perfectly protected - it is protected not only by the anterior abdominal wall of the mother, but also by the fetal bladder, which is a strong multilayer "bag" inside which the child is located surrounded by amniotic fluid.

The inner membrane of the bladder is called the amnion, it is she who participates in the synthesis and renewal of amniotic fluid. The environment inside the fetal bladder is sterile, it protects the baby from contact with bacteria, viruses, fungal flora and other undesirable agents and organisms.

The baby swallows water, so that they participate in the formation of the digestive system, in addition, the amniotic fluid is an excellent natural shock absorber.

In natural childbirth, the bladder opens itself. This usually occurs even when there are active intense contractions and the dilatation of the cervix is approaching 5-6 centimeters. The contracting reproductive organ leads to an increase in intrauterine pressure, the cervix, when opened during labor, secretes a special enzyme that thinns the fetal bladder.

The mechanism is supplemented by the baby himself, who presses the head on its lower part, as a result, the shells rupture, the waters leave their place, go out.

Sometimes labor begins with rupture of the membranes, rather than with contractions. And then doctors mean childbirth, complicated by premature outpouring of water. Sometimes the walls of the bladder are so strong that even with the onset of attempts they are not disturbed. This is a variant of the norm, doctors can leave it (if the baby is born prematurely) or manually puncture it.

It is a manual or instrumental violation of the integrity of the fetal sac that is called amniotomy. In childbirth, this uncomplicated and painless manipulation can play a decisive role. The birth canal and cervix receive a large amount of enzymes that go out with the waters and stimulate the cervix to open more actively. This measure shortens the delivery time by about a third in most cases.

If a woman has a placenta previa and bleeding begins, an amniotomy can help stop it. In women with high blood pressure, the pressure after a bladder puncture decreases, which allows doctors to facilitate the course of labor and the condition of the woman in labor.

An amniotomy is not performed on women who are about to have a planned caesarean section.

With all the advantages of amniotomy, it is not recommended to carry out it without the presence of certain medical indications established by the clinical guidelines for this manipulation.

Indications

Speaking of clinical guidelines, it should be noted that a bladder puncture is strongly recommended for pregnant women who do not start giving birth even after the date of the expected birth is long behind. Usually, specialists begin to seriously think about such manipulation when it is 42 weeks of gestation, and there is no labor. Then the induction of labor begins precisely with amniotomy.

After the puncture, labor contractions of the uterus usually begin within 2-5 hours, the cervix is naturally stimulated to open. Due to this, the birth process becomes shorter, and after about 10-12 hours or a little more, you can count on the appearance of a child during the first birth, and after 8-9 hours with the second and subsequent.

When the process is already underway, a puncture may be needed in such situations.

The contractions are transitional, the neck is open up to 8 centimeters or more, the fetal sac remains intact. If this birth is not premature, then there is no point in preserving it.
The woman has weak contractions, the cervix is not opening well, the contractions have weakened or stopped, primary birth weakness is recorded.
The woman was diagnosed with polyhydramnios during pregnancy.
Diagnosed oligohydramnios (the so-called flat bladder).
Natural childbirth with multiple pregnancies. This only applies to twins who have separate fetal bladders. With identical twins, amniotomy is avoided. The fetal bladder of the second child from twins is opened 10 minutes after the birth of the first baby.

The recommendations strongly urge doctors to be vigilant and avoid early amniotomy. Early is called a puncture, which is done when the cervix is not ready for childbirth, there are no signs of the beginning of disclosure. An immature cervix is not stimulated by enzymes from amniotic fluid, and therefore various complications may develop.

Among them - the development of primary birth weakness, fetal hypoxia, a long anhydrous period. Ultimately, everything will end with an emergency caesarean section. A long anhydrous period before surgery will increase the likelihood of endometriosis and other inflammatory processes in the postpartum period tenfold.

When is it not pierced?

Amniotomy deprives the child of protection in the form of amniotic fluid, and therefore the likelihood of infection of the uterine cavity and the baby itself while being without water is high. In connection with this risk, a bladder puncture is not performed if a woman has an exacerbation of genital herpes or other diseases of the genital tract, if there is vaginosis, the analysis of a smear for microflora revealed a violation of the flora.

