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 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.

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

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

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

• presenting the head of the fetus;
• full-term pregnancy of at least 38 weeks with one fetus;
• estimated fetal weight over 3000 g;
• signs of a mature cervix;
• normal indicators of the size of the pelvis;
• There are no contraindications for natural childbirth.

Types of amniotomy

The moment of the puncture determines the type of procedure:

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

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

Indications for bladder puncture during childbirth

Bladder puncture stimulates planned labor or is carried out during them.

Labor induction with amniotomy is indicated in the following cases:

• preeclampsia, when there are indications for urgent delivery;
• premature detachment of the placenta;
• fetal death in utero;
• prolongation of pregnancy;
• heavy chronic diseases of cardio-vascular system, lungs, kidneys, in which delivery is indicated from 38 weeks;
• Rhesus conflict between mother and child;
• pathological preliminary period.

The last condition is the occurrence of small contractions over several days, which do not develop into normal labor activity. This causes intrauterine suffering of the fetus from a lack of oxygen and fatigue of the woman.

How long does it take to go into labor after a bladder puncture? The onset of labor is expected no later than 12 hours later. Although at present, doctors do not take that much time to wait. Prolonged exposure of a child to an anhydrous environment increases the risk of infection. Therefore, 3 hours after opening the amnion, if contractions have not begun, stimulation with medications is used.

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

1. The cervix dilated 6-8 cm, but the water did not break. Their further preservation is impractical, the bubble no longer fulfills its function.
2. Weakness of labor activity. Puncture of the bladder in most cases leads to its activation. After amniotomy, they wait 2 hours, if there is no improvement, then they resort to stimulation with oxytocin.
3. Polyhydramnios overstretches the uterus and prevents normal contractions from developing
4. With oligohydramnios, a flat fetal bladder is observed. It covers the baby's head and does not function during childbirth.
5. A low-attached placenta may begin to slough off after contractions develop. And opening the amnion will allow the fetal head to cling tightly to the lower segment of the uterus and hold back the detachment.
6. In case of multiple pregnancy, the bladder of the second child is punctured 10-15 minutes after the appearance of the first.
7. High blood pressure is reduced after the opening of the waters.

Bladder puncture technique for a woman in labor

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

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

If a large volume of water is drained at once, this can lead to prolapse of umbilical cord loops or small parts of the fetal body.

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

Is it painful or not to perform a bladder puncture before childbirth? The shells are not penetrated by nerve endings, so the procedure is absolutely painless.

However, complications sometimes develop:

• traumatization of the umbilical cord vessel, if it was attached to the membrane;
• prolapse of the loops of the umbilical cord or parts of the body of the fetus (handles, legs);
• deterioration of the fetus;
• violent labor activity;
• secondary generic weakness;
• child infection.

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

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

Contraindications to bladder puncture in a pregnant woman

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

1. Herpetic eruptions on the perineum will lead to infection of the child.
2. Pelvic, foot, transverse or oblique presentation of the fetus, loops of the umbilical cord in the head area.
3. Complete placenta previa. Childbirth in this case is impossible - the placenta is attached above the internal pharynx and prevents the lower segment of the uterus from turning around.
4. Insolvency of the scar on the body of the uterus after caesarean section or other surgical interventions.
5. Narrowing of the pelvis of 2-4 degrees, bone deformities, tumor processes in the small pelvis.
6. Fetal weight over 4500 g.
7. Rough scars causing deformation of the cervix or vagina.
8. Triplets, conjoined twins, breech presentation of the first child of twins.
9. High myopia.
10. Delayed fetal development of the 3rd degree.
11. Acute fetal hypoxia.

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

Yulia Shevchenko, obstetrician-gynecologist, specially for the site

Useful video

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

What happens if the amniotic sac bursts before contractions?

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

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

The amniotic fluid should be clear or pink and odorless. If black, brown or green color, then this means that the feces of a newborn are in the waters. This suggests that the fetus has oxygen starvation, which requires a quick delivery. An admixture of yellow can mean the presence of an Rhesus conflict, which also requires quick action.

When the waters break at home, the woman in labor must urgently go to the hospital. In the hospital, a woman must accurately report the time of their departure.

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

What is an amniotomy?

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

If an autopsy or rupture occurs in a natural way, then the uterus begins the process of fetal expulsion. As a result, contractions develop and a child is born.

