How to pierce the bladder in pregnant women. Puncture of the fetal bladder: a whim of doctors or a life-saving operation

27.08.2019

There is no pregnant woman who is not worried about the birth of her baby. Everyone is looking forward to his appearance and are afraid of the pain. Sometimes women who have given birth report that they had a bladder puncture before giving birth without contractions. Gynecologists call this procedure an amniotomy. It is tolerated by about 10 percent of women in labor. Those who find out about this situation start to get scared. They do not have specific ideas and knowledge about the need for this process and negatively set themselves up. There is no reason for fear, since it is organized for the good and will not bring harm to the baby.

The discharge of waters sometimes precedes the onset of labor. It can occur partially or completely, which happens in about 12% of all women. Such a deviation is considered a premature rupture of amniotic fluid. This is a very noticeable phenomenon, since it is associated with their large volume.

They are normally light or pink and should be odorless. If a brown, green, or black color is found, then this indicates the presence of a newborn's feces in them. This means that the fetus has oxygen starvation, and it needs a quick delivery. When a yellow tint is mixed in, there is a Rh conflict. Here, too, early action is needed.

When the waters drain at home, the woman in labor should urgently go to the hospital. Upon arrival, she reports the exact time of the outpouring. When the body is fully ready for childbirth, contractions occur immediately or after a certain period of time after the passage of water.

What is an amniotomy?

This is an operation to open the amniotic fluid. The fetus in the mother's body is protected by a special shell - the amnion. It is he who is filled with amniotic fluid. Protects the baby from shock and penetration of vaginal infections. It is a kind of "refuge" for the baby. If it is opened or a rupture occurs naturally, then the uterus begins to expel the fetus. As a result, contractions grow, and a baby is born.

Surgical intervention - the puncture of the bladder before childbirth without contractions is organized with a special device, similar to a hook. It is carried out at the moment of its greatest severity, so as not to touch the soft tissues of the child's head.

Varieties of amniotomy

There are several types, depending on the period of the operation:

Prenatal. Organized before the onset of labor to induce labor arousal.
Early. It is carried out when the cervix is opened by seven centimeters.
Timely. When there is an opening of up to 10 cm.
Belated. Done in the process of expulsion of the fetus. The procedure is needed to exclude hypoxia in a baby, or bleeding in a woman in labor.

The delivery takes place unchanged and in accordance with the natural state. The baby's well-being is monitored by the KGT apparatus.

Bladder puncture before childbirth without contractions

It is carried out in the following cases:

Postterm pregnancy. It usually lasts forty weeks. But if it increases, then obstetrics are required. The placenta begins to age and loses its functionality. The child is suffering from oxygen starvation.
Gestosis is a disease characterized by edema, high blood pressure and the presence of protein in the urine. It has a negative effect on the health of the fetus and mother.
Rhesus conflict. It brings complications and causes stimulation of labor.
Hypertension, diabetes mellitus in a pregnant woman.
Weakness of contractions, impossibility of self-delivery.

Asking why the bladder is pierced before childbirth, you should trust a professional specialist. After all, he does this when he sees a real threat to the life of the baby and the mother.

If childbirth has begun, then the operation is done when there is:

the opening of the cervix by six to eight centimeters, and the water does not leave. Saving them does not make sense, since the bubble is not fulfilling its purpose;
impotence in childbirth. When the contractions fade away, the cervix slows down the activity and, so that labor does not stop, the bladder is punctured. Monitoring of the woman in labor is organized. In the absence of positive dynamics, oxytocin is administered within two hours;
polyhydramnios. The presence of a large volume of amniotic fluid does not allow the uterus to contract naturally;
high blood pressure with gestosis, liver and kidney disease, has a negative effect on childbirth and the fetus;
flat fetal bladder. In this state (lack of water), there is almost no front water. This contributes to the difficulty of labor and its complete cessation;
low location of the placenta. May cause detachment and bleeding.

Implementation of the procedure

An amniotomy is considered a surgical procedure, but the surgeon and anesthesiologist may not be present. The doctor makes a vaginal examination (assesses the cervix, the location of the head), then opens the bladder. The process consists of several stages:

Before starting the operation, the woman's genitals are treated with antiseptic agents, they are offered to take an antispasmodic or no-shpu. After the effect of the drug begins, it is placed on the gynecological chair and must lie motionless, not interfere with the doctor's manipulations.
The healthcare professional puts on gloves and gently inserts the instrument into the vagina. Hooks the amniotic fluid with a hook and pulls it until it ruptures. Outpouring of amniotic fluid begins.
After the completion of the action, the woman in labor remains in a horizontal position for another half hour. The control over the condition of the fetus is carried out by the KGT apparatus.