There is no expediency in a puncture of the fetal sac and with an incorrect presentation of the fetus - pelvic, oblique or transverse. The procedure for labor induction is not performed with placenta previa, as well as when the umbilical cord loop is touched the exit from the uterine cavity.

A narrow pelvis, triplets in the mother's womb, pregnancy after IVF, suspicion of baby hypoxia, Rh-conflict between mother and child - all these are grounds for refusing amniotomy and indications for a cesarean section.

How is it done?

Exactly how to open the fetal bladder, the obstetrician or doctor decides according to the situation. It is possible to pierce, tear, cut or tear it by hand without the use of tools. If the cervix is weak, it is usually preferred to pierce the membranes, if the opening is sufficient to allow the obstetrician's fingers to pass, then it will be torn by hand.

Often women are interested in whether it hurts to pierce the fetal bladder. The answer is completely unambiguous - it does not hurt, since there is not a single nerve endings and pain receptors in the membranes. Accordingly, a woman cannot even theoretically feel pain.

The procedure is quick, almost lightning fast, but requires some preparation. It consists in taking an antispasmodic drug about half an hour before the proposed amniotomy in order to relax the muscles of the cervix. Usually they use "No-Shpu" in tablets or give an injection with a solution of this drug.

The procedure does not belong to the category of surgical intervention, and therefore it can be carried out not only by a doctor, but also by an obstetrician. Feelings of a woman are not much different from the sensations during a regular gynecological examination in a chair. The healthcare professional puts on sterile gloves. The fingers of one hand are inserted into the vagina, with the other hand a special branch is inserted - a long thin stick with a small hook at the end. With a slight disclosure of the cervix, the fetal membrane is hooked up and pulled towards itself.

With fingers in a sterile glove, the doctor or obstetrician slightly expands the tear and makes sure that the water flows away smoothly, indistinctly, because their massive discharge can cause a part of the baby's body, the umbilical cord to fall out into the genital tract, which will significantly complicate childbirth or will immediately be a reason for carrying out emergency caesarean section.

A woman lies for at least half an hour, cardiotocograph sensors are installed on her tummy in order to monitor the condition of the baby in real time, who unexpectedly for himself was left without a familiar habitat.

At any stage of labor, a puncture or rupture of the bladder can be performed as indicated. For the beginning of labor - in front of them, to intensify the contractions - during the first stage, to prevent bleeding when the baby passes through the birth canal, the bubble can be opened already during the period of attempts.

In preterm labor, it is considered desirable to preserve the integrity of the fetal bladder if it does not rupture itself. So it will be easier for a baby who is in a hurry to be born to adapt. Babies who are born with the membranes intact are usually said to be "born with a shirt." The people have always believed that this is how the higher powers celebrate the rare lucky ones, who will be promoted by incredible luck throughout their life.

Consequences and complications

Problems after a bladder puncture do not happen often, but nevertheless, by signing an informed consent for such an intervention, a woman automatically agrees that she is familiar with the list of possible consequences. And they can be different - from the development of weakness of contractions to infection. If primary birth weakness develops, hormonal stimulation is started. If after that within a couple of hours the contractions do not start, preference is given to operative delivery.

Amniotomy is not considered natural, it is stressful for the female body, and therefore the consequences can be very significant:

rapid, impetuous labor develops;
prolapse of the umbilical cord, arms or legs of the fetus into the genital tract;
damage to a blood vessel if it is located on the surface of the bladder, and subsequent bleeding;
development of a state of acute oxygen deficiency in a baby;
the likelihood of infection in the uterus.

To avoid infection and damage to blood vessels, doctors pay sufficient attention to sanitary and hygienic requirements, use disposable sterile gloves and tools. But no preventive measures can guarantee that the uterus will begin to contract, and the cervix will open, and therefore a puncture is always a certain risk.

Reviews

Despite the fact that the Ministry of Health prescribes doctors to notify the woman in labor about all the details of the upcoming procedure and the risks associated with it, doctors, according to women, often carry out a puncture according to the situation, and only then tell that the puncture took place. On the one hand, sudden manipulation has its advantages - the woman does not have time to get scared. On the other hand, the lack of complete information infringes upon the patient's rights.