Amniotomy. When is a puncture of the amniotic sac needed and does it hurt? Does it hurt to pierce a bladder with water before childbirth

Amniotomy is an obstetric manipulation, which consists in piercing the fetal bladder.

In maternity hospitals, safe indications for its implementation
Amniotomy pregnant hard
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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, due to which 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 in front of the baby's head leaves, irritation of the birth canal occurs, which helps to intensify contractions.

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

Some women are afraid of an amniotomy during childbirth - this is completely in vain. It is safe for mother and child, and is done only according to indications. Amniotomy, judging by the reviews, is completely painless, it does not require any means of anesthesia.

Conditions for the procedure

Carried out 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, some conditions are still required for its implementation.

1. Manipulation should only be carried out by an obstetrician-gynecologist in a hospital setting.
2. The cervix must be fully prepared for the birth process.
3. The child must take the correct position, and his head - the desired position in the pelvis of the woman in labor.
4. Amniotomy without contractions should be performed only if all of the above conditions are met, if indicated.

If all the conditions for the procedure are met, the amniotomy is performed according to the indications and the manipulation technique is observed, the probability 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 specific list of reasons for this procedure.

1. Preeclampsia, accompanied by severe edema, increased pressure, increased protein content in the urine.
2. Post-term pregnancy, when labor does not begin before 41-42 weeks.
3. Weak labor activity.
4. placental insufficiency.
5. Too dense bubble shell.
6. Rhesus conflict in mother and child.

There are also indications for early amniotomy.

1. Flat fetal bladder, i.e. lack of anterior waters.
2. Low position of the placenta.
3. Polyhydramnios.
4. Maternal high blood pressure.

Quite often, the procedure is done with twins, since in this case there is often a weakening of labor activity. The need for carrying out should be assessed by the doctor during the birth 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 during childbirth cannot break it on its own. It is considered the most dangerous, since with it the probability of hitting the child's head is highest.

However, it is necessary to carry it out, otherwise the most serious consequences for the health of the newborn are possible - he may face hypoxia and suffocation. The period of contractions is considered the most favorable time for a puncture, 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 does not have any nerve endings.

Both planned and conventional amniotomy are performed in exactly the same way. The procedure does not give the woman any discomfort, so you should not be afraid of it. However, it must be remembered that in order to conduct it, the doctor must obtain the consent of the woman in labor, and also inform her of all 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. During the contraction, when the wall of the bladder protrudes, the doctor gently pierces it.
5. Then, with a finger, gently widen the hole and release the amniotic fluid.
6. In the next 30 minutes, the woman in labor should be under observation, the condition of the fetus is monitored using CTG.

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

Contraindications for carrying out

It is performed 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 loops of the umbilical cord;
• complete placenta previa.

An autopsy of the fetal bladder is not done in the presence of viral infections in a woman in labor. These include:

• genital herpes;
• immunodeficiency virus;
• hepatitis.

During the manipulation, the risk of infection of the child increases, so 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, the indications for caesarean section are:

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

Possible Complications

Like any medical operation, it has its complications.

When the operation is performed correctly, there are practically no complications after it. 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 given an amniotomy, the following risks may occur:

• prolapse of the umbilical cord: in this case, the formation of acute hypoxia in the baby is possible, therefore, urgent surgical intervention is required in the process of childbirth;
• damage to a large vessel of the fetal bladder: for this reason, bleeding occurs, which can threaten the life of the child;
• rapid childbirth: 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 activity, 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 a qualified specialist is able to correctly assess the need for this or that obstetric intervention. Find out what it is.

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

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According to statistics, at least 50% of women have a bladder puncture before giving birth. Many even believe that this is a routine procedure that is necessarily included in the delivery plan. Why do obstetricians resort to such manipulations? Does it hurt and can the child suffer? How do former women in labor assess the need for such actions and their consequences?

Mandatory step or last resort: why do an amniotomy?

Nature is programmed so that the outflow of amniotic fluid during childbirth occurs without outside interference. Normally, the bubble bursts when the cervix is ​​already almost completely open and the baby is ready to leave the mother's tummy. But in fact, many women before childbirth are given an artificial puncture of the bladder. Such manipulations are usually resorted to if the contractions are already in full swing, attempts will soon begin, and the waters have not yet receded.