The autopsy is carried out only in the absence of contractions, which ensures the convenience and safety of the operation.

How long does labor start after a bladder puncture?

The start is expected no later than twelve hours later. But today, doctors do not wait that long. The child has an increased risk of infection with prolonged exposure to an anhydrous environment. Therefore, when three hours pass and there are no contractions, they resort to drug stimulation.

Duration of labor after the procedure

Women respond as follows:

for those who gave birth for the first time, this activity lasted until fourteen hours;
in multiparous from five to twelve.

Contraindications and consequences

The procedure has some limitations and is not performed when:

the pregnant woman has herpes on the genitals in an acute stage;
the loops of the umbilical cord create obstacles for the operation;
natural childbirth is not recommended;
there is a low location of the placenta;
the fetus is oblique, transverse, or breech presentation;
pelvic narrowing of 2-4 categories, tumor in the small pelvis;
the baby weighs more than 4.5 kg;
deformation of the vagina or neck due to rough scars;
twins who have grown together, triplets;
high myopia;
acute suffocation of the baby.

There is a prohibition for heart disease.

Possible complications

There are a few exceptions that can lead to negative outcomes after an amniotomy:

trauma to the umbilical cord vessel when fixing it to the shell. This will lead to blood loss;
deterioration of the baby's well-being;
falling out of the arms or legs;
toddler heart disease;
restless labor and their secondary weakness;

Such completion is rare, but sometimes there is a danger that when the fetal bladder is punctured, the desired result will not occur. As a result, doctors may use drugs that cause contractions. There are times when they resort to caesarean section. Since a prolonged finding of a child without water will have a negative impact.

How does a woman feel during an amniotomy?

Does it hurt or not? Any mommy will be afraid because of the possible appearance of pain. But it will not be, since the amniotic fluid does not contain nerve endings.

The woman in labor should simply relax and lie down in a comfortable position. With the correct procedure, she only feels how the water flows out. They are warm in temperature. If the muscles tighten, discomfort and adverse outcomes such as damage to the vaginal walls can occur.

Compliance with the rules

There are certain requirements for this operation. To exclude complications, you should adhere to some provisions:

cephalic presentation,
pregnancy at least thirty-eight weeks,
self-delivery and lack of prohibitions in this,
readiness of the birth canal,
the presence of only one fruit.

The maturity and preparedness of the uterus is of great importance. For the operation, it must be in accordance with six points on the Bishop scale.

The famous doctor M. Oden tells his view of this procedure from the medical point of view of European countries - “it is a relic of the past”:

Each operation, which includes the puncture of the bladder before childbirth without contractions, does not always lead to a positive outcome. Organization of amniotomy, carried out in compliance with all requirements, reduces the risk of various complications. Therefore, when there is a need for it, the pregnant woman must agree to surgery.

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 nearing attempts, but the waters are still on. In this case, the doctor decides whether the bladder should be punctured.

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 down, the lower part of 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 hard not to notice, because 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. It is imperative 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 time. 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 (opening) of the amniotic fluid 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.

Initially, nature arranged a woman so that she could bear and give birth to a child without the help of outside medical interventions. But this did not always lead to a successful pregnancy outcome. Currently, about 10% of women undergo an operation such as an amniotomy. What is it, and is it obligatory to do it?

In the womb, the baby is surrounded by amnion - a special membrane with amniotic fluid. This shell protects the fetus from possible external infections and prevents it from bumping when moving. As the birth approaches, the baby's head rests on the cervix, thanks to this process, a fetal bladder is formed, which stretches it and forms the birth canal. During the birth process, the bubble bursts and the baby moves outward. However, there are times when the fetal bladder cannot burst on its own and the doctors taking part in childbirth resort to amniotomy and pierce it.

An operation such as an amniotomy is a puncture of the bladder with a special medical instrument. It is done solely by the decision of the doctor and cannot be carried out at the request of the woman in labor. ... First, the woman is given pain reliever based on drotaverine, then after 30 minutes, an examination is carried out on a gynecological chair, and in the process, the bladder shell is captured with a thin hook, similar to a needle, and pierced. Capture occurs through that part of the bladder where contact with the soft tissues of the child is minimal. The procedure can be compared to popping a balloon with a needle.

Contrary to the fears of women in labor, the bladder is pierced absolutely painlessly, since there are no nerve endings on the fetal membrane. However, the fear of this manipulation usually leads to muscle spasm and some women may notice that the bladder puncture was painful. To avoid discomfort and internal injury, it is necessary to remain as calm and still as possible.

Amniotomy water is collected in a tray and evaluated. The green color of the amniotic fluid with meconium flakes indicates fetal hypoxia and the need for increased attention to it.

Types of amniotomy

Amniotomy is divided into 4 types in terms of time:

How long does it take to give birth after piercing the bladder?

Women who have undergone a puncture of the bladder are interested in the question of how long to wait for the birth of their child. Somebody think that in terms of time the procedure is similar to the operation of a cesarean section, hoping in just a few minutes to enjoy the first minutes with the baby. However, this is a big misconception.

In general, the process of childbirth after amniotomy does not differ from natural. For primiparous women, the normal duration of labor is between 7 and 14 hours. The second birth can take 5 - 12 hours, and each subsequent birth can further reduce the waiting time for a meeting with the baby.

With a prenatal bladder puncture, the normal contractions should begin within two hours, while the woman in labor is connected to the CTG apparatus for half an hour to assess the state of the fetus and readiness to give birth. If, after two hours, the contractions have not begun and labor is absent, then labor begins to be stimulated with special drugs. For a child, it is a huge danger being in a waterless space in the womb for more than 12 hours, therefore, if after this time the woman has not given birth, then an emergency cesarean section is performed.

Who is amniotomy indicated and contraindicated?

Not all women are pierced with a fetal bladder, and only in the following cases:

Full-term pregnancy from 38 weeks with a single fetus and 36 weeks with a multiple.
Head presentation of the fetus.
Estimated body weight over 3 kilograms.
Fully mature cervix and normal pelvic size.
No contraindications for natural childbirth.

Indications

As with any operation, the bladder is pierced only according to the testimony of a doctor and after a thorough examination.

Most often, the amnion is pierced with prolonged pregnancy, namely after 41.5 weeks. If a woman has not given birth to a child before this period, then further pregnancy can be dangerous for both the fetus and the woman in labor. The placenta begins to age, oxygen is supplied to the child worse, which is why children born later than the term are usually diagnosed with hypoxia.

In addition, amniotomy is indicated in cases where urgent delivery is required. These include:

Intrauterine death or fetal hypoxia.
Premature placental abruption.
Gestosis and polyhydramnios in a pregnant woman.

With some diseases in a woman, childbirth must be called upon reaching 38 weeks. For instance, with Rh-conflict between mother and child or severe chronic diseases of a woman.

A special case for a bladder puncture is a long preliminary period, when contractions last for several days, but they never go into labor. The cervix does not open, the woman in labor suffers from endless sick contractions, and the fetus suffers from hypoxia. In this case, amniotomy helps to give birth as soon as possible.

Contraindications

Despite all the benefits of such an operation, amniotomy has a number of contraindications, in which this procedure is strictly prohibited and doctors should choose another method for delivery. Almost all of them are similar to contraindications for natural childbirth.... Among them:

In the absence of contraindications, amniotomy does not threaten the condition of the mother and child and, contrary to opinion, is performed absolutely not painfully. You should not refuse this procedure., since if the doctor prescribed this operation, then there are good reasons for this. It is worth considering how many women amniotomy helped to give birth easily and quickly, and all doubts will immediately disappear. Fully following the instructions and advice of your obstetrician-gynecologist, you can be completely calm about the health of your child and be sure that the birth will be successful and without pain.

The article discusses how to pierce the bladder during childbirth. We will tell you why this procedure is carried out and whether it hurts. You will find out what are the contraindications for a puncture.

The value of amniotic fluid

The amniotic fluid plays an important role in childbirth. They usually leave shortly after the beginning of the labor process. If the water has departed at your home, then you should immediately go to the hospital. Don't worry about missing the drain. By volume, they are approximately equal to one glass.

So what is the role of amniotic fluid? Contractions act on the neck, promoting its opening. They also promote the child through the birth canal. The cervix softens and unfolds, and this process occurs by the contraction of the muscles of the uterus. But opening also occurs when exposed to the fetal bladder.

Contractions cause, the pressure inside this organ increases, the bladder tightens. In this case, the amniotic fluid is directed downward. The lower region of the bladder penetrates the inner pharynx and helps open the neck.

Most often, the bladder ruptures if the neck is fully or partially opened. The front waters, which are in front of the child's head, flow out first. In this case, the woman in labor does not experience anything, since there are no nerve endings in the fetal bladder.

In some cases, the bladder ruptures in the area of contact with the wall of the uterus. Because of this, the water does not flow out rapidly, but only drop by drop, which is not always noticeable with the naked eye.

Normal waters are clear in color and odorless. Cloudy water or an unpleasant odor means the presence of infections in the body of a pregnant woman or recent illnesses.

In the case when the fetal bladder does not rupture by itself, experts perform an amniotomy. This is the name of the operation to open the amniotic fluid.

What is amniotomy

There are several types of puncture:

prenatal - carried out to stimulate contractions and labor;
early - performed in case of neck opening up to 7 cm;
timely - carried out when the neck opens from 8 to 10 cm;
belated - performed to prevent the development of hypoxia in the child and bleeding in the mother.

When a puncture is performed, the process of childbirth is no different from conventional delivery, in which the bladder ruptures by a natural method. At the same time, specialists monitor the condition of the fetus using KGT.

When a bladder puncture is needed

As a rule, amniotomy is performed in cases of emergency delivery. Sometimes the procedure is carried out due to the absence of contractions in the following cases:

Postterm pregnancy. Typically, pregnancy lasts 40 weeks. If the mother-to-be oversteps this period, doctors begin to think about a bladder puncture. This is due to the onset of aging of the placenta and the loss of its ability to perform its functions. First of all, this negatively affects the health of the child, since hypoxia begins.
Gestosis is a disease, the main symptoms of which are edema, high blood pressure, and the presence of protein in the urine. The disease negatively affects the well-being of the pregnant woman and the fetus.
Rhesus conflict. This pregnancy is classified as difficult, for this reason, stimulation of the labor process is required.

If the birth process has begun, then the puncture is applied:

With weak labor. If, after a certain time, the contractions become weaker instead of increasing, the cervix slows down the labor process, then an amniotomy is performed. This measure allows you to speed up the contractions. If there are no changes a few hours after the puncture, then the woman in labor is given an oxytocin drip.
When, since a large amount of water prevents the uterus from contracting.
With increased blood pressure. Diseases of the kidneys and heart, as well as preeclampsia, provoke an increase in blood pressure. This situation can adversely affect the process of childbirth and the condition of the fetus.
With a flat bubble. In such a case, there is almost no anterior water, which is why the process of childbirth is difficult or completely stopped.
With low placentation. This position of the placenta can cause bleeding or placental abruption.

Contraindications

Sometimes amniotomy is prohibited. Namely:

the presence of herpes on the genitals of a pregnant woman;
the loops of the umbilical cord interfere with the puncture;
natural childbirth is undesirable;
finding the fetus not in the cephalic presentation.

How is an amniotomy performed?

Bladder puncture is equivalent to an operation, but during it there is no need for the presence of an anesthesiologist and a surgeon. Mommies' feedback on the procedure is positive, since it does not bring any discomfort or pain.

After the doctor examines the mother-to-be on the armchair, he proceeds to the puncture. Amniotomy includes several stages:

Before the operation, the pregnant woman takes an antispasmodic agent. After it begins to act, the pregnant woman lies down in the gynecological chair.
The specialist puts on gloves. Then, with a gentle movement, he inserts a special instrument into the female genital organ. He hooks the bubble with the tool and pulls it towards himself until it bursts. Then water is poured out.
After the puncture, the expectant mother should be in a supine position for half an hour. At this time, the child's condition is monitored using CT.

A puncture is made if there are no contractions, which ensures the complete safety of the operation.

Amniotomy is done only in special cases. You should not be afraid of her, since she does not cause any pain to either the pregnant woman or the fetus. After the puncture, labor activity improves, which means that the time before meeting with the newborn decreases.

During childbirth, obey the doctors and do not be afraid of anything! Only in this case the childbirth will be successful and without any complications! Be healthy and have an easy delivery!

See you in the next article!

