Pierced the bubble what's next. Break or puncture? When and why the fetal bladder is opened. Bladder opening procedure

About 7-10% of women in the hospital go through an amniotomy. Pregnant women who hear about this manipulation for the first time are frightened by it. Natural questions arise: amniotomy, what is it? Is it not dangerous for the child? Not knowing what this procedure is for, many expectant mothers are pre-configured negatively. Information about the indications, contraindications and possible consequences of amniotomy will help to understand whether fears have a basis.

Amniotomy is an obstetric operation (translated as amnion - water membrane, tomie - dissection), the essence of which is to open the amniotic fluid. The amniotic sac and the amniotic fluid filling it play an important role in the normal intrauterine development of the baby. During pregnancy, they protect the fetus from external mechanical stress and microbes.

After opening or natural rupture of the amnion, the uterus receives a signal to expel the fetus. As a result, contractions begin and the child is born.

The manipulation of opening the amniotic sac is carried out with a special tool in the form of a hook at the moment when the bladder is most pronounced, so as not to damage the soft tissues of the baby's head. Amniotomy is a completely painless operation, since there are no nerve endings on the membranes.

Types of amniotomy

The opening of the fetal bladder, depending on the moment of the manipulation, is divided into four types:

prenatal (premature) amniotomy - performed before the onset of labor in order to induce labor;
early amniotomy - performed when the cervix is opened up to 7 cm;
timely amniotomy - the amniotic sac is opened with a cervical opening of 8-10 cm;
delayed amniotomy - opening the amniotic fluid on the delivery table, when the head has already sunk to the bottom of the small pelvis.

When is it needed?

Basically, an amniotomy is performed during childbirth if the fetal sac has not ruptured on its own. But there are situations in which urgent delivery is necessary. In this case, the puncture of the amniotic fluid is performed even in the absence of contractions. The indications for it are:

Postterm pregnancy. A normal pregnancy lasts up to 40 weeks, but if the period is 41 weeks or more, the question arises of the need for labor induction. With a post-term pregnancy, the placenta "grows old" and can no longer perform its functions in full. Accordingly, this affects the child - he begins to experience a lack of oxygen. In the presence of a "mature" cervix (the cervix is soft, shortened, misses 1 finger), the woman agrees and there is no indication for a cesarean section at the moment, a bladder puncture is performed for labor induction. In this case, the fetal head is pressed against the entrance to the small pelvis, and the volume of the uterus decreases slightly, which contributes to the occurrence of contractions.
Pathological preliminary period. The pathological preliminary period is characterized by prolonged preparatory contractions for several days, which do not turn into normal labor and tire the woman. During this period, the child experiences intrauterine hypoxia, which solves the issue in favor of prenatal amniotomy.
Rh-conflict pregnancy. With a negative Rh of the mother's blood and a positive one in the fetus, a conflict arises over the Rh factor. At the same time, antibodies accumulate in the blood of a pregnant woman, which destroy the erythrocytes of the fetus. With an increase in antibody titer and the appearance of signs of hemolytic disease of the fetus, urgent delivery is necessary. In this case, the amniotic fluid is also punctured without contractions.
Gestosis. This is a serious illness of pregnant women, characterized by the occurrence of edema, the appearance of protein in the urine and an increase in blood pressure. In severe cases, preeclampsia and eclampsia join. Gestosis adversely affects the condition of the woman and the fetus, which is an indication for amniotomy.

If labor has already begun, with certain characteristics of the body of the expectant mother, you will also have to resort to opening the fetal sac. Indications for which amniotomy is performed during labor:

