How to make a bladder puncture before childbirth. Puncture of the fetal bladder: a whim of doctors or a life-saving operation
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 is mixed with it, 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 the soft tissues of the 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?
There is a stimulation of labor by piercing the bladder in case of situations when an 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, gestosis contribute to an increase in 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.
The waiting period for a baby is the most beautiful in the life of every woman. The expectant mother is looking forward to the first meeting with her blood, because she wants to hug this little lump to herself as soon as possible, to look at him.
But, despite all the charm, there are not very pleasant sensations that can accompany this period. A young mother will have to face various problems face to face. There are times when, for one reason or another, contractions do not start, and doctors for the normal birth of a baby must be called out with their own hands.
One of the most common options to induce labor is to puncture the amniotic sac. There is no need to be afraid of this procedure, since it is done for the good of the baby and will not harm him in any way.
Puncture without contractions
Very often, the opening of the organ in question in pregnant women causes great excitement, since few people know how this manipulation is performed. The first step is to figure out in which cases this procedure is mandatory, and when it is impossible to do without it. In any case, a woman should be aware of the fact that if the doctor told her about the need for a bladder puncture, then you should not refuse.
Often the bubble needs to be pierced, because there is a certain threat to the life of the crumbs. Manipulation is carried out for various reasons, on the most common there is a threat and. Also, the bladder is pierced if a woman has a disease such as diabetes, hypertension, impaired kidney function.
Very often, doctors are forced to provoke childbirth in this way during the intrauterine death of a baby, during a pregnancy that is postponed, with.
It also happens that contractions do not appear regularly rarely. In this case, the woman in labor cannot give birth on her own. The opening of the cervix is greatly slowed down, and the child cannot come out normally. And in the amniotic fluid are prostaglandins, which greatly enhance labor activity. Therefore, they decide to perform an amniotomy. If the expected effect from such a manipulation did not work out, then the woman in labor is injected with special drugs that activate.
Women want to know how this procedure is carried out. As noted earlier, there is no need to worry about a bladder puncture. Initially, the maternity hospital workers treat the female genital organs with the help of antiseptic agents, additionally give her a drink with an analgesic agent.
After some time, after the painkiller works, the doctor expands the lumen of the vagina and slowly inserts the hook. With this special tool, the bubble is captured and gently pulled towards itself until the bubble walls burst. Next, the expectant mother is observed for 30 minutes. If everything was done correctly, then the contractions are not long in coming - they begin almost immediately.
This is an absolutely safe procedure. Complications occur very rarely. Manipulation is carried out only with great need, only with the permission of the woman in labor. The doctor must notify the potential consequences.
This may be fetal hypoxia, infection inside the womb (occurs very rarely), the occurrence of bleeding, a weak heartbeat in the baby, prolapse of umbilical cords. And the most important thing is that after the bubble is opened, no more than 20 hours should pass until the birth begins. The baby cannot be without water for a long time, it is dangerous for his life.
Does it hurt to pierce a bladder?
The bubble bursts without pain, because there are no nerve receptors in the fruit membrane. This procedure does not last long - a few minutes. However, in almost all cases, the fear of the woman in labor turns out to be higher than the explanations of the doctors, and a spasm of the vaginal muscles occurs. The woman at this time should take one position and not move so that the doctor does not inflict any internal damage.
If you set yourself up correctly and relax completely during the procedure, then there will be no pain, even the smallest. The only thing that a woman can feel is the flow of water from the vagina.
As indicated earlier, the bladder is pierced only in case of great need, and if the doctor told the patient that such a procedure should be done, then she should not refuse it.
Baby scratches after amniotomy
Many women are worried when they see scratches on their little cub's head. Yes, this does happen sometimes. If a bladder puncture was used for childbirth, then the baby may be born with scratches left on the head from a special bladder puncture hook.
Of course, such a spectacle is not pleasant. But don't worry - it's not dangerous at all. Abrasions in the sterile conditions of the maternity hospital quickly healed.
Typically, such traces remain during the amniotomy with. After all, it is in this state that the fetal membranes are on the baby's head.
The operations that prepare the birth canal, the most commonly used in childbirth, are amniotomy ( puncture) and perineal incision.