During pregnancy, many women tend to worry about the upcoming birth. Naturally, most expectant mothers are afraid of pain, or rather, medical manipulations that can cause it.

One of the most common procedures for assisting in labor is an amniotomy, which is a puncture of the membranes. In addition to indications and possible complications, pregnant women are often interested in whether it hurts to pierce the fetal bladder or not. To dispel fears and doubts about amniotomy, it is enough to have a general idea of this procedure.

Puncture of the amniotic fluid. Basic indications.

Amniotomy is a manipulation to improve labor, the need for stimulation of which occurs in about 10-15% of women in labor. The fetal bladder (amnion) plays the role of a "refuge" for the child, where he is protected from the pressure of the walls of the uterus, as well as infection ascending (through the vagina). The amnion is filled with amniotic fluid - the natural environment for the fetus to live in. The baby not only swims freely in the amniotic fluid, but also swallows water, which is an excellent workout for his digestive tract. Amniotic fluid is conventionally divided into "front" and "back". During amniotomy, about 200 ml of "anterior" waters are discharged, due to which the functions of the fetal bladder are partially preserved during childbirth.

A natural question arises: why and for what purpose they make a puncture of the fetal bladder, which for nine months is a "safety cushion" for the fetus, and protects it from harmful factors?

There are clear indications according to which the amniotic fluid is punctured. These include:

low placentation (as a prevention of bleeding during childbirth);
severe gestosis, arterial hypertension (puncture of the fetal bladder is necessary to speed up labor, after which the mother's condition is normalized);
partial detachment of the placenta (with a small detachment of the placenta and active labor, the puncture of the amniotic fluid promotes the omission of the head, which presses the vessels against the walls of the pelvis, thereby preventing massive bleeding);
post-term pregnancy (gestational age 41-42 weeks or more);
primary weakness of labor (the baby's head after opening the fetal bladder affects the cervix, contributing to its opening);
opening of the uterine pharynx 7 cm or more (as a prevention of weakening of labor);
flattened fetal bladder;
polyhydramnios, multiple pregnancies (puncture of the fetal bladder in this case increases intrauterine pressure and returns the ability to fully contract to the walls of the uterus);
Rh-conflict between mother and fetus;
antenatal fetal death.

How is a fetal bladder puncture performed?

Any intervention by medical personnel in the process of childbirth is regarded by a woman as a violation of her personal space and the sacrament of the birth of a new life. However, even such a procedure as a puncture of the amniotic fluid can be performed only after the consent of the woman in labor. At the same time, oral permission to puncture the amnion will not be enough; for reinsurance, doctors suggest signing an amniotomy protocol. Puncture of the amniotic fluid without the written consent of the woman is a gross violation.

IMPORTANT! Before performing an amniotomy, the doctor must familiarize the woman with such possible complications as loss of umbilical cord loops, bleeding, intrauterine infection and fetal hypoxia, rapid labor, etc.

The procedure for opening the fetal bladder takes no more than 5 minutes. After assessing the general condition of the fetus and the woman in labor, the doctor conducts vaginal examinations in order to determine the dilatation of the cervix. After making sure of the maturity of the birth canal, under the control of the hand, the obstetrician-gynecologist introduces a branch of bullet forceps into the cervical canal, which is shaped like a hook. By puncturing the fetal bladder, the doctor inserts the index and middle fingers into the opening and slowly releases the "front" amniotic fluid.

IMPORTANT! The nature and amount of water is an important diagnostic sign of the presence of intrauterine infection, fetal hypoxia, and the presence of Rh-conflict.

What does a woman feel when the amniotic fluid is punctured?

It is quite obvious that at the sight of a doctor with a kind of sharp instrument in his hands, the woman in labor is justifiably afraid. Naturally, it is quite difficult to relax in such a situation, and even when contractions have begun, because the expectant mother will have to work hard before she can hug her baby.

The fact that the fetal bladder has no nerve endings very rarely calms a woman. As a result, even a vaginal examination causes unpleasant sensations, since tense muscles offer incredible resistance to the actions of an obstetrician-gynecologist. At the time of puncture of the fetal bladder, the woman in labor should lie as still as possible, because during the movements of the pelvis, the doctor can accidentally injure the wall of the vagina with the jaws, which is very painful. If a woman is relaxed and motionless, the only thing she will feel when the amniotic fluid is punctured is the warm amniotic fluid flowing out.