Bladder puncture before childbirth: indications, technique, reviews. Why pierce the fetal bladder before childbirth without contractions, does it hurt and how long after the procedure do they give birth? Pierced the bubble

Normally, the water should flow away on its own during childbirth. But sometimes it happens that the contractions have already intensified and the matter is approaching attempts, and the waters are still on. In this case, the doctor decides whether to puncture the bladder.

Contractions help the cervix to open, and the baby - to move along the birth canal. The cervix is ​​smoothed and then opened, and all this is due to the contraction of the muscles of the uterus. But the disclosure also occurs due to the fetal bladder: from contractions, the uterus actively contracts, the intrauterine pressure rises and the fetal bladder strains, and the amniotic fluid rushes downward, Bottom part the fetal bladder enters the uterine pharynx (internal) and promotes the opening of the cervix.

Usually, the bladder ruptures when the neck is fully or almost completely open. The anterior waters flow out first - they are in front of the presenting part (most often this is the head). When the fetal bladder ruptures, the woman does not feel anything, since there are no nerve endings in it.

Some, about 10% of women in labor, drain water before labor begins. It is difficult not to notice, since about a glass (200 ml) of liquid immediately flows out. But it also happens that the bubble does not burst at the exit of the cervix, but at the point of contact with one of the walls of the uterus. Then the water just drips out, gradually staining your underwear.

If the water has departed at home, you need to urgently go to the hospital. Be sure to remember the time of their departure and tell the doctor about it. It is worth paying attention to the nature of the waters - their color and smell. Normally, they should be transparent and odorless.

As you can see, the role of amniotic fluid for the normal course of labor is quite large. If there is no discharge of water during childbirth, childbirth is delayed. In this case, we are talking about protracted childbirth, and in this case, an artificial opening of the fetal bladder is necessary.

Indications for a puncture of the bladder during childbirth

Puncture (autopsy) amniotic fluid it is necessary in a number of cases. Among them:

How is the amniotic fluid pierced?

The procedure itself is absolutely painless, since, as already mentioned, there are no painful nerve endings in the fetal bladder. An autopsy is performed during a vaginal examination using a special instrument - a metal hook. After the bladder is punctured and the water is poured out, childbirth becomes more rapid, and soon the baby will be born.

During pregnancy, women are faced with the fact that the terms have already passed, and childbirth does not begin. Then the decision is made to induce delivery. The bladder is pierced before childbirth to provoke contractions. This is not the only way to stimulate, but the most gentle.

Indications and timing

The procedure is performed if there are reasons that threaten the woman or the fetus. A woman in labor should understand that a qualified doctor will not prescribe manipulation without good reason, so she should immediately agree with his decision.

Why the bladder is pierced during childbirth:

1. there is a rhesus conflict;
2. late toxicosis is diagnosed;
3. if a woman suffers from hyponia;
4. a woman in labor is sick with diabetes mellitus;
5. with kidney disease in a pregnant woman

Puncturing the bladder before delivery is called an amniotomy. If the child is in danger or there was a leakage of amniotic fluid, and the contractions did not start, he suffers from a lack of oxygen. The indication for the procedure is also prolonged pregnancy.

Bladder piercing before childbirth is used as a method of increasing contractions when labor is weak. IN amniotic fluid contain prostaglandins that stimulate labor. Only if the onset of full-fledged contractions with amniothymia has not been achieved, medication stimulants are administered to the woman in labor.

When is the bladder pierced during childbirth? It all depends on the reason for the appointment of the procedure. If the reason is prolongation, at 41 weeks, a planned bladder puncture is used to start delivery. If the basis for the manipulation is weak labor, then the procedure is carried out during the onset of labor, regardless of the timing.

• premature (one that is carried out before the onset of contractions as a method of stimulation);
• early (a puncture is made when the uterus is open by 7 cm);
• late (performed on the delivery chair after lowering the child into the small pelvis, when attempts began, but the water did not leave).

Bladder puncture during pregnancy is also carried out in the absence of anterior waters (flat fetal sac). Then the shell wraps around the baby's head and delays the birth process. The reason for amniotomy is considered to be too low attachment of the placenta. Bleeding and detachment are likely, so it will be safer for the woman in labor to pierce the bladder.