The intention to shorten the duration of delivery is the first answer to the question of why the bladder is pierced before childbirth. It is believed that amniotomy improves labor activity, makes it possible to do without stimulation, to examine the amniotic fluid for the presence of meconium or blood in it.

This practice flourishes in maternity hospitals, but it should be understood that this is an optional procedure. Amniotic fluid helps to open the cervix, serves as a kind of "safety cushion" for the baby - it alleviates the pressure and pain that he has to experience during labor, facilitates progress through the birth canal (therefore, the head is less deformed), and reduces the likelihood of intrauterine infection.

When is it really necessary?

The decision on whether to pierce the bladder should be taken by a panel of doctors, but in practice it is often decided by one doctor or even a midwife. There are specific medical indications for this procedure. It is necessary if:

• the walls of the bladder are too strong, due to which the fetal membrane is not able to break on its own, even if the neck is fully opened;
• labor activity is very weak. Amniotomy will help intensify contractions and increase their duration;
• gestosis developed;
• pregnancy with Rh-conflict, and this led to complications during childbirth;
• the woman in labor has polyhydramnios. If the liquid begins to drain on its own, the umbilical cord may fall out or the contractions will be too sluggish;
• low attachment. The placenta can move ahead of time, which threatens to cause fetal hypoxia;
• irregular and ineffective contractions that do not dilate the cervix. The woman in labor suffers for several days, but the final does not come. Artificial opening stimulates labor activity;
• flat bubble. If there are no anterior waters or there are too few of them, then the membrane tightly wraps around the baby's head, which is fraught with the development of premature placental abruption, and this is already an emergency caesarean;
• high blood pressure;
• the bladder burst at the site of its contact with one of the walls of the uterus, which caused a slow leakage of fluid.

The puncture of the bladder before childbirth without contractions for labor induction, according to many doctors, is an unnecessary and even harmful measure. Early amniotomy (up to 6-7 cm) does not prevent, but increases distress. This reduces the amount of water, which provokes partial compression of the umbilical cord and a decrease in the amount of oxygen that the baby receives. But it is necessary if the woman passed the term (the puncture will "start" childbirth).

Important! If the bubble does not burst itself by the end of the first phase of labor (7-8 cm), then the staff is obliged to open it, because at this stage it simply interferes.

Who can't?

Contraindications to this procedure are: herpes on the perineum, complete placenta previa, foot, pelvic, oblique or transverse location of the fetus, an umbilical cord loop on the head, a weak scar on the uterus after cesarean, tumors, narrowing of the small pelvis, the baby's weight is more than 4.5 kg, deformation of the vagina due to cicatricial changes, high myopia, triplets, fetal growth retardation of the 3rd degree, acute hypoxia.

Will it hurt?

For such manipulations, a special tool is used - a branch, a thin metal needle with a curved end. Everything happens very quickly, under sterile conditions. The woman in labor is placed on a chair, during the vaginal examination, this hook is inserted into the vagina and the membrane is torn. The gynecologist inserts a finger into the resulting hole and releases water. No painful sensations arise, because nature does not provide for the sheath of nerve endings.

Did the puncture help give birth faster: what do women say?

So is it necessary or not to do a bladder puncture before childbirth? If we summarize the reviews, the conclusions will be as follows:

• usually no one asks a woman in labor if she agrees to such a procedure, and the moment is not the most suitable. Therefore, it is better to find a doctor in advance, whose actions she trusts;
• if the obstetrician insists that this is necessary, then it is better not to refuse. After all, on her own she will not be able to determine whether there is evidence for this. In addition, some women note that after the puncture, the waters are already green, so this was a clearly necessary measure. But some strongly disagree. They believe that it is possible to challenge the decision of the obstetrician, ask what this situation threatens, and ask for another hour or two for spontaneous rupture;
• a puncture speeds up the process and relieves pain (especially if this is not the first baby). Therefore, the help of doctors is necessary: ​​protracted childbirth exhausts a woman, she may not have the strength to give birth herself. But some write that the puncture did not speed things up. After such a manipulation, 5-12 hours passed - and nothing. As a result, I had to put oxytocin;
• making a puncture does not hurt, you don’t feel anything at all;
• the procedure is far from safe. There are reviews in which women report that the baby had a wound on the head after birth.