Flat fetal bladder. The amount of front water is approximately 200 ml. A flat fetal bladder is practically the absence of anterior waters (5-6 ml), and the fetal membranes are stretched over the baby's head, which interferes with normal labor and can lead to a slowdown and cessation of contractions.
Weakness of the labor force. In the case of weak, short and unproductive contractions, the dilatation of the cervix and the advancement of the fetal head are suspended. Since the amniotic fluid contains prostaglandins that stimulate the dilation of the cervix, an early amniotomy is performed in order to enhance labor. After the procedure, the woman in labor is observed for 2 hours and, if there is no effect, the issue of oxytocin rhodostimulation is decided.
Low location of the placenta. With this position of the placenta, as a result of contractions, its detachment and bleeding may begin. After the amniotomy, the fetal head is pressed against the entrance to the pelvis, thereby preventing bleeding.
Polyhydramnios. The uterus, overstretched by a large amount of water, cannot contract correctly, which leads to weakness of labor. The need for early amniotomy is also explained by the fact that its implementation reduces the risk of loss of umbilical cord loops or small parts of the fetus during spontaneous outpouring of water.
High blood pressure. Gestosis, hypertension, heart and kidney diseases are accompanied by high blood pressure, which adversely affects the course of childbirth and the condition of the fetus. When the amniotic fluid is opened, the uterus, having decreased in volume, releases the nearby vessels and the pressure decreases.
Increased density of the amniotic sac. Sometimes the membranes are so strong that they cannot open on their own even with the full opening of the cervix. If an amniotomy is not performed, the baby can be born in a fetal bladder with water and all membranes (in a shirt) where it can suffocate. Also, this situation can lead to premature placental abruption and bleeding.

Are there any contraindications?

Although in many situations opening the amniotic fluid makes it easier for the baby to be born, there are contraindications to this procedure. Amniotomy during childbirth is not performed if:

a pregnant woman has genital herpes in the acute stage;
the fetus is in a leg, pelvic, oblique or transverse presentation;
the placenta is too low;
the loops of the umbilical cord do not allow the procedure to be performed;
natural childbirth is prohibited for a woman for one reason or another.

In turn, a contraindication to natural delivery is the incorrect location of the fetus and placenta, the presence of scars on the uterus and abnormalities in the structure of the birth canal. They are also prohibited for severe symphysitis, heart pathologies and other diseases of the mother that threaten her health and life or interfere with the normal birth process.

Technique

Although an amniotomy is an operation, the presence of a surgeon and anesthesiologist is not required. Opening of the amniotic fluid (puncture) is performed by an obstetrician during a vaginal examination of a woman in labor. The manipulation is absolutely painless and takes a few minutes. A puncture during pregnancy is performed with a sterile plastic instrument resembling a hook.

The procedure consists of the following steps:

Before amniotomy, the woman in labor is given No-shpu or another antispasmodic drug. After the start of its action, the woman should lie down on the gynecological chair.
Then, the doctor, wearing sterile gloves, expands the woman's vagina and inserts the instrument. Having hooked the amniotic sac with a plastic hook, the obstetrician pulls it out until the membrane is torn. After this, the outpouring of waters occurs.
At the end of the procedure, the woman needs to stay in a horizontal position for about half an hour. During this time, the child's condition is monitored using special sensors.

The amniotic sac is opened outside the contraction, which ensures the safety and convenience of the procedure. If a woman is diagnosed with polyhydramnios, the water is released slowly to prevent the loops of the umbilical cord or fetal extremities from falling into the vagina.

Mandatory conditions

Compliance with a number of rules allows you to avoid complications during manipulation. The mandatory conditions, without which amniotomy is not performed, include:

cephalic presentation of the fetus;
childbirth no earlier than 38 weeks;
no contraindications to natural delivery;
pregnancy with one fetus;
readiness of the birth canal.

The most important indicator is the maturity of the cervix. To perform an amniotomy, it must correspond to 6 points on the Bishop scale - be smoothed, shortened, soft, skip 1-2 fingers.

Complications and consequences

When done correctly, amniotomy is a safe procedure. But, in rare cases, childbirth after a bladder puncture can be complicated. Among the undesirable consequences of amniotomy are:

Prolapse of the umbilical cord or fetal limbs into the vagina of the woman in labor.
Injury of the vessels of the umbilical cord during its sheathing attachment, which can be accompanied by massive blood loss.
Deterioration of uteroplacental blood flow after manipulation.
Change in fetal heartbeat.

There is also a risk that opening the amniotic bladder will not give the desired result and labor will not become active enough. In this case, it will be necessary to use drugs that stimulate contractions or conduct a caesarean section, since the child's prolonged stay without water threatens his life and health.

Many women who are preparing to become mothers have heard that a puncture of the fetal bladder is a very effective measure for the 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 you 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 dilatation of the cervix 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 flows away.

If the integrity of the bladder is violated before the 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 reduces 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 childbirth. Before the cesarean 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 discouraged 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 other 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 ajar and gently pulls on himself.

Then the instrument is removed, and the obstetrician expands the puncture with his fingers, controlling 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 labor to begin, then they talk about premature amniotomy. To enhance 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 carry out 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 opening of the cervix is 7-8 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 immature, then the consequences of early amniotomy can be deplorable - 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 not 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 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 scars on the uterus in the amount of more than two;
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 - caesarean section, and natural childbirth can be dangerous for her.

Possible 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, an emergency caesarean section is performed.

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);
the 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 say in advance how the uterus will behave, whether it will begin to contract, whether the necessary contractions will begin at the right pace.

Artificial opening of the fetal bladder, or amniotomy, often raises some concerns in women who are expecting a baby. Not every patient in the maternity ward understands the meaning of this procedure: why open the fetal bladder, if during childbirth the water will go away on its own? 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, at different stages of pregnancy, including in its last week before the onset of spontaneous labor on the part of the mother and 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 lung disease, 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 that stimulate 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 frequently due not only to possible complications (anomaly of head insertion, impaired uterine contractile activity, 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.

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 amount of 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 of the genitourinary system), with the development of fetal diseases (hemolytic disease or the presence of various 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.
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 in hypertension. In this case, the reduced volume of the uterus after amniotomy exerts less pressure on large vessels, blood pressure decreases.
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:

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 along with it, the placenta begins to exfoliate from its bed - bloody discharge appears. 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. To prevent such complications, they resort to delayed amniotomy already in the second stage of labor. After opening 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 is experiencing a lack of 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 a 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 cervix 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

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 tune themselves. 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 contractions to induce labor arousal.
Early. It is carried out when the cervix is opened by seven centimeters.
Timely. When there is an opening 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 the question 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 is pointless, 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. The 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 after a bladder puncture does labor begin?

The start is expected no later than twelve hours later. But today, doctors don't 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.

Length 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 against heart disease.

Possible complications

There are a few exceptions that lead to negative consequences 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 are tense, 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.

During the normal course of labor, the water leaves on its own. But it happens that when the contractions have become stronger, attempts will soon come, and the water has not moved away. In such a situation, the obstetrician decides to fit into the process. Puncture of the bladder before childbirth is called amniotomy.

Concept and types

Inside the mother's body, the baby is protected by a shell - an amnion, filled with fluid. Thanks to him, the baby is protected from influences and bacteria from the external environment. With a puncture or a standard rupture, the uterus begins to push the fetus out. Contractions occur, and attempts appear. A puncture of the amniotic fluid without contractions is carried out in emergency cases. The operation takes place with the help of a hook, during the period of incomplete disclosure of the cervix. This is done so as not to hurt the baby's head. An autopsy before labor is divided into varieties.

Amniotomy types:

prenatal - before delivery, so that contractions appear;
early - the cervix is open by 7 cm;
timely - opening of the uterus by 10 cm;
belated - opening the bladder during childbirth. It is performed to prevent fetal hypoxia and bleeding in a woman.

About 10% of women in labor experience amniotomy. When a woman hears about the procedure, she is very frightened and sets herself up negatively. After all, mom has no idea that this is right and necessary. Thanks to contractions, the cervix opens, and the fetus moves to the birth canal. But the disclosure is due to the water bubble. There is an active contraction of the organ, the pressure inside the uterus rises. Water flows downward, causing the cervix to open.

Basically, the rupture of the membrane goes away when the uterus is fully opened. First, the first waters come out. The woman in labor does not feel anything, because there are no nerve endings in the bladder. There are women who drain water before labor. This is noticeable because a lot of liquid comes out. But the membrane can burst at the point of contact with the wall of the uterus. Here water flows out in a small amount, in the form of drops.

If the water is discharged at home, it is necessary to urgently go to the hospital. And remember the time when it happened in order to provide this information to the obstetrician. Attention should be paid to the smell and shade of the waters. Under normal circumstances, the liquid is clear and odorless. If the water does not leave, then it passes much longer. Accordingly, it is necessary to artificially pierce the bubble.

Indications and contraindications

Amniotic fluid plays an important role in standard delivery. There are a number of cases where amniotomy is recommended. After all, the procedure helps to stimulate childbirth.