However, this method of stimulation is not always used generic activity... Dr. E. Komarovsky believes that the period when a child is born should be extremely natural. To help female body follows as the most extreme measure. He believes that too frequent use of amniotomy is nothing more than the desire of doctors to speed up the delivery.

Contraindications and diagnostics

As with other medical procedures, the puncture cannot be performed due to the characteristics of the woman in labor. If a woman has heart disease, as well as high blood pressure childbirth is not carried out in the usual way.

It is forbidden to cause contractions in pregnant women with sutures on the uterus, especially if they have become too thin during the gestation period. The condition of the birth canal is assessed before prescribing an amniotomy for the expectant mother.

It is forbidden to puncture the fetal sac if:

1. the expectant mother has genital herpes;
2. the fetus has a transverse presentation;
3. low location of the placenta;
4. heavy umbilical cord entanglement of the child;
5. vaginal delivery is prohibited for medical reasons

It is advisable to undergo ultrasound diagnostics shortly before the procedure. So you can find out the state of the birth canals, and accurately determine the degree of opening of the uterus. Also, blood pressure is measured and the intestines are cleansed, because childbirth after a puncture of the amniotic fluid can quickly and suddenly gain momentum.

It is necessary to weigh the pros and cons and only after that proceed to the manipulation. If the woman is nervous, the obstetrician should try to convince her that this is really necessary. After all, a woman in labor knows that, despite the safety of the operation, there is a possibility of complications.

Operation technique

In order to prepare as much as possible for a possible obstetric manipulation, you should familiarize yourself with the procedure during pregnancy. Not necessarily an amniotomy will be applied, but it doesn't hurt to be informed about the issue.

How to pierce the bladder during childbirth:

• a woman to sit on an examination chair;
• the nurse treats the genitals with septic agents;
• the woman in labor is taking pain medications;
• the obstetrician spreads the walls of the vagina and inserts a special hook there;
• the doctor grabs the fetal bladder with the device and pulls it towards himself until the moment of rupture;
• contractions should appear for half an hour.

This procedure is rather unpleasant than painful. Pulls the hook towards the obstetrician, gives discomfort to the woman in labor. This is the only sensation that accompanies a woman in labor during a mini-surgery.

Why does the water drain when you start to give birth? In the natural course of labor, the cause of the outflow of amniotic fluid is the rupture of the fetal bladder. If an amniotomy was performed, the water moved away as a result of it.

How is labor going with planned bladder piercing? The procedure is carried out with prolongation, intrauterine fetal death or gestosis. As a rule, after the integrity of the fetal sac has been violated, there is a gradual outpouring of amniotic fluid, and then contractions begin.

Over time, the strength of uterine spasms increases, and the neck, waters, by the influence of prostaglandins, smoothes and opens more intensively. When the body has not prepared itself for delivery, contractions are much more painful than those that come without an amniotomy.

But a puncture of the bladder does not always lead to contractions. It also happens that one opening of the fetal sac is not enough to start a full-fledged labor, then medication methods of stimulating labor are used.

Is it possible to give birth if the waters have not departed? No, because the child, along with the amniotic fluid, is in the fetal sac. And if it is not opened and the water has not departed, it means that the birth of the baby will not occur naturally. The only possible option without the outpouring of water is a cesarean section. Then the baby is removed directly from the placenta.

Complications

Amniotomy, of course, causes generic activity and helps the baby to be born, but there are also unpleasant consequences of a puncture of the amniotic fluid. Such pathologies are extremely rare, however, they do happen.

Complications of a puncture of the fetal sac:

1. bleeding (appears as a result of the obstetrician getting into a large vessel that passed along the membrane);
2. prolapse of the umbilical cord, body parts (arms, legs);
3. deterioration of the child's well-being due to a sharp change in the environment;
4. scratches in the newborn;
5. decrease in labor activity;
6. excessively rapid development of the generic process;
7. infection of the fetus.

The reason for such pathologies is the lack of professionalism of the obstetrician, that is, the incorrect performance of the operation. Therefore, a bladder puncture during childbirth should be trusted by an experienced obstetrician.