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

Types of amniotomy

Bladder puncture before childbirth can be divided into several varieties, depending on the time of the operation:

• Prenatal. It is carried out before the onset of contractions for the purpose of labor induction.
• Early. It is performed if the opening of the cervix is ​​up to 7 cm.
• Timely. If the neck is open up to 8-10 cm.
• belated. Can be carried out at the time of expulsion of the fetus. The procedure is used to prevent hypoxia in the fetus or bleeding in the mother.

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

When is an amniotomy necessary?

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

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

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

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

In some cases, there are contraindications for this procedure.

Are there any contraindications?

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

• a pregnant woman has herpes on the genitals in the acute stage;
• the placenta has a low location;
• loops of the umbilical cord interfere with the operation;
• natural childbirth is not recommended;
• finding the fetus in oblique, transverse and pelvic presentation.

The procedure is prohibited in case of mother's heart disease, in the presence of scars on the cervix and other pathologies.

How is the bladder punctured?

Why and how is the bladder punctured before childbirth? Amniotomy is equivalent to surgery, but the presence of an anesthesiologist and a surgeon is not necessary. After a vaginal examination, the doctor will open the bladder. The procedure includes several steps:

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

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

What does a woman feel during an amniotomy?

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

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

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

Mandatory conditions

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

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

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

Complications and consequences of amniotomy

With an error-free puncture of the bladder before childbirth, the whole process occurs safely. But there are a few exceptions when after an amniotomy, childbirth can become more complicated. There are the following consequences:

• injury to the umbilical cord vessel, if it is attached to the sheath, which can lead to blood loss;
• the child's condition worsens;
• loops of the umbilical cord or limbs of the fetus (handles, legs) fall out;
• violation of the child's heartbeat;
• violent labor activity;
• secondary birth weakness.

There is a risk that the puncture of the fetal bladder will not lead to the desired result and labor activity will not become active. Therefore, doctors resort to the use of drugs that cause contractions. In some situations, a caesarean section is performed on a woman, because a long stay of a child without water is fraught with negative consequences.

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

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

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

Ovchinnikova Olga
Obstetrician-gynecologist. medical clinic Gazprommedservice.

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

A short digression into physiology

Normally, childbirth begins with contractions. Contractions help open the cervix and move the fetus through the birth canal. The cervix is ​​smoothed and opened by contraction of the muscles of the uterus. The fetal bladder also contributes to the opening of the cervix. During contractions, the uterus begins to actively contract, resulting in increased intrauterine pressure, the fetal bladder tightens, and amniotic fluid rushes down. The lower pole of the bladder is introduced into the inner one and helps to open the cervix.

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

The degree of cervical dilatation is determined in centimeters during a vaginal examination. The opening of the cervix by 11–12 cm, in which it is not possible to determine its edges, is considered complete.

The first stage of labor is characterized by the occurrence of regular contractions and the advancement of the presenting part of the fetus (the part that first passes through the birth canal and faces the cervix before birth) through the birth canal. Most often, the presenting part of the fetus is its head. At normal delivery the waters come out on their own. Usually, the fetal bladder ruptures when the cervix is ​​fully or almost fully dilated, and the anterior amniotic fluid (they are so called because they are in front of the presenting part of the fetus) is poured out. Rupture of the fetal bladder is a painless process, since in amniotic sac no nerve endings.

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

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

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

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

Indications for amniotomy

It happens that with the full opening of the cervix, the fetal bladder remains intact. This may be due to its excessive density or elasticity, as well as a small amount of front water. Such childbirth is characterized by a protracted period of expulsion of the fetus, slow progress of its presenting part, the appearance of bloody discharge from the genital tract. There is a risk of premature detachment of the placenta and fetal hypoxia. In this case, an artificial opening of the fetal bladder is performed for medical reasons.

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

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

The course of the procedure

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

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

taken from here:

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

Approximately 7-10% of women in the maternity hospital undergo 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 dangerous for a child? Not knowing what this procedure is for, many expectant mothers are pre-set negatively. Information about indications, contraindications and possible consequences amniotomy will help to understand whether there is a basis for fears.

Amniotomy is an obstetric operation (amnion is a water shell, tomie is a dissection), the essence of which is to open the amniotic sac. The amniotic sac and the amniotic fluid that fills it play an important role in the normal intrauterine development of the child. 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 baby is born.

Manipulation to open 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 for the purpose of labor induction;
• early amniotomy - performed when the cervix opens up to 7 cm;
• timely amniotomy - the amniotic sac is opened at a cervical opening of 8-10 cm;
• belated amniotomy - opening the amniotic sac on the birth table, when the head has already sunk to the bottom of the small pelvis.

When is it needed?

Basically, 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 sac is performed even in the absence of contractions. The indications for it are:

1. Postponed 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 "ages" and can no longer perform its functions in full. Accordingly, this is reflected in the child - he begins to experience a lack of oxygen. In the presence of a "mature" cervix (the cervix is ​​soft, shortened, skips 1 finger), the consent of the woman and the absence of indications for caesarean section at the moment, the bladder is punctured 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 somewhat, which contributes to the occurrence of contractions.
2. Pathological preliminary period. The pathological preliminary period is characterized by long, several days of preparatory contractions, which do not turn into normal labor and tire the woman. The child during this period experiences intrauterine hypoxia, which decides the issue in favor of prenatal amniotomy.
3. Rh-conflict pregnancy. With a negative Rh blood in the mother and positive in the fetus, a conflict arises over the Rh factor. At the same time, antibodies accumulate in the blood of the pregnant woman, which destroy the red blood cells 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 sac is also punctured without contractions.
4. Preeclampsia. it serious disease 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. Preeclampsia 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 an amniotomy during childbirth:

1. Flat fetal bladder. The amount of anterior waters 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.
2. Weakness of tribal forces. In the case of weak, short and unproductive contractions, the opening of the cervix and the advancement of the fetal head are suspended. Since the amniotic fluid contains prostaglandins that stimulate the opening of the cervix, an early amniotomy is performed in order to enhance labor activity. After the procedure, the woman in labor is observed for 2 hours and, if there is no effect, the issue of labor stimulation with oxytocin is decided.
3. 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 small pelvis, thereby preventing bleeding.
4. Polyhydramnios. The uterus, overstretched with a large amount of water, cannot contract properly, which leads to weakness in labor. The need for early amniotomy is also explained by the fact that its implementation reduces the risk of prolapse of umbilical cord loops or small parts of the fetus during spontaneous outflow of water.
5. High blood pressure. preeclampsia, hypertonic disease, diseases of the heart and kidneys are accompanied by high blood pressure, which adversely affects the course of childbirth and the condition of the fetus. When the amniotic sac opens, the uterus, having decreased in volume, releases nearby vessels and the pressure decreases.
6. Increased density of the amniotic sac. Sometimes the fetal 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 child may 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 detachment of the placenta and bleeding.

Are there any contraindications?

Although in many situations opening the amniotic sac facilitates the process of the birth of a child, 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 foot, pelvic, oblique or transverse presentation;
• the placenta is too low;
• umbilical cord loops do not allow the procedure to be performed;
• natural childbirth is forbidden to 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 anomalies in the structure of the birth canal. They are also prohibited with severe symphysitis, heart pathologies and other diseases of the mother that pose a threat to her health and life or interfere with the normal birth process.

Technique

Although an amniotomy is an operation, the presence of a surgeon and an anesthetist is not required. The opening of the amniotic sac (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:

1. Before an amniotomy, a woman in labor is given No-shpu or another antispasmodic drug. After the start of its action, the woman should lie on the gynecological chair.
2. 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. This is followed by the outpouring of water.
3. At the end of the procedure, the woman needs to remain 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 the limbs of the fetus from falling into the vagina.

Mandatory conditions

To avoid complications during manipulation allows compliance with a number of rules. The mandatory conditions, without which an amniotomy is not performed, include:

• head presentation of the fetus;
• childbirth not 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 performed 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:

1. Prolapse of the umbilical cord or limbs of the fetus into the vagina of the woman in labor.
2. Injury to the vessels of the umbilical cord during its sheath attachment, which may be accompanied by massive blood loss.
3. Deterioration of uteroplacental blood flow after manipulation.
4. Change in fetal heart rate.

There is also a risk that opening the amniotic sac will not give the desired result and labor activity will not become sufficiently active. In this case, the use of drugs stimulating contractions or a caesarean section will be required, since a long stay of a child without water threatens his life and health.