Why specifically pierce the bladder before childbirth:

a dense shell that cannot rupture on its own;
weak labor, in which piercing accelerates the process of opening the uterus;
Rh-conflict gestation causes a difficult delivery, therefore an autopsy is required;
overmaturity - a puncture of the bladder before childbirth without contractions stimulates the onset of the first contractions of the uterus;
gestosis while waiting for the baby;
in case of insufficient contractions, opening the water bladder accelerates the birth process;
polyhydramnios;
the low location of the placenta leads to its detachment, which contributes to a lack of oxygen in the fetus;
the shell is flat when almost no liquid is present.

The latter condition includes the appearance of contractions that do not go into childbirth. The fetus suffers inside the womb, as it lacks oxygen, and the woman gets tired. After piercing the bladder, labor is facilitated, but there are certain restrictions on the procedure.

Contraindications:

the presence of herpes in the groin area;
the placenta is located at the bottom;
the procedure is interfered with by the loops of the umbilical cord;
standard delivery is not recommended;
presentation of the fetus;
the presence of heart disease in a woman in labor;
scars on the uterus.

If the listed contraindications are absent, then the procedure does not adversely affect the fetus and its condition. In 12% of women in labor, water flows out before childbirth. This phenomenon cannot be overlooked, since water comes out in a large volume. The liquid should not have any color or aroma.

When a greenish, brown color is present, the baby's feces are in the water. This indicates that the baby does not have enough oxygen, so it is urgent to give birth. When the body is ready for delivery, contractions begin immediately.

Puncture technique

An autopsy, although it is equivalent to surgery, is painless, since there are no nerve endings in the sheath. After opening the bubble, the expectant mother is offered to lie down for half an hour. The fetus is controlled using a CTG apparatus. Childbirth after a bladder puncture without contractions becomes rapid, the baby will be born soon.

How to pierce the bladder during childbirth:

before the procedure, the woman in labor takes a spasmolytic;
when the medication worked, the woman fits in for examination;
vaginal examination;
introduction of the instrument;
the surface is fixed with a hook;
tear the shell;
leakage of liquid.

How is the bladder pierced during childbirth? On examination, an opening is carried out with a certain tool - a metal hook. As soon as the bubble is pierced, the water flows out. You just need to relax the body, lie down comfortably.

Is it painful to pierce the bladder before childbirth? There is absolutely no pain. For the operation to be comfortable and safe, an amniotomy is required between contractions. Some women are concerned about whether it hurts or not to carry out this procedure. The woman in labor only feels how the water flows out. When the muscles tighten, discomfort occurs.

If the bladder is pierced before childbirth, the following rules are followed:

correct position of the child;
gestation period 38 weeks or more;
standard delivery is not contraindicated;
readiness of the birth canal;
singleton pregnancy;
the uterus is mature and ready for labor.

How long does the second labor last after a puncture of the fetal bladder? According to women in labor, the second labor lasts 2-3 hours faster than the first. The onset of labor occurs when contractions begin after the bladder is punctured.

Timing

How long does it take to give birth after a bladder puncture? Primiparous women claim that childbirth took 8-13 hours, multiparous women - 6-11 hours. The desired results do not always occur after obstetric intervention. To avoid complications after amniotomy, conditions must be met.

A woman should not arbitrarily refuse the procedure that is required in the process of labor. The time of delivery after a bladder puncture is different. But from puncture to delivery should not take more than 12 hours. If a child is without water for a long time, his life is in danger.

Three hours after opening, drug stimulation is applied. However, along with this, there may be consequences. When the puncture is done correctly, delivery is considered safe, but there are exceptions where labor is more difficult.

Complications:

trauma to the umbilical cord vessel;
the baby's position becomes worse;
prolapse of the limbs of the fetus;
poor heartbeat in the baby;
prompt delivery;
secondary birth weakness.

It happens that after a puncture there is no result, childbirth is inactive, then drugs that cause contractions are used. With a protracted childbirth, a cesarean section is performed, since the fetus cannot be without water for a long time.
Obstetricians say that a bladder puncture without contractions at 38 - 39 weeks is not needed, stimulation will not have an effect. This is an early period, so pregnancy can be reached. Bladder puncture without contractions at 40 - 41 weeks is carried out according to indications when the cervix has opened more than 6 cm.

Amniotomy is a safe method of accelerating childbirth in a hospital setting. Not all women in labor know what it is, since they had a birth without a bladder puncture. The shell protects the child, therefore, it is opened only if indicated.