Complications provoke health problems for the baby. It is unacceptable to do such a manipulation at the request of doctors or women in labor. Childbirth with a puncture of the bladder should be reasoned and indicated for the state of health of the woman or fetus.

Amniotomy is a mini-operation, but it should be used if indicated. The desire of a doctor or a woman in labor to induce labor is not a basis for manipulation. When prescribing a procedure, a woman should find an experienced obstetrician so that complications do not arise.

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

During childbirth, 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. Successful amniotomy is possible when certain conditions are met:

• the head of the fetus is presented;
• full-term pregnancy of 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 - carried out before the onset of contractions, 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. Belated - in modern conditions performed rarely, performed at the time of 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 giving birth to 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 in childbirth

Bladder puncture stimulates or is performed during planned labor.

Labor induction using amniotomy is indicated in the following cases:

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

The latter condition is the occurrence of small contractions over several days that do not develop into normal labor. This causes fetal suffering from a 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 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 prevents normal contractions from developing
4. With oligohydramnios, 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 after 10-15 minutes from the appearance of the first.
7. High arterial pressure decreases after the opening of the waters.

The technique of piercing the bladder 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 meconium flakes 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's body.

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;
• violent 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 of them coincides with the 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 region.
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 interventions.
5. Narrowing of the pelvis of 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 these 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

Artificial opening of the fetal bladder, or amniotomy, often raises some concerns in women who are expecting a baby. Not every patient maternity ward understands the meaning of this procedure: why open the fetal bladder, if during childbirth the water will go away by itself? Let's try to reassure expectant mothers and answer this question.

According to the tasks and timing of the amniotomy, they are divided into three types. Premature amniotomy is used to induce labor. Early and delayed amniotomy may be necessary during labor.

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 labor induction means the immediate onset of labor: once the membranes are opened, there is no way back. During pregnancy, the obstetrician is forced to initiate labor activity most often ahead of schedule, in different terms pregnancy, including in its last week before the onset of spontaneous labor on the part of the mother and the fetus - this is induced labor... Indications for amniotomy can be:

• severe form of late pregnancy, when edema, high blood pressure, changes in urine tests cannot be corrected with medication, the condition of the mother and fetus remains unsatisfactory, despite treatment;
• maternal diseases (cardiovascular disease, diabetes mellitus, liver disease, chronic diseases lungs, etc.);
• post-term pregnancy;
• acute increasing polyhydramnios with symptoms of cardiopulmonary insufficiency of a pregnant woman;
• deterioration of the fetus for various reasons.

In other cases, premature amniotomy for the purpose of labor is performed on time without medical indications, when the fetus has reached full maturity, and there are no signs of spontaneous labor. This prophylactic induction with amniotomy during normal pregnancy is called programmed childbirth.

One of the possible conditions for the use of amniotomy for the purpose of childbirth is the presence in a woman of optimally expressed signs of readiness for childbirth, In 70-80% of cases at full-term pregnancy, when the cervix is ​​"ripe" pelvis), childbirth can be caused by only one amniotomy without the use of medications stimulating uterine contractions (, prostaglandins).

Premature amniotomy in the absence or insufficient severity of signs of readiness for childbirth does not always lead to the development of adequate labor activity - as a rule, childbirth is protracted, requires drug delivery, there is a danger of an increase in the waterless gap, infection of the birth canal and fetus, asphyxia (cessation of oxygen access ) and birth trauma in the fetus.

Programmed childbirth, widespread in the 90s, is now practiced less often due to not only possible complications(head insertion anomaly, violation contractile activity uterus, bleeding after childbirth), but primarily due to the tendency towards the natural course of pregnancy and childbirth.

Early amniotomy

During childbirth, an early amniotomy may be required - it is performed when the opening of the cervix is ​​still small. Let's list the indications for its use.