Amniotomy - artificial opening of the fetal bladder. Depending on the deadline, it may be:
- Premature - produced before the onset of childbirth. The indication for premature amniotomy is the conduct of labor-stimulating therapy;
- Early - if the amniotomy is performed in the interval from the onset of labor to 7 cm of the opening of the uterine os. It is carried out according to the following indications:
- a flat fetal bladder, as it inhibits the development of labor;
- polyhydramnios, since overstretching of the uterus leads to weakness of labor activity;
- incomplete requires opening the fetal bladder to ensure that the head of the bleeding area of the placental site is pressed and bleeding is reduced;
- conducting labor-stimulating therapy with weakness of labor activity, when childbirth lasts more than 12 hours, the woman is mentally and physically tired, which increases the effectiveness of uterine contractions;
- diseases of the cardiovascular system, arterial hypertension in late, hypertension, kidney disease.
An amniotomy is performed during a vaginal examination, usually with a forceps jaw (a special hook-like instrument). The puncture of the amniotic membranes is performed at the height of the contraction with the maximum tension of the fetal bladder, which ensures the convenience of performing and the safety of this benefit (the skin of the presenting part of the fetus is not injured). The index finger is inserted into the hole in the fetal bladder, then the middle finger, the hole gradually expands, and the water is slowly released.
This procedure is completely painless, as there are no nerve endings in the shells.
At the time of the amniotomy, the doctor evaluates 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 - meconium is mixed with amniotic fluid. Yellow amniotic fluid indicates a disease that develops in the fetus when the blood of the mother and fetus is incompatible in terms of Rh or blood type.
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Comment on the article "Puncture of the fetal bladder (amniotomy)"
Detachment of the lower part of the amniotic sac increases the likelihood of labor starting within a week. The puncture of the amniotic membranes is performed at the height of the contraction with the maximum tension of the fetal bladder, which ensures the convenience and safety of this ...
Discussion
Yul, I stand by my opinion from your last topic. Personally, in your situation, I would choose PKC at 39 weeks over stimulation at 37.
There, below, many personal examples and medical advice were given. I don't know what my opinion is based on - I just feel it's better this way.
I will duplicate my message in your own topic dated May 16 (in case you did not see it).
On my example:
1st birth - everything was decided by the doctors. Stimulated at 38.5 weeks by Buscopan and "cervical protrusion" - that's what they offer you. Medical. As a result - a child weighing 2670 g, but with a strong rupture of the vagina and episio.
2nd childbirth - trusted nature. Spontaneous delivery at 39.5 weeks. A child weighing 3540 g. Without ruptures and episio.
I also have a "generally uniformly narrowed pelvis", OB less than 90 cm.
It seems to me that the readiness of tissues for childbirth (their elasticity and the ability to stretch and disperse, skipping the baby) is much more important than the weight of the baby. Therefore, I am in favor of waiting for the natural onset of labor, and not inducing them at 38 weeks.
Post from 18.05:
“It seems to me that doctors are very wrong when they scare women of the CS and rush to give birth.
I also have a narrow pelvis and a history of two natural births :)
Although already at the beginning of the first pregnancy, my gynecologist mother said - tune in to the COP (I also have myopia -7).
The first time she gave birth to a daughter in 2670, a strong rupture of the vagina and episio.
The second time a rather big boy was expected. When at 38 weeks my mother measured my stomach and the height of the fundus of the uterus, she calculated that the little one already weighs about 3400 g (her calculations were later confirmed :)), and she was eager to send me to the hospital.
But I had an iron mind for the natural course of events.
I signed a contract with the Vidnovsky maternity hospital, where they take vertical births. True, not as vertical as I would like :), but still - you sit on a special transforming chair, slightly leaning back.
5 days before the due date, she gave birth to a boy 3540 g, 56 cm, head 34 cm, with a small tear, without episio. The contractions lasted 2 hours (they arrived with full disclosure, they barely had time), the attempts - 40 minutes.
So, my conclusions from personal experience and knowledge gleaned from books, the Internet and courses:
1) you need to trust your nature. Of course, there are exceptions, but still, nature usually gives a woman a child that she is able to give birth to (if she is not interfered with).
2) by the end of pregnancy, the tissues soften in a woman, the ligaments become more elastic, the pelvic bones diverge (including during childbirth) in order to miss the baby (I felt this very well in the last stages - it was difficult to walk). Therefore, it is important to bring the baby to term and not cause premature birth. Let the child be a little larger, but the fabrics will be better prepared.
3) It is highly desirable to give birth in vertical positions (not lying down) - both in contractions, and in attempts. In a vertical position with legs spread apart, the pelvic aperture expands, and the force of attraction helps the efforts of mother's muscles. Childbirth goes faster, less likely that childbirth will be delayed. You need to listen to your feelings and take the postures that the body asks for. And there are fewer gaps (my experience has confirmed this).
4) Do not rush to try, give the tissues time to stretch to avoid tears. Doctors are very often in a hurry (they are afraid for the child, and just want to do their job as soon as possible - they may have other women in labor).
My contractions become rare, with long intervals. In the first birth, the doctor, seeing that the contractions "disappeared", immediately put a dropper with oxytocin. My daughter was born literally in 3 contractions, tearing everything for me there. In the second birth, the doctors only sighed, seeing my unhurried and not very effective attempts. But - they monitored the heartbeat (with a tube, not CTG), when the head appeared - they looked at its color, how the child was there, and did not interfere! For which we thank them very much. Because as a result, I didn’t tear, and the episio was not required, and the child’s head and everything else is in perfect order.
And more information from courses on how to prepare tissues for childbirth so that they are more elastic:
1) perineum massage with oil (I used almond oil) - daily,
2) after 32 weeks. reduce or completely exclude meat from the diet (it makes the tissues more "hard"), eat light food - cereals, vegetables, fruits, nuts, fish (without getting carried away), less flour and sweets.
3) increase your intake of vit. A (carrot juice with cream).
4) increase the consumption of vegetable oil (3-4 tablespoons per day),
5) fish oil - up to 3 g per day - to soften tissues.
6) drink more pure water.
Of course, I didn’t follow all this exactly, but I tried to move in this direction :)
Both times, my fetal bladder was torn under the hands of a doctor during examination. No piercing was required at all. But yes, often just to speed up the process. On the contrary, they took care of my bladder in the third birth, even doing a manual examination when transferring from prenatal to maternity hospital ...
Discussion
Mash, I'm slowing down and I can't find how to write you in a personal. I climbed the whole page .... I have a question not on your topic, but maybe you can tell me. I looked after a video baby monitor made in England, and now my friends are going to London, I want to order them, but I can’t find its cost in pounds on any English site. Firm Angels care, tell me, please, on which site of yours should I look for it)
Section: Childbirth (puncture of the fetal bladder with oligohydramnios). Why is the bubble pierced? It doesn't make it any easier for mom or baby. I had an 8 cm bladder pierced, and I remember very well my thoughts after that - "next time only with an epidural!", although before that it was painful, but ...
Discussion
I will write about the neck, opening and prolapse of the bladder. What I didn't worry about at all was her. Pregnancy second (the first was 17 years ago), one fetus. At 22 weeks neck 38 mm, everything is closed and wonderful. All hormones have always been normal. I did not work, there was no physical activity.
Before the planned train to Germany for 27 weeks. for a few days, I decided to play it safe and just check everything just in case.
January 13 (26 weeks 3 days) Ultrasound - disclosure of the internal. pharynx 17 mm over 21 mm, length of the closed part 23 mm. Nobody is flying anywhere. She lay at home, injected, if the pills. A week later, my stomach started to hurt.
January 23 (28 weeks) - went to the hospital by ambulance. Neck length 32 mm, int. the pharynx is open for 17 mm. The length of the closed part is already 15 mm. They planned to put a pessary, having previously passed all the tests.
January 30 (29 weeks) - the length of the neck is 24 mm, the internal os is open, the fetal bladder prolapses to the external os. Doctor: "strict bed rest, going to the ship, because of the prolapse, we decided not to put a pessary." The ship didn't work. My husband brought diapers, I got up no more than 3 times a day (well, the toilet with a hygienic shower was in the ward). Round the clock drips, pills, foot end of the bed up.
February 9 (30.2 weeks) - ultrasound without changes, the length of the neck is 22 mm, the fetal bladder prolapses. The doctor says to make it to 33 weeks.
February 22 (32 weeks) - Ultrasound - cervix 28 mm, ext. and outdoor pharynx are closed. Discharged. HOORAY
At home now there is a strict bed rest, although, of course, I still get up more than in the maternity hospital.
If I were to become pregnant again now, I would do an ultrasound every two weeks. Everyone comes from their experience. I didn’t even know and didn’t think about what problems could be due to the neck.
Girls, is the neck length 4 cm long or short? And then the doctor scared me in the early stages that my neck was short, she even put the ICN.
About bubble rupture. Is the bladder always pierced during labor? Section: Childbirth (are there always very painful contractions after a bladder puncture?) The main thing is that detachment does not happen (operative cesarean) - for this, the fetal bladder is pierced to reduce ...
Discussion
was 3 cm at the time of delivery (until 20 weeks, the pharynx was partially blocked). She gave birth naturally :) the placenta passed away perfectly, after the birth of the baby.
they do, but not 100% of the time
not sure what you need
just anything below 6 cm SHOULD cause alertness and more careful management of the birth process
that's all - you need an adequate doctor
there is a danger of detachment - of course, you need to take measures and make sure, the main thing is not to play it safe, so that the doctor is not interested in just making life easier for himself, we are all human :-)
Usually, the fetal bladder ruptures on its own with full or almost complete disclosure of the cervix, and the anterior amniotic bladder is punctured. The doctor said that most likely they would pierce my fetal bladder. The bubble must be pierced only on ...
Discussion
They pierce most often so that the opening goes faster. IMHO - nothing terrible, harmful, although there is no benefit either. My opening didn’t break by six centimeters - well, they pierced it. Apparently, it doesn’t break with us, with modern women :) It seems to me that it’s bad if they pierce, when the birth has not yet begun at all, in order to start them. This is not the most successful method of stimulation - there is no more water, and oxytocin is not produced by the body, as a result, the child sits without water, there is no opening, hormones begin to inject, or even cesarean immediately ...
but I read and I can’t understand - what’s wrong with that?
in stimulation, in bursting the bubble?
Now, if there is no activity, but is it time? wait and under the knife? well, someone says that cesarean is better - they say it is fashionable now and kids like healthier and so on ...
I was stimulated with the first one and the bladder was pierced (they don’t pierce it with needles, it’s just called that, the doctor simply tears it with his handles so that the pressure increases and labor activity goes ..
Sometimes when amniotic fluid is poured out (more often when the bladder is punctured too early, earlier than 8 cm 1, about prolapse of the umbilical cord, I’ll also sign it, but it really happens if it’s not cephalic presentation. But the rupture of the fetal bladder is usually from some kind of childbirth at home: pros and cons.
Throughout pregnancy, the baby is surrounded by amniotic fluid, which reliably protect him from external stimuli. With the onset of labor, with each contraction of the uterus, the amniotic sac is compressed, which in turn puts pressure on the internal os of the uterus, contributing to its opening. Normally, with full or almost complete opening of the uterine os, the fetal bladder ruptures, followed by the outflow of amniotic fluid. In some cases, there is a need for an amniotomy - an operative puncture of the fetal bladder.
What is a rupture of the fetal bladder?
Amniotomy is a procedure in which the doctor performs an instrumental opening of the amnion using a special surgical tool that resembles a hook. After a vaginal examination under the control of the hand, the doctor gently inserts the instrument into the cervical canal, makes a small hole in the amnion, and then stretches it with his fingers. The procedure does not require special preparation or anesthesia.
IMPORTANT! Amniotic fluid is conventionally divided into "anterior" and "rear". After the amniotomy, only a part of the “front” waters is poured out, so the stories about difficult “dry” births that are full of forums are nothing more than fiction.
Amniotic sac puncture: main indications
There must be good reasons for opening the amnion, because the procedure is performed in only 10-15% of cases of all births. The need for an amniotomy arises in the following situations:
- If the gestational age has exceeded 41 weeks
- With a complicated course of pregnancy, for example, late gestosis, when it is necessary to speed up the course of labor to alleviate the condition of the woman in labor
- In the event of a condition that threatens the fetus (partial placental abruption, low-lying placenta, cord entanglement, prolonged anhydrous period)
- Weakness of labor activity, as well as factors that can contribute to this (overdistension of the uterus with polyhydramnios, twins, physical fatigue of the woman in labor, cervical dilatation of more than 7 cm, flat fetal bladder)
- The presence of Rhesus conflict
IMPORTANT! Mandatory conditions for the implementation of the puncture of the fetal bladder is a full-term pregnancy and the weight of the fetus in the head presentation is more than 3000 grams. Despite the simplicity of the procedure at first glance, amniotomy is a kind of surgical intervention, therefore it is carried out only after obtaining the consent of the woman in labor in writing.
Puncture of the amniotic sac without contractions
It happens that an amniotomy is performed long before the onset of labor. As a rule, the main purpose of such manipulation is the excitation of labor activity. Opening the amnion in the absence of contractions is performed in the case of preliminary preparation of the birth canal with special preparations, as well as in the pathological preliminary period in the mature birth canal.
Puncture of the amniotic sac during childbirth
Amniotomy during active labor is performed more often than others, as it is aimed at accelerating the birth process and increasing the effectiveness of contractions. The opening of the amnion during labor activity is divided into: earlier, timely and late. An early puncture of the amniotic sac is done when the opening of the uterine os is less than 7 cm, in case of weakening of contractions. Timely amniotomy occurs when the amnion does not open spontaneously with almost complete cervical dilatation. A belated puncture of the fetal bladder is carried out when the baby's head is already lowered into the exit cavity from the small pelvis, to facilitate birth.
Amniotic sac puncture: risks and consequences
Almost all women in the position are interested in the safety of the amnion opening procedure. As a rule, if the manipulation is carried out correctly and all the necessary conditions are met, the amniotomy does not carry any risk. It should be noted that the presence of polyhydramnios and other factors that contribute to the overstretching of the uterus during the opening of the fetal bladder can lead to arbitrary prolapse of the umbilical cord loops, which is an indication for emergency operative delivery. In order to avoid the development of this complication, as well as to prevent bleeding during the manipulation, the main condition must be met - the fetal head is lowered into the small pelvis.
If, after an early amniotomy, labor activity has not begun, with a long anhydrous period (more than 24 hours), there is a risk of developing infectious complications.
During pregnancy, women are faced with the fact that the terms have already passed, and childbirth does not begin. Then the decision is made to induce childbirth. The bladder is pierced before childbirth to provoke contractions. This is not the only way to stimulate, but the most gentle.
The procedure is carried out in the presence of reasons that threaten the woman or the fetus. A woman in labor should understand that a qualified doctor will not prescribe manipulation without good reason, so you should immediately agree with his decision.
Why is the bladder pierced during childbirth:
- there is a Rh conflict;
- late toxicosis is diagnosed;
- if a woman suffers from hyponia;
- the woman in labor suffers from diabetes;
- with kidney disease in pregnancy
The puncture of the bladder before childbirth is called an amniotomy. If the baby is in danger or there was a leak of amniotic fluid, and the contractions did not start, he suffers from a lack of oxygen. An indication for the procedure is also a prolonged pregnancy.
Bladder piercing before childbirth is used as a method of intensifying contractions with weak labor activity. The amniotic fluid contains prostaglandins that stimulate labor. Only if the onset of full-fledged contractions by amniothymia has not been reached, the woman in labor is administered drug stimulants.
When is the bladder pierced during childbirth? It all depends on the reason for the procedure. If the reason is overdue - at 41 weeks, a planned puncture of the bladder is used to start delivery. If the basis for the manipulation is a weak labor activity, then the procedure is carried out during the onset of labor, regardless of the timing.
- premature (the one that is carried out before the start of contractions as a method of stimulation);
- early (a puncture is made when the uterus is open by 7 cm);
- late (performed on the birth chair after lowering the child into the small pelvis, when attempts began, but the water did not break).
Bladder puncture during pregnancy is also carried out in the absence of anterior waters (flat fetal sac). Then the shell fits the baby's head and delays the birth process. The reason for the amniotomy is considered to be too low attachment of the placenta. Bleeding and detachment are likely, so it will be safer for the woman in labor to pierce the bladder.
However, this method of labor induction is not always used. Dr. E. Komarovsky believes that the hundredth period of the birth of a child should pass extremely naturally. Helping the female body should be the most extreme measure. He believes that the too frequent use of amniotomy is nothing more than the desire of doctors to speed up the delivery.
Contraindications and diagnosis
Like other medical manipulations, a puncture cannot be performed due to the characteristics of the woman in labor. If a woman has heart disease, as well as with increased pressure, childbirth is not carried out in the usual way.
It is forbidden to cause contractions for pregnant women with sutures on the uterus, especially if they have become too thin during the gestation period. The state of the birth canal is assessed before prescribing an amniotomy for the expectant mother.
It is forbidden to puncture the fetal sac if:
- the expectant mother has genital herpes;
- the fetus has a transverse presentation;
- low location of the placenta;
- severe entanglement with the umbilical cord of the child;
- natural birth is prohibited for medical reasons
It is advisable to undergo an ultrasound examination shortly before the procedure. So you can find out the condition of the birth canals, and accurately determine the degree of opening of the uterus. Blood pressure is also measured and the intestines are cleansed, because childbirth after a puncture of the amniotic sac can quickly and suddenly gain momentum.
You need to weigh the pros and cons, and only then proceed to the manipulation. If a woman is nervous, the obstetrician should try to convince her that this is really necessary. After all, the woman in labor knows that despite the safety of the surgical action, there is a possibility of complications.
Operation technique
In order to prepare as much as possible for a possible obstetric manipulation, you should familiarize yourself with the course of the procedure even during pregnancy. Not necessarily an amniotomy will be applied, but it will not hurt to be informed on the issue.
How to pierce the bladder during childbirth:
- a woman sit on an examination chair;
- the nurse treats the genitals with septic agents;
- the woman in labor is taking painkillers;
- the obstetrician spreads the walls of the vagina and inserts a special hook there;
- the doctor grabs the fetal bladder with the device and pulls it towards him until the moment of rupture;
- contractions should appear within half an hour.
This procedure is rather unpleasant than painful. Pulls the hook towards the obstetrician, gives discomfort to the woman in labor. This is the only sensation that accompanies a woman in labor during a mini-operation.
Why does the water break when you start giving birth? In the natural course of childbirth, the cause of the outflow of amniotic fluid is the rupture of the fetal bladder. If an amniotomy was performed, the waters departed as a result of its implementation.
How is childbirth with a planned bladder piercing? The procedure is carried out with overwearing, intrauterine death of the fetus or preeclampsia. As a rule, after the integrity of the fetal sac has been broken, there is a gradual outflow of amniotic fluid, and then contractions begin.
Over time, the strength of uterine spasms increases, and the cervix, water, by the influence of prostaglandins, smoothes and opens more intensively. When the body has not prepared itself for delivery, the contractions are much more painful than those that come without an amniotomy.
But not always the puncture of the bladder leads to contractions. It also happens that one opening of the fetal sac is not enough to start a full-fledged labor activity, then medical methods of labor induction are used.
Is it possible to give birth if the water has not broken? No, because the baby, along with the amniotic fluid, is in the fetal sac. And if it is not opened and the water has not broken, it means that the baby will not be born naturally. The only possible option without the outpouring of water is a caesarean section. The baby is then removed directly from the placenta.
Complications
Amniotomy, of course, causes labor activity and helps the baby be born, but there are also unpleasant consequences of a puncture of the amniotic sac. Such pathologies are extremely rare, however, they do happen.
Complications of a puncture of the fetal sac:
- bleeding (appears as a result of the obstetrician getting into a large vessel that passed through the membrane);
- prolapse of the umbilical cord, body parts (arms, legs);
- deterioration of the child's well-being due to a sharp change in the environment;
- scratches in a newborn;
- decrease in the activity of childbirth;
- excessively rapid development of the generic process;
- fetal infection.
The reason for such pathologies is the unprofessionalism of the obstetrician, that is, the incorrect performance of the operation. Therefore, the puncture of the bladder during childbirth should be trusted by an experienced obstetrician.
Complications provoke health problems for the baby. It is unacceptable to do such a manipulation at the request of doctors or women in labor. Childbirth with a puncture of the bladder should be reasoned and shown for the health of the woman or the fetus.
Amniotomy is a mini-surgery, but it should be used if there is an indication. The desire of a doctor or a woman in labor to induce labor is not a basis for manipulation. When prescribing the procedure, a woman should find an experienced obstetrician so that complications do not arise.