In an ideal birth process, amniotic fluid drains just before delivery itself, when the opening of the uterus is 8 or more fingers. However, if labor induction is necessary, or there are other indications, an amniotomy is prescribed for women in labor.

Description of the procedure

Amniotomy is a painless medical manipulation, which consists in puncturing the bladder before childbirth. The technique is quite simple: with a special device similar to a hook, the doctor opens the fetal bladder, after which water is poured out. The organ itself is covered with a network of blood vessels, so as not to touch any of them, the puncture is carried out when the shell is clearly visible.

After the procedure and the outflow of water, the contractions become more intense and painful. If at the time of opening the bladder they were not there, after the manipulation, labor activity begins.

Indications for bladder puncture

Depending on the period of carrying out, prenatal, early, timely and late amniotomy is distinguished.

Prenatal bladder puncture is used when there is a need to stimulate the birth process, in conditions such as preeclampsia, pregnancy for more than 42 weeks, and chronic diseases of the mother. Early - carried out with weak labor activity to accelerate and strengthen.

Timely and late opening of the amniotic waters is carried out if the bladder did not burst itself during childbirth, since its presence when the uterus opens more than 8 cm is not advisable.

In addition, the amniotic sac is pierced with a low placenta, polyhydramnios and oligohydramnios, as well as to reduce the high blood pressure of the woman in labor.

Contraindications for amniotomy

Despite the apparent simplicity of the procedure, it is a real obstetric operation and has its own contraindications.

This manipulation is not carried out in case of premature birth and multiple pregnancy. Restrictions are also imposed on the weight of the child, a contraindication is a weight of less than 3 kg and more than 4.5 kg.

In addition, a puncture of the bladder before childbirth is not done if there are indications for a caesarean section, for example, scars on the uterus, pelvic or transverse location of the fetus.

Possible Complications

Amniotic sac puncture is safe for both mother and baby and is effective when the cervix is ​​ready for delivery, otherwise additional stimulant medications may be needed.

After how much labor will begin depends on the degree of cervical dilatation. According to reviews, on average, women give birth after an amniotomy within 10 minutes - 6 hours. However, the water-free period should not exceed 12 hours. If during this time the mother did not give birth on her own, an emergency is indicated, since infection of the woman in labor and the baby is possible.

A woman has the right not to agree to pierce the amniotic sac during childbirth by signing the appropriate document that she knows about the possible consequences and voluntarily refuses the procedure.

You can read more about how childbirth goes.

A bit of physiology

Labor is always preceded by labor. With their onset, the cervix begins to open. The fetus moves along the birth canal, the muscles of the uterus are intensively reduced, and the cervix is ​​smoothed out.

The fetal bladder also contributes to the opening of the cervix, while protecting the head and neck of the newborn from injury. It reliably protects newborns from various types of infections, and labor activity, if present, is almost painless and natural. If the birth is normal, then the amniotic fluid begins to drain on its own, and the bubble breaks painlessly (there are no nerve endings in it).

In some women in labor, the discharge of water occurs before the onset of childbirth. Amniotic fluid is poured out in a small amount (200 ml). If the fetal bladder breaks before exiting the cervix, then water is released in drops.

So why is the fetal bladder pierced during childbirth?

For this, there are the following medical indications:

• prolongation of pregnancy;
• syndrome of disruption of the work of some body systems and organs of a pregnant woman (gestosis);
• irregular contractions;
• weak generic activity;
• very dense amniotic membrane. A child can be born "in a shirt", that is, in an unruptured bubble. This is dangerous, since the newborn cannot take a full first breath;
• polyhydramnios;
• various pathological conditions of women in labor.

Often during the passage of any childbirth, the following can happen: childbirth takes a long time, the fetus moves slowly, abundant discharge with blood appears from the genital tract, there is a threat of placental abruption, the occurrence of hypoxia (oxygen starvation) of the fetus. All this also applies to medical indications for opening the amniotic sac.

Bladder opening procedure

The bubble is opened by a doctor during examination with a special sterile instrument. This manipulation should not be afraid, as it is absolutely painless. After the bladder is opened, amniotic fluid begins to drain, mechanical irritation of the mother's birth canal by the baby's head, stimulation of the production of special biologically active substances (prostaglandins). They also begin to intensify tribal activity.

Sometimes the bubble is also opened in order to carry out a diagnostic measure, when there is a suspicion of hypoxia (oxygen starvation) of the fetus. In any case, if the doctor decided to puncture the bladder, then this is necessary for the health of the woman in labor and the baby.

Every expectant mother is looking forward to the appearance of her baby, because after many months she wants to quickly look at him and press him to her chest. But, as you know, childbirth is not a source of pleasant sensations, and a woman will have to face a number of various difficulties. It happens that for certain reasons, contractions do not start, and specialists have to provoke them with their own hands. One of the easiest ways to induce labor is considered to be a puncture of the amniotic sac. It is absolutely not worth being afraid of this, since the procedure is carried out for the good and will not harm the crumbs.

Bladder puncture without contractions

Often the opening of the bladder in the fairer sex causes irresistible excitement due to ignorance. First of all, it is necessary to analyze in what particular situations it is impossible to do without this procedure. In any case, the woman in labor should understand that if the doctor has informed about the need for an amniotomy, then it is strongly not recommended to refuse.

Often you have to pierce the bubble because of the threat to the life of the baby. The most common indications for manipulation are preeclampsia and the threat of Rhesus conflict. Also, the indications include the presence of serious disorders in the functioning of the kidneys, hypertension and diabetes mellitus in a woman. Quite often, specialists are forced to induce labor in this way with fetal hypoxia and post-term pregnancy, the death of a baby in the womb.

There are also cases when the contractions are so weak and unproductive that the expectant mother simply cannot give birth on her own without an amniotomy. In such a situation, the opening of the cervix is ​​​​slowed down, and the baby cannot be born. And amniotic fluid, in turn, contains prostaglandins, which significantly enhance labor activity. Therefore, the decision is made to puncture the bladder. If the desired result could not be achieved, then the woman is given special drugs that activate contractions.

Most expectant mothers are worried about how this manipulation is carried out. As already mentioned, there is absolutely no need to be afraid of amniotomy. First, the medical staff treats the woman's genitals with antiseptic agents, and also gives her an anesthetic pill. Next, the doctor gently expands the vagina and slowly introduces a special tool, which is a kind of hook. It captures the bladder, after which the obstetrician gently pulls it towards himself until a rupture occurs. Then the woman in labor is observed for half an hour and, with a positive outcome, the contractions begin.

Serious complications from bladder puncture are rare. Such a procedure is carried out only in case of emergency, only with the permission of the expectant mother herself. The specialist is obliged to report possible consequences, such as prolapse of the umbilical cord, weak baby's heartbeat, bleeding, intrauterine infection (very rare), fetal hypoxia. And most importantly, from the moment the bladder opens to the onset of childbirth, more than twelve hours should not pass. As you know, a baby cannot be without water for a long time, as this threatens his life.

Does it hurt to pierce the bladder before childbirth?

The rupture of the bubble occurs absolutely painlessly, since the nerve endings are completely absent in the fruit membrane. Moreover, manipulation in most cases lasts only a few minutes. But in fact, the woman's fear always turns out to be higher than the obstetricians' explanations, and a spasm of the muscles of the vagina occurs. At this time, the woman in labor should not move so that the specialist does not injure her from the inside.

If, during the manipulation, the expectant mother still manages to relax, then there will not be even the slightest discomfort. The only thing that can be felt is the leakage of fluid from the vaginal cavity. Therefore, it is really important to tune in to the amniotomy in advance and trust highly qualified specialists who definitely do not want to harm.

As already mentioned, the puncture of the bladder is carried out only when necessary, and if the woman was informed about this, then in no case should she refuse manipulation, as this threatens the life of the baby.