1. Cases when acceleration of labor is necessary:
   • with weakness of labor(there is a close relationship between a low level of uterine contractility and the slow progress of labor at any stage of the first and second periods), Early opening of the fetal bladder leads to increased production and release of prostaglandins - special physiologically active substances... Prostaglandins cause uterine contractions, and also contribute to increased uterine activity during labor;
   • with a functionally defective fetal bladder("flat" or "flaccid"). The usual volume of anterior waters located in front of the fetal head is up to 200 ml. If there is little anterior water, which happens with low water, the membranes are stretched over the head of the fetus ("flat fetal bladder"). A decrease in the volume of amniotic fluid in most cases is associated with the presence of malformations of the urinary system of the fetus, with prolonged gestation, a decrease in the amount of amniotic fluid to 50-100 ml is also observed. Such a bladder ("flat" or "flaccid") does not fulfill its function as a "hydraulic wedge" in the opening of the cervix, which is also the reason for the slow progress of labor;
   • with polyhydramnios due to a large number amniotic fluid, the uterus is overstretched, its contractions are weak, More often than in half of the cases, the causes of polyhydramnios remain unclear. Polyhydramnios is not only a disease of the amnion (membranes) - it can be associated with a disease of the mother ( diabetes mellitus, inflammatory diseases genitourinary system), with the development of fetal diseases ( hemolytic disease or the presence of a variety of defects and chromosomal abnormalities). The infectious nature of polyhydramnios is possible when the mother is sick with syphilis, influenza, etc. Early amniotomy with polyhydramnios results in a decrease in the volume of the uterus, as a result of which the contractions of the uterus become stronger.
2. Use of amniotomy for the therapeutic goal of the day of achievement:
   • hemostatic (hemostatic) effect in bleeding associated with partial presentation or low attachment of the placenta, that is, in cases where the placenta is attached close to the exit from the uterus. The placental tissue is not capable of stretching, the membranes during contractions entail the edge of the placenta. As a result, a portion of the placenta breaks away from the presenting wall of the uterus, which leads to a violation of the integrity of the vessels of the placental site and bleeding. After amniotomy, the wall of the lower segment of the uterus, together with the membranes and the placenta, is displaced upward, the placenta no longer exfoliates, so the bleeding stops. The presenting part of the fetus descending into the entrance of the pelvis presses the bleeding part of the placenta to the walls of the uterus and to the walls of the pelvis and thereby also helps to stop bleeding;
   • hypotensive effect- lowering blood pressure during childbirth in women in labor with late toxicosis (preeclampsia), as well as hypertension... In this case, the reduced volume of the uterus after amniotomy exerts less pressure on large vessels, blood pressure decreases.
3. The presence of indications on the part of the fetus, if, with additional methods of examination in childbirth, signs that threaten the vital functions of the fetus are revealed:
   • detection of green amniotic fluid(with an admixture of meconium) during amnioscopy, examining the amniotic fluid through the membranes with an optical device - this indicates that the fetus is experiencing a lack of oxygen;
   • violation of blood flow in the vessels umbilical cord according to Doppler data;
   • pathological type of fetal cardiotocogram curves that does not require a cesarean section.

Delayed amniotomy

Sometimes, despite the complete opening of the uterine pharynx, the fetal bladder remains intact and the period of expulsion occurs when the anterior waters have not departed. The reasons for this pathology may be as follows:

• the excessive density of the membranes interferes with their timely opening under the pressure of intrauterine pressure;
• excessive elasticity of the membranes leads to the fact that the fetal bladder becomes thinner and fills a significant part of the vagina, and sometimes comes out of the vagina;
• with a "flat" bladder with a small or negligible amount of anterior waters, the membranes are stretched over the head of the fetus and cannot be opened independently,

In these cases, the period of expulsion (the second, tighter period of labor) is delayed. A non-opening fetal bladder interferes with the insertion of the head into the pelvis and pulls the overlying sections of the membranes with it, the placenta begins to exfoliate from its bed - appear bloody issues... In rare cases, a child can be born in a fetal bladder with a detached placenta (people say about such cases: "born in a shirt"), as a rule, in a state of asphyxia. In order to prevent such complications, they resort to delayed amniotomy already in the second stage of labor. After the opening of the fetal bladder and the outpouring of water, labor activity intensifies, the forward movements of the fetus begin along the birth canal.

Amniotomy. Procedure progress

After processing the external genital organs, the doctor inserts the index and middle fingers into the uterine os of the cervix until it touches. at the end, the fetal membranes are opened, after which the obstetrician uses his fingers to dilute the fetal membranes to the sides. The manipulation is painless because there are no nerve endings in the membranes.

