Why pierce the bladder before childbirth. Indications for puncturing the bladder before childbirth

Olga Ovchinnikova
Obstetrician-gynecologist. Medical clinic "Gazprommedservice".

Many expectant mothers, who have never even been to the delivery room, have heard of such a procedure as amniotomy - opening the fetal bladder. Someone may have a natural question: why rush things and "help" the amniotic fluid to pour out, if sooner or later it will happen by itself? It turns out that this simple manipulation helps to avoid many troubles concerning the health of the mother and baby.

A small excursion into physiology

Labor usually begins with contractions. Contractions help open the cervix and move the fetus through the birth canal. The cervix is \u200b\u200bsmoothed and dilated by contracting the muscles of the uterus. The fetal bladder also helps to open the cervix. During contractions, the uterus begins to actively contract, as a result of which the intrauterine pressure rises, the fetal bladder strains, and the amniotic fluid rushes down. The lower pole of the bladder is inserted into the inner pole and helps to open the cervix.

The opening of the cervix in primiparous and multiparous occurs in different ways. In primiparous, the internal uterine pharynx first opens, the cervix smoothes and becomes thinner, and then the external uterine pharynx opens. In multiparous women, the external uterine pharynx is ajar already at the end of pregnancy. During childbirth, the opening of the internal and external os, as well as smoothing of the cervix, occur simultaneously.

The degree of dilatation of the cervix is \u200b\u200bdetermined in centimeters during vaginal examination. The opening of the cervix by 11-12 cm, in which its edges cannot be determined, is considered complete.

The first stage of labor is characterized by the occurrence of regular contractions and the advancement of the presenting part of the fetus (the part that first passes through the birth canal, and before childbirth is facing the cervix) through the birth canal. Most often, the presenting part of the fetus is its head. During normal childbirth, the water flows away on its own. Usually, the fetal bladder ruptures when the cervix is \u200b\u200bfully or almost completely dilated, and the anterior amniotic fluid (they are called so because they are in front of the presenting part of the fetus) is poured out. The rupture of the fetal bladder is a painless process, since there are no nerve endings in the fetal bladder.

10% of women drain water before labor starts. When the amniotic fluid is poured out, about 200 ml of fluid is released at once, that is, approximately a glass. This cannot be overlooked. But it also happens that the fetal bladder does not open directly near the exit from the cervix, but higher, where it comes into contact with the wall of the uterus. In this case, water leaks from the genital tract drop by drop, the watery spot on the underwear increases gradually.
When childbirth begins with the outpouring of water, they speak of a premature outflow of amniotic fluid. The outpouring of water after the onset of labor, but with incomplete disclosure of the cervix, is called early discharge of water.

With premature outpouring of amniotic fluid, the course of labor depends to a greater extent on whether the woman's body is ready for childbirth, and with early outpouring of water - on the regularity and strength of labor and the location of the presenting part of the fetus. If the body of a pregnant woman is ready for childbirth, premature rupture of amniotic fluid will not become an obstacle to their normal flow. Usually labor in such cases develops 5-6 hours after rupture of the membranes, but the first contractions may appear immediately after the outpouring of water. However, often premature or early rupture of amniotic fluid leads to weakness of labor, a prolonged course of labor, fetal hypoxia, and inflammatory processes of the membranes.

Therefore, in the event of discharge of water outside the maternity hospital, even in the absence of contractions, it is necessary to go to the hospital immediately. In this case, it is necessary to remember the time of discharge of amniotic fluid and inform the doctor. Pay attention to the color and smell of the amniotic fluid. Usually the waters are clear or slightly pink, odorless. A slightly greenish, dark brown or black color of amniotic fluid indicates the release of meconium (original feces) from the child's intestines, which means that he is experiencing oxygen starvation and needs help. Amniotic fluid is colored differently, depending on the amount of secretions. If the contractions do not begin soon after the water has passed, doctors resort to stimulation of labor.

It is not known exactly what causes the early or premature outpouring of water. However, in women who have been preparing for childbirth, such cases are less common. This is largely due to the emotional state of the woman, her ability to relax and the general mood for a successful birth.
Very rarely, the fetal bladder does not rupture at all, and the child is born covered with membranes. People say about such a kid that he was "born in a shirt."

Indications for amniotomy

It so happens that when the cervix is \u200b\u200bfully dilated, the fetal bladder remains intact. This may be due to its excessive density or elasticity, as well as a small amount of front water. Such births are characterized by a protracted period of fetal expulsion, slow progress of the presenting part, the appearance of bloody discharge from the genital tract. There is a danger of premature placental abruption and fetal hypoxia. In this case, an artificial opening of the fetal bladder is performed for medical reasons.

Like any manipulation in medicine, amniotomy should be justified, since the fetal bladder performs certain functions: it protects the child from infection and makes childbirth less unpleasant, soft and natural. It allows the cervix to open smoothly and gradually. In addition, if the amniotomy is done while the baby is in a high position, there is a risk of the umbilical cord falling out, leading to serious complications.

The indications for amniotomy are:
Postponing pregnancy. This refers to the so-called true prolongation of pregnancy, when certain changes occur in the placenta, due to which it can no longer provide the delivery of the required amount of oxygen to the fetus. Thus, the fetus is in a state of hypoxia (lack of oxygen). In this situation, amniotomy can serve as a way to stimulate labor.
Gestosis of pregnant women. This condition is a syndrome in which the work of many organs and systems is disrupted. It develops as a result of pregnancy. Its main symptoms are: pathological weight gain, edema, arterial hypertension, proteinuria (protein in the urine), seizures and / or coma. Gestosis of pregnant women is not an independent disease; This is a syndrome caused by the inability of the adaptive systems of the mother's body to meet the needs of the developing fetus.
Rh-conflict pregnancy. This pregnancy can also be complicated. If vaginal delivery is possible, amniotomy may be a stimulus.
Preliminary period. This is the name for irregular and ineffective prenatal contractions that do not lead to the opening of the cervix, sometimes lasting several days. They can also become an indication for opening the fetal bladder.
Weakness of labor. It is characterized by contractions that are weak in strength, short in duration, and rare in frequency. With such contractions, the opening of the cervix and the movement of the fetus through the birth canal occurs slowly.
Increased density of membranes. When the cervix is \u200b\u200bfully or almost completely dilated, the membranes cannot rupture on their own, amniotomy is the only way to prevent the birth of a baby “wearing a shirt”. This situation is unfavorable, because the baby cannot breathe in immediately after birth.
Polyhydramnios. The opening of the fetal bladder with polyhydramnios is carried out because a large amount of amniotic fluid can cause weakness in labor, as well as prolapse of the umbilical cord with self-effusion of amniotic fluid.
Flat fetal bladder. Sometimes (most often with lack of water) there is very little or no anterior water in the fetal bladder - then the membranes are stretched over the fetal head, which can lead to abnormalities in labor and to premature placental abruption.
Low location of the placenta. The onset of labor can provoke its premature detachment, which is extremely dangerous for the fetus, since this stops oxygen delivery to the fetus. During amniotomy, water is poured out, and the fetal head presses the edge of the placenta, thus preventing its detachment.
Various pathological conditions associated with high blood pressure and impaired blood circulation - gestosis, hypertension, heart and kidney disease, etc. Amniotomy allows you to quickly reduce the size of the uterus due to the outflow of amniotic fluid. As a result, the pressure of the uterus on the nearby large vessels decreases, blood circulation improves, and blood pressure decreases.

Procedure progress

The opening of the fetal bladder is performed during a vaginal examination with a sterile instrument resembling a hook. This procedure is completely painless, since the fetal bladder is devoid of pain receptors. It is assumed that when the fetal bladder is opened, the anterior waters are poured out, and the fetal head presses on the cervix, mechanically irritating the mother's birth canal.

Amniotomy is a painless procedure that, as a rule, proceeds without complications and does not affect the child's condition in any way. If, despite the amniotomy, labor is not activated, the likelihood of infection of the uterus and the fetus, which is now not protected by the fetal bladder and amniotic fluid, increases. In such situations, doctors resort to the stimulation of labor, and if it is ineffective and in the presence of other indications, they decide the issue of delivery by caesarean section.

taken here:

www.rody.ru/publications/birth/6/

In utero, the baby is protected by a special shell - amnion, filled with amniotic fluid. They protect it from shock when moving, and the membrane prevents the ascending penetration of infection from the vagina.

During labor, the baby's head is pressed against the cervix and a fetal bladder is formed, which, like a hydraulic wedge, gradually stretches the cervix and forms the birth canal. Only then does it break on its own. But there are situations when a bladder puncture is performed before childbirth without contractions.

This procedure is not prescribed at the request of the woman or the whim of the doctor. The success of an amniotomy is possible under certain conditions:

• the head of the fetus is presented;
• full-term pregnancy at least 38 weeks with one fetus;
• the estimated weight of the fetus is more than 3000 g;
• signs of a mature cervix;
• normal indicators of the size of the pelvis;
• there are no contraindications for natural childbirth.

Amniotomy types

The moment of the puncture determines the type of procedure:

1. Prenatal - is carried out before the onset of labor, its goal is labor arousal.
2. Early - before the disclosure of the neck by 6-7 cm, it is able to speed up this process.
3. Timely - performed with effective contractions, neck opening 8-10 cm.
4. Late - in modern conditions it is rarely performed, it is performed at the time of the expulsion of the fetus. An amniotomy is needed to prevent bleeding in a woman in labor or hypoxia in a child.

How is labor going after a bladder puncture? The process of the birth of a child in this case does not differ from the natural one. In any case, the condition of the fetus is monitored using the CTG apparatus.

Indications for a puncture of the bladder during labor

Bladder piercing stimulates or is performed during planned labor.

Labor induction with amniotomy is indicated in the following cases:

• gestosis, when there are indications for urgent delivery;
• premature placental abruption;
• fetal death in utero;
• prolonged pregnancy;
• severe chronic diseases of the cardiovascular system, lungs, kidneys, in which delivery is indicated from 38 weeks;
• rh-conflict between mother and child;
• pathological preliminary period.

The latter condition is the onset of small contractions over several days that do not develop into normal labor. This causes fetal suffering from lack of oxygen and fatigue of the woman.

How long will labor start after the bladder is punctured? The onset of labor is expected no later than 12 hours later. However, doctors do not spend that much time waiting at this time. Prolonged stay of a child in a waterless environment increases the risk of infection. Therefore, 3 hours after opening the amnion, if the contractions have not begun, stimulation with medications is used.

With already developed labor, the puncture is performed according to the following indications:

1. The cervix opened 6-8 cm, and the water did not leave. Their further preservation is impractical, the bubble no longer fulfills its function.
2. Weakness of labor. Bladder puncture in most cases leads to its activation. After the amniotomy, they wait 2 hours, if there is no improvement, then they resort to oxytocin stimulation.
3. Polyhydramnios overstretches the uterus and interferes with the development of normal contractions
4. With low water, a flat fetal bladder is observed. It covers the baby's head and does not function during labor.
5. A low-attached placenta may begin to flake off after the onset of contractions. Opening the amnion will allow the head of the fetus to snuggle tightly against the lower segment of the uterus and contain detachment.
6. In multiple pregnancies, the bladder of the second child is punctured 10-15 minutes after the appearance of the first.
7. High blood pressure decreases after opening the waters.

Bladder puncture technique in a woman in labor

• 30 minutes before the stimulation of labor by puncturing the bladder, the woman is injected with the antispasmodic Drotaverin.
• Later, an examination is carried out on the obstetric chair, the doctor assesses the neck, the location of the head.
• With a sliding movement of the fingers, a special branch is inserted into the vagina - a hook.
• With its help, the shell clings during the contraction, and the gynecologist inserts a finger into the resulting hole. The tool is being removed.
• Holding the head of the fetus through the abdomen with the other hand, the membranes are gently divorced and the anterior amniotic fluid is released.

They are collected in a tray, and their condition is visually assessed. Green waters with flakes of meconium indicate intrauterine fetal hypoxia. This condition deserves additional attention. The pediatric service is warned in advance about the possible condition of the child.

If a large volume of water is drained at once, it can lead to the loss of the umbilical cord loops or small parts of the fetus.

After the procedure, the CTG apparatus is connected to the mother in labor for 30 minutes to assess the condition of the child.

Is it painful or not to puncture the bladder before giving birth? The membranes are not penetrated with nerve endings, so the procedure is absolutely painless.

At the same time, complications sometimes develop:

• trauma to the umbilical cord vessel, if it was attached to the shell;
• loss of umbilical cord loops or parts of the fetus (arms, legs);
• deterioration of the fetus;
• rapid labor activity;
• secondary birth weakness;
• infection of the child.

How long does labor last after a bladder puncture? The duration depends on their parity or quantity:

• In primiparas, the normal duration of labor is 7-14 hours.
• Multiparous ones need less time - from 5 to 12.

Contraindications to a puncture of the bladder in a pregnant woman

Despite the simplicity of the procedure and the small number of complications of the manipulation, there are serious contraindications for its implementation. Most of them coincide with contraindications for natural childbirth:

1. A herpetic rash on the perineum will lead to infection of the child.
2. Pelvic, leg, transverse or oblique presentation of the fetus, umbilical cord loops in the head area.
3. Complete placenta previa. In this case, childbirth is impossible - the placenta is attached over the internal pharynx and prevents the lower segment of the uterus from expanding.
4. Inconsistency of the scar on the body of the uterus after cesarean section or other surgical procedures.
5. Narrowing of the pelvis 2-4 degrees, bone deformities, tumor processes in the small pelvis.
6. Fruit weight over 4500 g.
7. Severe scars causing deformation of the cervix or vagina.
8. Triplets, conjoined twins, breech presentation of the first child of twins.
9. High myopia.
10. Fetal growth retardation grade 3.
11. Acute fetal hypoxia.

In the absence of the listed contraindications, amniotomy is a safe procedure and does not affect the condition of the fetus.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

Useful video

In utero, the baby is protected by a special shell - amnion, filled with amniotic fluid. They protect it from shock when moving, and the membrane prevents the ascending penetration of infection from the vagina.

During labor, the baby's head is pressed against the cervix and a fetal bladder is formed, which, like a hydraulic wedge, gradually stretches the cervix and forms the birth canal. Only then does it break on its own. But there are situations when a bladder puncture is performed before childbirth without contractions.

This procedure is not prescribed at the request of the woman or the whim of the doctor. The success of an amniotomy is possible under certain conditions:

• the head of the fetus is presented;
• full-term pregnancy at least 38 weeks with one fetus;
• the estimated weight of the fetus is more than 3000 g;
• signs of a mature cervix;
• normal indicators of the size of the pelvis;
• there are no contraindications for natural childbirth.

Amniotomy types

The moment of the puncture determines the type of procedure:

1. Prenatal - is carried out before the onset of labor, its goal is labor arousal.
2. Early - before the disclosure of the neck by 6-7 cm, it is able to speed up this process.
3. Timely - performed with effective contractions, neck opening 8-10 cm.
4. Late - in modern conditions it is rarely performed, it is performed at the time of the expulsion of the fetus. An amniotomy is needed to prevent bleeding in a woman in labor or hypoxia in a child.

How is labor going after a bladder puncture? The process of the birth of a child in this case does not differ from the natural one. In any case, the condition of the fetus is monitored using the CTG apparatus.

Indications for a puncture of the bladder during labor

Bladder piercing stimulates or is performed during planned labor.

Labor induction with amniotomy is indicated in the following cases:

• gestosis, when there are indications for urgent delivery;
• premature placental abruption;
• fetal death in utero;
• prolonged pregnancy;
• severe chronic diseases of the cardiovascular system, lungs, kidneys, in which delivery is indicated from 38 weeks;
• rh-conflict between mother and child;
• pathological preliminary period.

The latter condition is the onset of small contractions over several days that do not develop into normal labor. This causes fetal suffering from lack of oxygen and fatigue of the woman.

How long will labor start after the bladder is punctured? The onset of labor is expected no later than 12 hours later. However, doctors do not spend that much time waiting at this time. Prolonged stay of a child in a waterless environment increases the risk of infection. Therefore, 3 hours after opening the amnion, if the contractions have not begun, stimulation with medications is used.

With already developed labor, the puncture is performed according to the following indications:

1. The cervix opened 6-8 cm, and the water did not leave. Their further preservation is impractical, the bubble no longer fulfills its function.
2. Weakness of labor. Bladder puncture in most cases leads to its activation. After the amniotomy, they wait 2 hours, if there is no improvement, then they resort to oxytocin stimulation.
3. Polyhydramnios overstretches the uterus and interferes with the development of normal contractions
4. With low water, a flat fetal bladder is observed. It covers the baby's head and does not function during labor.
5. A low-attached placenta may begin to flake off after the onset of contractions. Opening the amnion will allow the head of the fetus to snuggle tightly against the lower segment of the uterus and contain detachment.
6. In multiple pregnancies, the bladder of the second child is punctured 10-15 minutes after the appearance of the first.
7. High blood pressure decreases after opening the waters.

Bladder puncture technique in a woman in labor

• 30 minutes before the stimulation of labor by puncturing the bladder, the woman is injected with the antispasmodic Drotaverin.
• Later, an examination is carried out on the obstetric chair, the doctor assesses the neck, the location of the head.
• With a sliding movement of the fingers, a special branch is inserted into the vagina - a hook.
• With its help, the shell clings during the contraction, and the gynecologist inserts a finger into the resulting hole. The tool is being removed.
• Holding the head of the fetus through the abdomen with the other hand, the membranes are gently divorced and the anterior amniotic fluid is released.

They are collected in a tray, and their condition is visually assessed. Green waters with flakes of meconium indicate intrauterine fetal hypoxia. This condition deserves additional attention. The pediatric service is warned in advance about the possible condition of the child.

If a large volume of water is drained at once, it can lead to the loss of the umbilical cord loops or small parts of the fetus.

After the procedure, the CTG apparatus is connected to the mother in labor for 30 minutes to assess the condition of the child.

Is it painful or not to puncture the bladder before giving birth? The membranes are not penetrated with nerve endings, so the procedure is absolutely painless.

At the same time, complications sometimes develop:

• trauma to the umbilical cord vessel, if it was attached to the shell;
• loss of umbilical cord loops or parts of the fetus (arms, legs);
• deterioration of the fetus;
• rapid labor activity;
• secondary birth weakness;
• infection of the child.

How long does labor last after a bladder puncture? The duration depends on their parity or quantity:

• In primiparas, the normal duration of labor is 7-14 hours.
• Multiparous ones need less time - from 5 to 12.

Contraindications to a puncture of the bladder in a pregnant woman

Despite the simplicity of the procedure and the small number of complications of the manipulation, there are serious contraindications for its implementation. Most of them coincide with contraindications for natural childbirth:

1. A herpetic rash on the perineum will lead to infection of the child.
2. Pelvic, leg, transverse or oblique presentation of the fetus, umbilical cord loops in the head area.
3. Complete placenta previa. In this case, childbirth is impossible - the placenta is attached over the internal pharynx and prevents the lower segment of the uterus from expanding.
4. Inconsistency of the scar on the body of the uterus after cesarean section or other surgical procedures.
5. Narrowing of the pelvis 2-4 degrees, bone deformities, tumor processes in the small pelvis.
6. Fruit weight over 4500 g.
7. Severe scars causing deformation of the cervix or vagina.
8. Triplets, conjoined twins, breech presentation of the first child of twins.
9. High myopia.
10. Fetal growth retardation grade 3.
11. Acute fetal hypoxia.

In the absence of the listed contraindications, amniotomy is a safe procedure and does not affect the condition of the fetus.

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

Useful video

From women giving birth, you can hear about such a concept as a puncture of the bladder before childbirth without contractions. This procedure is called an amniotomy. Usually about 7-10% of women in childbirth encounter it. Many pregnant women are frightened when they hear about an amniotomy. Having no idea about the correctness and necessity of this procedure, women set themselves up negatively.

What happens if the fetal bladder ruptures before contractions?

In some cases, childbirth begins with the outpouring of water. Moreover, it can be complete or partial. According to statistics, such a deviation can occur in 12% of all women. This process is called

Women immediately notice this phenomenon, especially if it happens with a large amount of water.

The amniotic fluid should be light or pink and odorless. If black, brown or green is mixed with it, then this means that there is a newborn's feces in the waters. This suggests that the fetus is undergoing oxygen deprivation, which requires rapid delivery. An admixture of yellow color can mean the presence of a Rh conflict, which also requires quick action.

When the water goes away at home, the woman in labor needs to urgently go to the hospital. In the hospital, a woman must accurately report the time of their departure.

If the body is completely ready for the birth of a child, contractions begin immediately or some time after the passage of water.

What is an amniotomy?

Amniotomy is an operation in which the amniotic sac is opened. In utero, the fetus is protected by a special membrane - the amnion, which is filled with amniotic fluid. It protects the baby from blows and infection from the vagina.

If an autopsy or rupture occurs naturally, then the uterus begins the process of excreting the fetus. As a result, contractions develop and a child is born.

The operation to puncture the bladder before childbirth without contractions is carried out with a special device in the form of a hook at the moment of its greatest severity, so as not to affect the soft tissues of the baby's head.

Amniotomy types

The bladder puncture before childbirth can be divided into several types, depending on the time of the operation:

• Prenatal. It is carried out before the onset of contractions in order to induce labor.
• Early. Done if the opening of the cervix is \u200b\u200bup to 7 cm.
• Timely. If the neck is open to 8-10 cm.
• Belated. Can be carried out at the time of expulsion of the fetus. The procedure is used to prevent fetal hypoxia or bleeding in women in labor.

The process of childbirth does not change at all and corresponds to the natural one. The condition of the fetus is necessarily recorded using the KGT apparatus.

When is an amniotomy necessary?

Labor is stimulated by piercing the bladder in case of situations when an emergency delivery is needed. The procedure can be carried out in the absence of contractions:

• Postterm pregnancy. A normal pregnancy lasts 40 weeks, if it is longer, then the question of the need for obstetric aid is raised. The placenta in this situation is aging and cannot perform its functions. As a result, the child suffers, experiencing oxygen starvation.
• Gestosis. This disease is characterized by edema, high blood pressure, and the presence of protein in the urine. Gestosis negatively affects the health of the mother and fetus, therefore, an amniotomy is needed.
• Rhesus conflict. Such a pregnancy is considered difficult, so this operation helps to stimulate labor.

If labor has begun, then surgery is resorted to in the following cases:

• If the contractions do not intensify, but they weaken, the cervix slows down the process of childbirth, and so that they do not stop, the bladder is punctured. The woman in labor is monitored for 2 hours, if there is no positive dynamics, then a decision is made to resort to "Oxytocin".
• Polyhydramnios. The presence of a large amount of amniotic fluid leads to the fact that the uterus cannot naturally contract.
• High blood pressure. Diseases of the kidneys and heart, gestosis contribute to an increase in blood pressure, which negatively affects the process of childbirth and the condition of the fetus.
• Flat fetal bladder. In this situation, the anterior waters are almost completely absent, which makes labor activity difficult, and its termination may occur.
• Low location of the placenta. This position of the placenta can lead to its detachment and bleeding.

In some cases, there are contraindications for this procedure.

Are there any contraindications?

Puncture of the bladder before childbirth helps to facilitate the process of giving birth, but in some cases there are some limitations of the procedure. An amniotomy is not performed if:

• a pregnant woman has herpes on the genitals in the acute stage;
• the placenta is low;
• umbilical cord loops impede surgery;
• natural childbirth is not recommended;
• finding the fetus in an oblique, transverse and breech presentation.

The procedure for diseases of the mother's heart, with the existence of scars on the cervix and other pathologies is prohibited.

How is the bladder punctured?

Why and how is the bladder punctured before childbirth? Amniotomy is equivalent to surgery, but the presence of an anesthesiologist and surgeon is optional. After a vaginal examination, the doctor will open the bladder. The procedure includes several stages:

• Before the operation, the woman takes No-Shpu or another antispasmodic. After exposure to the drug, the woman lies down on the gynecological chair.
• Then the specialist, wearing gloves, inserts the instrument into the vagina. The amniotic fluid is hooked and pulled by the doctor until it ruptures. After that, the amniotic fluid begins to pour out.
• After the end of the manipulation, the woman is in a horizontal position for 30 minutes. The condition of the fetus is monitored by the KGT apparatus.

The bladder is necessarily opened in the absence of contractions, which leads to the convenience and safety of the operation.

What does a woman feel during an amniotomy?

Bladder puncture before childbirth - does it hurt or not? Any woman is afraid of such a procedure because of the possible pain. However, in this case, unpleasant sensations are not observed, because the amniotic fluid has no nerve endings.

A woman just needs to relax and take a comfortable position. All that she can feel after a properly performed procedure is only the flow of amniotic fluid.

With muscle tension, unpleasant sensations and negative consequences can occur in the form of injury to the walls of the vagina.

Mandatory conditions

What are the conditions for a bladder puncture before childbirth? To avoid complications during the procedure, you must follow some rules. These include:

• correct presentation of the fetus (head);
• pregnancy, the duration of which is at least 38 weeks;
• natural delivery and the absence of restrictions to this;
• preparation of the birth canal;
• pregnancy with one fetus.

The importance lies in the readiness and maturity of the uterus. When carrying out the operation, it must correspond to 6 points on the Bishop scale.

Complications and consequences of amniotomy

With an error-free bladder puncture before childbirth, the whole process is safe. But there are a few exceptions when labor can be more difficult after an amniotomy. There are the following consequences:

• trauma to the umbilical cord vessel, if it is attached to the membrane, which can lead to blood loss;
• the child's condition worsens;
• the loops of the umbilical cord or fetal extremities (arms, legs) fall out;
• violation of the child's heartbeat;
• rapid labor activity;
• secondary birth weakness.

There is a risk that a puncture of the fetal bladder will not lead to the desired result and labor will not become active. Therefore, doctors resort to using drugs that cause contractions. In some situations, a woman undergoes a cesarean section, because a child's prolonged stay without water is fraught with negative consequences.

How long does labor last after a bladder puncture before childbirth? Reviews of women who have gone through this procedure are as follows:

• for women who gave birth for the first time, childbirth took place within 7-14 hours;
• in multiparous women, this can take 5-12 hours.

Any intervention, which can include a bladder puncture, sometimes leads to consequences that are not always positive. Amniotomy should be performed in compliance with all the necessary conditions, which will reduce the risk of complications of various kinds. Therefore, if this procedure is necessary, women should not refuse surgery and other manipulations necessary during childbirth.

Many women who are preparing to become mothers have heard that a puncture of the fetal bladder is a very effective measure for induction of labor and acceleration of the labor process. What is such a procedure, to whom and when it is carried out, we will tell in this article.

What it is?

Throughout pregnancy, the baby is inside the fetal bladder. Its outer layer is more durable, it is a reliable protection against viruses, bacteria, fungi. In the event of a violation of the mucous plug in the cervical canal, he will be able to protect the child from their harmful effects. The inner membrane of the fetal sac is represented by the amnion, which is involved in the production of amniotic fluid - the very amniotic fluid that surrounds the child during the entire period of intrauterine development. They also perform protective and shock-absorbing functions.

The fetal bladder is opened during natural childbirth. Normally, this happens in the midst of active labor pains, when the cervical dilation is from 3 to 7 centimeters. The opening mechanism is quite simple - the uterus contracts, with each contraction the pressure inside its cavity increases. It is this, as well as the special enzymes that the cervix produces at the time of expansion, and affects the membranes. The bubble becomes thinner and bursts, the water leaves.

If the integrity of the bladder is violated before contractions, then this is considered a premature discharge of water and a complication of childbirth. If the opening is sufficient, attempts begin, and the fetal bladder did not even think to burst, this may be due to its abnormal strength. This will not be considered a complication, because doctors can mechanically pierce it at any time.

In medicine, a puncture of the fetal bladder is called "amniotomy". Artificial violation of the integrity of the membranes allows you to release an impressive amount of biologically active enzymes contained in the waters, which acts as a labor stimulant. The cervix begins to open more actively, the contractions become stronger and more intense, which can reduce the time of labor by about a third.

In addition, amniotomy can solve a number of other obstetric problems. So, after it, bleeding can stop with a presenting placenta, and this measure also significantly reduces blood pressure in women in labor with hypertension.

The bladder is pierced before childbirth or during labor. Before the caesarean section, the fetal bladder is not touched, its incision is carried out already during the operation. The woman is not given the right to choose, since the procedure is carried out only if indicated.But according to the law, doctors must ask consent to an amniotomy.

Opening a bubble is a direct intervention in the affairs of nature, in a natural and independent process, and therefore it is strongly not recommended to abuse it.

How is it done?

There are several ways to open the membranes. It can be punctured, cut or torn by hand. It all depends on the degree of dilatation of the cervix. If it is only 2 fingers open, a puncture is preferable.

There are no nerve endings, pain receptors in the membranes, and therefore amniotomy is not painful. Everything is done quickly.

30-35 minutes before the manipulation, the woman is given in tablets or injected intramuscularly with an antispasmodic. For manipulation, which does not have to be carried out by a doctor, sometimes an experienced obstetrician is enough. A woman lies down on a gynecological chair with her hips apart.

The physician inserts the fingers of one hand in a sterile glove into the vagina, and the woman's sensations will be no different from the usual gynecological examination. With the second hand, the health worker inserts a long thin instrument with a hook at the end - a branch into the genital tract. He hooks her to the fetal membrane when the cervix is \u200b\u200bajar and gently pulls on himself.

Then the instrument is removed, and the obstetrician expands the puncture with his fingers, making sure that the water flows out smoothly, gradually, since their rapid outpouring can lead to the washing out and loss of body parts of the crumbs or umbilical cord into the genital tract. It is recommended to lie down for about half an hour after the amniotomy. CTG sensors are installed on the abdomen of the woman in labor to monitor the state of the baby in the womb.

The decision to perform an amniotomy can be made at any time during labor. If the procedure is necessary for childbirth to begin, then they talk about premature amniotomy. To intensify contractions in the first stage of labor, an early amniotomy is performed, and a free amniotomy is performed to activate uterine contractions during almost complete cervical dilatation.

If the baby decided to be born “in a shirt” (in a bladder), then it is considered more reasonable to make a puncture already at the time of the baby's passage through the birth canal, since such childbirth is dangerous with possible bleeding in a woman.

Indications

Amniotomy is recommended for women who need to induce labor as soon as possible. So, with gestosis, post-term pregnancy (after 41-42 weeks), if spontaneous childbirth does not begin, a puncture of the bladder will stimulate them. With poor preparation for childbirth, when the preliminary period is abnormal and prolonged, after puncture of the bladder, contractions in most cases begin in 2-6 hours. Childbirth is accelerating, and after 12-14 hours you can expect the baby to be born.

In childbirth that has already begun, the indications may be as follows:

• the dilation of the cervix is \u200b\u200b7-8 centimeters, and the fetal bladder is intact, it is considered inappropriate to keep it;
• weakness of labor forces (contractions suddenly weakened or stopped);
• polyhydramnios;
• flat bladder before childbirth (oligohydramnios);
• multiple pregnancy (in this case, if a woman is carrying twins, the fetal bladder of the second child will be opened after the birth of the first in 10-20 minutes).

It is not customary to open the bubble on purpose without evidence. It is also important to assess the readiness of the female body for childbirth. If the cervix is \u200b\u200bimmature, then the consequences of early amniotomy can be dire - weakness of labor, fetal hypoxia, a difficult anhydrous period, and as a result - an emergency caesarean section in the name of saving the lives of the child and his mother.

When is it forbidden?

They will not pierce the bladder even if there is a strong and respectful indication for amniotomy the following reasons:

• the cervix is \u200b\u200bnot ready, there is no smoothing, softening, the assessment of its maturity is less than 6 points on the Bishop scale;
• the woman has an exacerbation of genital herpes;
• the child in the mother's womb is located incorrectly - presented with legs, booty or lies across;
• placenta previa, in which the exit from the uterus is closed or partially blocked by a "child's place";
• the umbilical cord loops are adjacent to the exit from the uterus;
• the presence of more than two scars on the uterus;
• a narrow pelvis that does not allow you to give birth to a child on your own;
• monochorionic twins (children in one fetal bladder);
• pregnancy after IVF (caesarean section is recommended);
• a state of acute oxygen deficiency of the fetus and other signs of trouble according to the results of CTG.

An obstetrician or doctor will never open a fetal sac if a woman has indications for operative delivery - cesarean section, and natural childbirth can be dangerous for her.

Potential difficulties and complications

In some cases, the period of time following the amniotomy is labor-free. Then after 2-3 hours they start stimulating with medications - they introduce "Oxytocin" and other drugs that enhance uterine contractions. If they are not effective either, or within 3 hours there is no normalization of contractions, a caesarean section is performed for emergency indications.

As already mentioned, a mechanical puncture or rupture of the fetal membrane is an external intervention. Therefore, the consequences can be very diverse. The most common:

• rapid childbirth;
• the development of the weakness of the generic forces;
• bleeding when a large blood vessel located on the surface of the bladder is damaged;
• loss of umbilical cord loops or parts of the fetus along with the outflowing waters;
• sudden deterioration of the child's condition (acute hypoxia);
• risk of infection of the baby if the instruments or hands of the obstetrician were not sufficiently processed.

If the procedure is carried out correctly, and in compliance with all the requirements, most complications can be avoided, but it is difficult to predict in advance how the uterus will behave, whether it will contract, whether the necessary contractions will begin at the right pace.