At the time of the amniotomy, the doctor assesses the color of the waters: on this basis, one can judge the condition of the fetus. Normally, the waters are transparent, but if the waters are green, this indicates that the baby lacks oxygen, which, in turn, leads to relaxation of the obturator muscles of the intestine, and the original feces are mixed with the amniotic fluid. Yellow amniotic fluid indicates a disease that develops in the fetus when the blood of the mother and the fetus is incompatible with Rh or blood group.

Fortunately, serious complications from amniotomy are rare. However, this manipulation may be accompanied by undesirable consequences: pain and discomfort, infection, worsening of the fetal heartbeat, prolapse of the umbilical cord or small parts of the fetus (arms or legs), as well as bleeding from the fetal vessels in the membranes, from the cervix or from the placenta attachment (partial) ...

The opening of the fetal bladder is used only if necessary, the manipulation is carried out with the consent of the woman. Since, as already mentioned, the fetal bladder plays a protective role, including protecting the fetus and uterus from infection, then no more than a day should pass from the moment the amniotic fluid flows out to the birth of the baby. Currently, the time limits have become even more stringent, and it is believed that the more sure protection against infection of the fetus and uterus is the duration of the anhydrous gap of no more than 12 hours.

Why is a fetal bladder needed?
The importance of amniotic fluid is great. They prevent the formation of adhesions between the membranes and the fetus; protect the umbilical cord and placenta (baby's place) from pressure from large parts of the fetus and uterine contractions during childbirth; make possible and easy fetal movements that are necessary for its proper development; protect the fetus from jolts and bruises from the outside; affect the position and distribution of the fetus - the relative position of the limbs, trunk; make fetal movements less noticeable for a pregnant woman; the integrity of the fetal bladder protects against infection, promotes the opening of the uterine pharynx during childbirth - during each contraction, the fetal bladder wedges into the cervical canal, facilitating the opening of the cervix. Normally, the opening of the fetal bladder occurs when the cervical dilation is more than 6 cm.

Lyudmila Petrova,
Obstetrician-gynecologist of the highest qualification
category, head of the maternity department
maternity hospital N 16, St. Petersburg
Article provided by the magazine "Pregnancy. From conception to childbirth" N 03 2007

Amniotomy is an obstetric manipulation that involves piercing the fetal bladder.

In maternity hospitals safe indications for its implementation
Amniotomy pregnant hard
sleep food listening

It is produced only by qualified employees to stimulate the birth process.

What is this process?

Amniotomy is one way to induce labor. During the procedure, the doctor pierces the fetal bladder, which is why the amniotic fluid leaves, and the process of contractions starts or intensifies.

Usually, the waters are poured out during childbirth on their own, but about 7% of women still need such a procedure. After the puncture, part of the water that is in front of the baby's head leaves, irritation of the birth canal occurs, which helps to intensify the contractions.

Also, when the water is poured out, the hormone prostaglandin begins to be produced in the expectant mother, which enhances the contractions of smooth muscles, thereby stimulating contractions.

Some women are afraid of amniotomy during childbirth - this is completely in vain. It is safe for mother and child, and is done only if indicated. Amniotomy, judging by the reviews, is completely painless, it does not require any pain relief.

Conditions for the procedure

Performed in about 7% of all births

Despite the fact that the procedure for opening the fetal bladder is quite simple, and also does not require the presence of a surgeon, certain conditions are still required for its implementation.

1. Only an obstetrician-gynecologist in a hospital setting should carry out the manipulation.
2. The cervix must be fully prepared for the birth process.
3. The child must take correct position, and its head - the desired position in the pelvis of the woman in labor.
4. A contraction-free amniotomy should only be performed if all of the above conditions are met and indicated.

If all the conditions for the procedure are met, the amniotomy is performed according to the indications and the manipulation technique is followed, the likelihood of negative consequences will be very small.

Indications for manipulation

The procedure is done according to indications, and not at the request of a doctor or a woman in labor. There is a list of reasons for this procedure.

1. Gestosis, accompanied by severe edema, increased pressure, increased protein content in the urine.
2. Postterm pregnancy, when labor does not begin until 41-42 weeks.
3. Weak labor activity.
4. Placental insufficiency.
5. The bubble shell is too tight.
6. Rhesus conflict between mother and child.

There are also indications for an early amniotomy.

1. Flat fetal bladder, i.e. lack of anterior water.
2. Low position of the placenta.
3. Polyhydramnios.
4. High blood pressure in the mother.

Quite often, the procedure is done for twins, since in this case, a weakening of labor is often observed. The need for conducting should be assessed by the doctor during the labor process.

Types of procedure

In total, there are 4 types of amniotomy, the technique does not change, and the difference lies only in the timing of the manipulation.

Late amniotomy is performed if the fetal membrane is too dense, and the child cannot tear it apart during childbirth. She is considered the most dangerous, since with her the likelihood of hitting the head of the child is the highest.

However, it must be carried out, otherwise the most severe consequences for the health of the newborn are possible - hypoxia and suffocation may threaten him. The most favorable time for a puncture is the period of contractions, since at this time the fetal bladder is clearly visible.

How is the manipulation carried out

This is a safe and painless procedure, since the bladder has no nerve endings.

Both planned and conventional amniotomy are performed in exactly the same way. The procedure does not give a woman any unpleasant sensations, therefore one should not be afraid of it. However, it must be remembered that for its implementation, the doctor must obtain the consent of the woman in labor, and also inform her about all the possible consequences.

Amniotomy is performed according to the following algorithm.

1. Before the operation, the doctor checks the condition of the fetus.
2. Further, on the obstetric chair, the gynecologist assesses the condition, the degree of cervical dilatation.
3. If the cervix is ​​in the right condition, the doctor inserts a plastic hook into the uterus.
4. In a contraction, when the wall of the bladder protrudes, the doctor punctures it carefully.
5. Then, with a finger, he gently expands the opening and releases the amniotic fluid.
6. In the next 30 minutes, the woman in labor should be monitored, the condition of the fetus is monitored using CTG.

You can learn more about how an amniotomy is performed by watching a video recording of this procedure.

Contraindications for conducting

It is carried out only if there are significant indications for its implementation.

Despite the simplicity of this operation, sometimes it can be contraindicated. An experienced doctor will never puncture the bladder if at least one of the following factors is present:

• malposition;
• presentation of the umbilical cord loops;
• full placenta previa.

Opening of the fetal bladder is not done if there is viral infections at a woman in labor. These include:

• genital herpes;
• immunodeficiency virus;
• hepatitis.

When carrying out the manipulation, the risk of infection of the child increases, therefore gynecologists prefer to protect the baby from a possible disease.

In addition, the fetal bladder is never pierced if the woman has contraindications for natural childbirth. To date, indications for caesarean section are:

• scars on the uterus;
• pathological conditions of the birth canal;
• large fetal weight;
• placental abruption;
• retinal tears;
• fundus changes;
• tears of the 3rd degree during the past childbirth;
• acute fetal hypoxia according to CTG.

Possible complications

Like any medical operation, has its complications

At correct execution surgery complications after it practically do not occur. This method is considered completely safe for the child and mother, if there are no contraindications. However, in extremely rare cases, when a woman is undergoing an amniotomy, the following risks may arise:

• prolapse of the umbilical cord: in this case, the formation of acute hypoxia in the baby is possible, therefore urgent surgical intervention in the process of childbirth;
• damage to a large vessel of the fetal bladder: for this reason, bleeding is formed, which can threaten the life of the child;
• rapid labor: this is possible due to a sharp change in pressure in the uterus, which is fraught with ruptures of the cervix and perineum;
• if the puncture did not lead to an increase in labor, then after a certain time it is necessary to apply other methods of stimulation, since without protection in the form of a fetal bladder, there is a danger of infection of the uterus and fetus.

Some women categorically refuse to puncture the fetal bladder, forgetting that only qualified specialist is able to correctly assess the need for a particular obstetric intervention. Find out what it is.

Refusing this procedure due to prejudice or unfounded fears, you can seriously harm yourself and your child. Therefore, listen to the opinion of the doctor - do not risk the life and health of your own child.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist